Department of Orthopedic Surgery - Pavillon T, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d'Arsonval, 69437, Lyon, France.
INSERM UMR 1033, Université de Lyon, Lyon, France.
Int Orthop. 2018 Oct;42(10):2329-2334. doi: 10.1007/s00264-018-3843-9. Epub 2018 Feb 22.
Using a cementless femoral stem in total hip arthroplasty (THA), optimal filling of the proximal femoral metaphyseal volume (PFMV) and restoration of the extramedullary proximal femoral (PF) parameters (i.e., femoral offset (FO), neck length (FNL), and head height (FHH)) constitute key goals for optimal hip biomechanics, functional outcome, and THA survivorship. However, almost 30% of mismatch between the PF anatomy and implant geometry of the most widely implanted non-modular cementless femoral stem has been demonstrated in a computed tomography scan (CT scan) study. Therefore, this anatomic study aimed to evaluate the relationship between the intra- and extramedullary PF parameters using tridimensional CT scan reconstructions.
One hundred fifty-one CT scans of adult healthy hips were obtained from 151 male Caucasian patients (mean age = 66 ± 11 years) undergoing lower limb CT scan arteriography. Tridimensional PF reconstructions and parameter measurements were performed using a corrected PF coronal plane-defined by the femoral neck and diaphyseal canal longitudinal axes-to avoid influence of PF helitorsion and femoral neck version on extramedullary PF parameters.
Independently of the femoral neck-shaft angle, the PFMV was significantly and positively correlated with the FO, FNL, and FHH (r = 0.407 to 0.420; p < 0.0001).
This study emphasized that the tridimensional PF geometry measurement in the corrected coronal plane of the femoral neck can be useful to determine and optimize the design of a non-modular cementless femoral stem. Particularly, continuous homothetic size progression of the intra- and extramedullary PF parameters should be achieved to assure stem fixation and restore anatomic hip biomechanics.
在全髋关节置换术（THA）中使用无水泥股骨柄，最佳填充股骨近端干骺端容积（PFMV）并恢复髓外股骨近端（PF）参数（即股骨偏心距（FO）、颈长度（FNL）和头高度（FHH））是优化髋关节生物力学、功能结果和 THA 存活率的关键目标。然而，在 CT 扫描研究中，已经证明最广泛植入的非模块化无水泥股骨柄的 PF 解剖结构与植入物几何形状之间存在近 30%的不匹配。因此，这项解剖学研究旨在使用三维 CT 扫描重建来评估 PF 内、外参数之间的关系。
从 151 名接受下肢 CT 扫描动脉造影的男性白种人患者（平均年龄 66 ± 11 岁）中获得了 151 个 CT 扫描。使用校正后的 PF 冠状面（由股骨颈和骨干管的纵轴定义）进行三维 PF 重建和参数测量，以避免 PF 扭转和股骨颈版本对髓外 PF 参数的影响。
独立于股骨颈干角，PFMV 与 FO、FNL 和 FHH 呈显著正相关（r = 0.407 至 0.420；p < 0.0001）。
这项研究强调，在股骨颈的校正冠状面进行三维 PF 几何测量有助于确定和优化非模块化无水泥股骨柄的设计。特别是，应该实现髓内和髓外 PF 参数的连续同形尺寸进展，以确保柄的固定并恢复解剖学髋关节生物力学。
