Sariali Elhadi, Boukhelifa Sena
University Hospitals Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France.
J Bone Joint Surg Am. 2025 Apr 28;107(12):1333-1341. doi: 10.2106/JBJS.24.00489.
Most femoral stem designs used in total hip arthroplasty (THA) take into account the proximal femoral morphotype in terms of lateralization and neck-shaft angle (NSA) but not version. The objective of this study was to analyze the acetabular anteversion and femoral anteversion (FA) values in a large cohort according to the 3-dimensional (3D) morphotype of the proximal femur. Our hypothesis was that FA is an anatomic parameter independent of the coronal morphotype (varus, neutral, valgus).
A retrospective study based on prospectively collected data included all patients who underwent, from January 2009 to December 2021, a THA planned on the basis of a low-dose computed tomographic (CT) scan 3D. The anatomic acetabular anteversion was calculated in the anterior pelvic plane. The 3D volume models were used to measure the NSA and the FA. We used a multivariable linear regression model to assess the relationship between the NSA and the other hip parameters.
The study included 849 consecutive patients (430 women and 419 men), with a mean age of 62 ± 15 years and a mean body mass index of 26.8 ± 5.7 kg/m 2 . The etiology was primary osteoarthritis in 616 patients, osteonecrosis in 141 patients, and dysplasia in 92 patients. The mean NSA was 129° ± 7°. The femoral morphotype was vara in 112 cases and valga in 105 cases. Acetabular anteversion was significantly lower in the vara group (mean, 21° ± 9°) and higher in the valga group (mean, 26° ± 9°) compared with the neutral group (mean, 24° ± 8°) (p < 0.001). The FA did not vary significantly according to the femoral morphotype (mean, 20° ± 12°; p = 0.3), with no significant association found between the NSA and FA (β = -0.004 [95% confidence interval, -0.5 to 0.05]; p = 0.8).
The FA was not associated with the NSA. A hip morphotype classification combining the NSA and FA is presented for use in guiding preoperative planning in THA. Customized patient-specific stems may be of interest in some morphotypes to accurately restore the hip anatomy.
Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
全髋关节置换术（THA）中使用的大多数股骨柄设计在股骨近端形态类型方面考虑了股骨外侧化和颈干角（NSA），但未考虑扭转角。本研究的目的是根据股骨近端的三维（3D）形态类型分析一大群患者的髋臼前倾角和股骨前倾角（FA）值。我们的假设是，FA是一个独立于冠状面形态类型（内翻、中立、外翻）的解剖学参数。
一项基于前瞻性收集数据的回顾性研究纳入了2009年1月至2021年12月期间所有基于低剂量计算机断层扫描（CT）3D计划进行THA的患者。在骨盆前平面计算解剖学髋臼前倾角。使用3D体积模型测量NSA和FA。我们使用多变量线性回归模型来评估NSA与其他髋关节参数之间的关系。
该研究纳入了849例连续患者（430例女性和419例男性），平均年龄为62±15岁，平均体重指数为26.8±5.7kg/m²。病因包括原发性骨关节炎616例、骨坏死141例、发育不良92例。平均NSA为129°±7°。股骨形态类型为内翻112例，外翻105例。与中立组（平均24°±8°）相比，内翻组的髋臼前倾角显著更低（平均21°±9°），外翻组更高（平均26°±9°）（p<0.001）。FA并未根据股骨形态类型有显著变化（平均20°±12°；p = 0.3），NSA与FA之间未发现显著关联（β = -0.004 [95%置信区间，-0.5至0.05]；p = 0.8）。
FA与NSA无关。提出了一种结合NSA和FA的髋关节形态类型分类方法，用于指导THA的术前规划。在某些形态类型中，定制的患者特异性股骨柄可能有助于准确恢复髋关节解剖结构。
预后IV级。有关证据水平的完整描述，请参阅作者指南。
