Anthropometry of the proximal femur and femoral head in children/adolescents using three-dimensional computed tomography-based measurements

Ali Darwich,Sonja Janssen,Ahmed Jawhar,Sascha Gravius,Mohamad Bdeir,Stefan O Schoenberg,Christiane Geiselhardt

doi:10.1007/s00276-021-02841-3

Abstract

PurposeDefining normal anthropometric ranges of proximal femur and femoral head for each age group in children/adolescents is a necessity when differentiating normal anatomical variants from pathological deformities. Aim of this study is to define a set of normal anthropometric parameters based on 3D-CT measurements in normal asymptomatic children/adolescents and analyse the variations arising depending on age, side, and/or gender.MethodsMorphology of the proximal femur was retrospectively assessed in 170 hips (85 children, < 15 years). Measurements included covered femoral head volume (CFHV), femoral head diameter (FHD), femoral head extrusion index (FHEI), coronal alpha angle (CAA), lateral centre-edge angle (LCEA), anterior (AOS) and posterior head-neck offset (POS) and femoral neck-shaft angle (FNSA). Correlation analyses as well as inter- and intra-rater reliability were performed.ResultsCFHV, LCEA, FHD and AOS/POS increased with age and FHEI, CAA, and FNSA decreased with age. None of the measurements correlated with the side. AOS showed a poor correlation with gender. Rapid growth phases were observed at the age of 1, 7 and 11. The inter- and intra-rater reliability was high (range ICC 0.8–0.99 Cronbach alpha 0.86–0.99).ConclusionThis data delivers a description of growth phases as well as gender and age-correlated reference values of the proximal femoral morphology that could be used by paediatricians and orthopaedic/paediatric surgeons to early diagnose proximal femur deformities and provide guidance in the planning of possible operations.

Highlights

The hip joint is considered as a ball-and-socket joint between the acetabulum and the proximal femur and femoral head facilitating load transmission to the lower limbs
Dysplasia is solely an example of the numerous pathologies involving the proximal femoral morphology and that of the femoral head and causing devastating consequences in young adulthood or late adolescence, proving that the geometry of the proximal femur plays a fundamental role in the existence and progress of these conditions [4]
Analysed age groups were categorized according to the year of birth: the first year of life was referred to as group 0, children aged 13–24 months were categorized as group 1, children aged 25–36 months were categorized as group 2 etc

Summary

Introduction

The hip joint is considered as a ball-and-socket joint between the acetabulum and the proximal femur and femoral head facilitating load transmission to the lower limbs. The hip may show a large array of morphological variations, especially with increasing age or depending on gender These variations can sometimes be excessive and pathological leading to a painful unproportionate load distribution in the joint causing eventually pathological wear of the joint cartilage, being defined as biomechanical risk factors for osteoarthritis [3]. Children with developmental dysplasia of the hip (DDH) present with acetabular malformation and hypoplasia, and with deformations of the proximal femur and femoral head This condition, when left untreated, results in most cases in a rapidly progressing osteoarthritis, as early as in young adulthood or late adolescence, where a 4.3-fold increase in the rate of radiographic hip osteoarthritis is seen [24]. Dysplasia is solely an example of the numerous pathologies involving the proximal femoral morphology and that of the femoral head and causing devastating consequences in young adulthood or late adolescence, proving that the geometry of the proximal femur plays a fundamental role in the existence and progress of these conditions [4]

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Results

Conclusion