Changes In Proximal Femur Research Articles

Exploring the morphology of adult tibia and fibula from Sima de los Huesos site in sierra de Atapuerca, Burgos, Spain.

The analysis of the locomotor anatomy of Late Pleistocene Homo has largely focused on changes in proximal femur and pelvic morphologies, with much attention centered on the emergence of modern humans. Although much of the focus has been on changes in the proximal femur, some research has also been conducted on tibiae and, to a lesser extent, fibulae. With this in mind, we present one of the largest samples of the same population of human tibiae and fibulae from the Middle Pleistocene to determine their main characteristic traits and establish similarities and differences, primarily with those of Neanderthals and modern humans, but also with other Middle Pleistocene specimens in the fossil record. Through this study, we established that the Middle Pleistocene population from the Sima de los Huesos (Atapuerca, Burgos, Spain) had lower leg long bones similar to those of Neanderthals, although there were some important differences, such as bone length, which this fossil individuals resembled those of modern humans and not to Neanderthals. This fact is related to the crural index and leg length, even though we do not have any true association between femora and tibiae yet, it has implications for establishing locomotor efficiency and climate adaptation.

Comparison of bone remodelling around short stem and conventional straight stem in total hip replacement: a prospective randomized radiographic and dual-energy X-ray absorptiometric study.

The aim of study was to evaluate periprosthetic bone mineral density (BMD) changes of proximal femur, osseointegration and clinical outcomes after implantation of short-stemmed and conventional straight-stemmed prostheses. This prospective, randomized study included 50 patients with unilateral total hip replacement. The patients were randomized into 2 cohorts: patients with a cementless short stem Metha (n=25) and patients with a cementless conventional straight stem Bicontact evaluated as the control (n=25). Periprosthetic BMD changes were measured using a DEXA performed at one-week, 3-monts, 6-months and 1-year follow up. Clinical evaluation with Harris hip score (HHS) and radiographic assessment were performed through a 1 year follow up. Compared to 1-week postoperative assessment, there were differences in BMD changes between the groups at the final follow-up in all ROIs, with statistical significances in ROI 1, 2, 3, 6 and 7. The loss of periprosthetic BMD in all ROIs around straight stems at each time-point was observed. There was a tendency towards a regain of BMD in all ROIs at 1-year follow-up compared to the 3-months postoperative assessment with the short stems. Less pronounced bone loss was observed around the short stems that the straight stems in ROI 1 (‒2.9 % % vs ‒16.2 %), 5 (‒4.7 % vs ‒8.9 %) and 7 (‒8.6 % vs ‒20 %). The periprosthetic BMD exceeded baseline values in the short stem cohort in ROI 2 (+4.4 % vs ‒5 %), 3 (+5.6 % vs ‒2.5 %) and 6 (+4.3 % vs ‒10 %). All stems had a radiographically stable fixation. Stress shielding-related bone resorption was markedly lower in the short stem cohort. The HHS score was comparable between the two cohorts. The implant-specific stress shielding altered the proximal loading condition for both stems; however, the results of this study suggest a more physiological strain distribution with the short stems versus the straight stems (Tab. 3, Fig. 3, Ref. 25).

Homeostasis-based aging model for trabecular changes and its correlation with age-matched bone mineral densities and radiographs

PurposeThis paper aims (1) to propose a novel bone adaptation model for age-related trabecular changes by adopting two implicit parameters in optimization, (2) to compare the simulated bone volume fraction (BV/TV) with the reported bone mineral density (BMD), and (3) to review the simulated trabecular architectures with the age-matched radiographs. Materials and methodsThe proposed model simulated the trabecular changes for an age span of 32–80 years. Quantitative comparison was conducted in terms of BMD and other morphometric indices. Then, two radiologists scored the simulated trabecular architectures using the age-matched radiographs. This protocol was approved by the hospital institutional review board. ResultsThe simulated BV/TV was well correlated with BMD reported in the literature (R2=0.855; p<0.05). In comparison with age-matched radiographs, the consensus scores of agreement of the trabeculae were higher in age groups over the 50s, and the means of the Ward's triangle areas were strongly correlated with those in the age-matched radiographs (R2=0.982; p<0.05). ConclusionThe proposed model could reflect the targeted trabecular changes in proximal femur with age. With further follow-up measurements, this research would contribute to the development of patient-specific models that assist radiologists in predicting skeletal integrity with aging.

DYNAMICS OF WIDTH OF PROXIMAL FEMORAL GROWING ZONE IN PATIENTS WITH PERTHES DISEASE AFTER SURGICAL TREATMENT

Objective - to study the effect of tunnelization and apparatus hip decompression on the state of proximal femur growing plate. Material and methods. A pattern of changes in proximal femur growing plate of the affected and intact extremities was investigated in 46 children with III degree Perthes disease. The follow-up was 3 years. To unload the affected joint, an external fixator (most often, the Ilizarov apparatus) was placed on pelvic and femoral bones, which was used in a mode of non-articulating arthrodiastasis. The measurements of width of proximal femur growing zone were performed on pelvic bones rentgenograms in anteroposterior projection with internal hip rotation achieved with 1 meter focal length and their subsequent transfer to a digital format. Results. In the study group wire tunneling and apparatus fixation were shown not to result in growing plate locking, providing conditions for recovery of the shape and structure of the femoral head, which was accompanied by a slowdown in its width decrease in the affected extremity and led to the compliance of this parameter between the intact and affected extremities. No correlation was revealed between the degree of structural metaphyseal damage and the state of proximal growing zone.

Significance of the cortical changes of proximal femur in the elderly

Significance of the cortical changes of proximal femur in the elderly

Stabilization of the proximal femur in hip joint replacement using M.E. Müller's acetabular roof socket

Extreme changes of the hip joint often require individual technical supplements in addition to the endoprosthesis. But the base of success are procedures using a model of prosthesis and a technique that are matured. This is available e.g. with the old M. E. Müller curved stem hip joint prosthesis. In special cases of extreme changes or damage of the proximal femur we perform in artificial joint-replacement of the hip or changing of prostheses a special kind of operative treatment. This is a combination of the Original-M. E. Müller curved stem endoprosthesis, long or short version of the femoral part, in addition fixated by bone-cement and M. E. Müller's special metal socket--primary indicated for stabilization of the acetabular roof. The indications for this method can be changes of proximal femur and hip-joint, especially dysplasias of pelvis or hip joint, extensive fractures especially in old patients, destructions in polyarthritis, dysplasia of pelvis and coxitis caused by juvenile chronic arthritis and long time therapy with corticosteroids, destructions, loosenings and fractures in changing operations of hip-endoprostheses. Until today we treated 15 different cases by this method--one case was operated 13 years ago--with good results, prooved by Merle d'Aubigné's score.

Bone mass and structure are enhanced following a 2-year randomized controlled trial of exercise in prepubertal boys

Exercise during growth has a positive influence on bone mineral accrual, yet little is known about how bone geometry and strength adapt to loading during growth. Our primary objective was to compare changes in proximal femur bone geometry and strength between 31 prepubertal (Tanner Stage 1) boys who participated in a school-based, high-impact circuit intervention (12 min, three times a week) for 20 months and 33 maturity-matched controls. Our secondary objective was to compare changes in total body (TB), proximal femur (PF), and lumbar spine (LS) bone mineral content (BMC) and bone area (BA) in these groups. We assessed geometric variables and bone strength at the narrow neck (NN), intertrochanteric (TR) region, and femoral shaft regions by applying the Hip Structure Analysis program to proximal femur dual energy X-ray absorptiometry scans (DXA, Hologic QDR 4500). Further, we assessed total body, lumbar spine, and proximal femur BMC and BA by DXA and derived total body lean mass and fat mass from total body scans. Intervention (10.2 ± 0.5 years) and control boys (10.1 ± 0.5 years) had similar baseline height (140.8 vs. 141.3 cm) and weight (36.9 vs. 35.4 kg), and average 20-month physical activity scores (Physical Activity Questionnaire for Children, PAQ-C) and calcium intakes (861 vs. 852 mg/day, food frequency questionnaire). Twenty-month height and weight changes were not significantly different between groups; lean mass changed more (P < 0.05) in intervention boys (22.8%) than control boys (18.6%). At the NN region, intervention boys had greater bone expansion on both the periosteal (+2.6%, P = 0.1) and endosteal (+2.7%, P = 0.2) surfaces, resulting in significantly greater changes in section modulus (bone bending strength) (+7.5%, P = 0.02, ANCOVA, adjusting for height change, final Tanner Stage, and baseline bone values). Changes at the intertrochanteric and femoral shaft regions were not significantly different between groups. Femoral neck (FN) BMC changes were significantly greater in intervention boys (+4.3%, P < 0.01); changes in BA and BMC for other regions were not significantly different between groups. In summary, a school-based, high-impact exercise intervention implemented three times a week for 12 min is an effective strategy for site-specific gains in bone strength at the narrow neck region of the proximal femur.

Secular trends in the incidence of hip fractures.

To explore possible changes in proximal femur (hip) fracture incidence over time, an earlier study among Rochester, Minnesota residents for 1928-1977 was updated through 1982. Reanalysis of data demonstrated rising age-adjusted rates for men over this time. Crude rates rose for women as well, but age adjusted rates leveled off in the mid-1950s, as did overall rates, since the majority of hip fractures were in women. Secular trends were primarily due to changes in the incidence of initial hip fractures associated with moderate trauma, the sort usually attributed to osteoporosis. No differences were noted in trends for cervical vs. intertrochanteric femur fractures; and, excluding the low values for 1928-1942, no significant trends were noted for women within various age groups. Our results for women conflict with estimates from a number of other studies, but these differences may provide a basis for hypothesis development.