Femoral Neck Length Research Articles

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management.

➤Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability.➤The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension).➤To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions.➤It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic.➤During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.

Relationships between the femoral neck-preserving ratio and radiologic and clinical outcomes in patients undergoing total-hip arthroplasty with a collum femoris-preserving stem.

The femoral neck-preserving ratio is crucial in arthroplasty with a collum femoris-preserving (CFP) stem. The aim of our study was to analyze the relationships between the neck-preserving ratio and the short-term radiologic and clinical outcomes of patients who underwent total-hip arthroplasty (THA) with a CFP stem.The data of 325 hips from January 2015 to December 2016 were retrospectively reviewed. The demographic and radiologic data before and after surgery were obtained from patients. The neck-preserving ratio was defined as the ratio of the preserved femoral neck length to the preoperative femoral neck length. Correlations between the neck-preserving ratio and the radiologic and clinical outcomes of patients were analyzed.The mean neck-preserving ratio was 66.38 ± 6.91% in the current study. We divided patients into 3 groups according to the neck-preserving ratio: group A (neck-preserving ratio ≤60.00%), group B (60.00% < neck-preserving ratio < 70.00%), group C (neck-preserving ratio ≥70.00%). Radiologic features, including the neck-shaft angle ratio (0.96 ± 0.05), canal fill ratio (0.64 ± 0.07), anterior-posterior offset ratio (1.04 ± 0.10), and lateral offset ratio (2.55 ± 1.56) (ratios of the postoperative values to the preoperative values), and the prevalence of complications was significantly different among the groups (χ2 = 21.173, P < .001). In the correlation analysis, we found a moderate negative correlation between the neck-preserving ratio and neck-shaft angle ratio (r = −0.308, P < .001) and a slight positive correlation of the neck-preserving ratio with the anterior-posterior offset ratio (r = 0.415, P < .001) and the lateral offset ratio (r = 0.164, P = .003). In the linear regression analyses, the neck-preserving ratio was significantly linearly correlated with the neck-shaft angle ratio (B = −0.232, 95% confidence interval [CI] = −0.311 to −0.154, P < .001), anterior-posterior offset ratio (B = 0.589, 95% CI = 0.447–0.730, P < .001), and lateral offset ratio (B = 3.693, 95% CI = 1.256–6.131, P = .003). However, there was no significant linear correlation between the neck-preserving ratio and the canal fill ratio (B = 0.073, 95% CI = −0.033 to 0.180, P = .174). Logistic regression analyses also showed that a sufficient neck-preserving ratio was a protective factor for periprosthetic femoral fractures (odds ratio [OR] = 0.924, 95% CI = 0.859–0.994, P = .035), dislocations (OR = 0.892, 95% CI = 0.796–0.999, P = .048), and thigh pain (OR = 0.886, 95% CI = 0.818–0.960, P = .003).For CFP stems, an insufficient neck-preserving ratio is significantly correlated with poor radiologic and clinical outcomes. Therefore, surgeons should be cognizant to preserve a sufficient femoral neck length during surgery to improve the outcomes for patients undergoing THA with CFP stems.

Canine Femoral Neck Lengthening Combined with DARthroplasty to Manage Severe Canine Juvenile Hip Dysplasia: A Case Report

Objective This study is a case description of femoral neck lengthening and dorsal acetabular rim (DAR) arthroplasty to treat severe hip luxation in a 5-month-old male Cocker Spaniel (14.3 kg) and to compare the clinical outcome with that of contralateral femoral neck excision. Study design Case report. Results Femoral head coverage improved after surgery (preoperative lateralization of the centre of the femoral head with regard to the dorsolateral acetabular rim: 10 mm; postoperative lateralization of the centre of the femoral head: –1.3 mm). The postoperative Barden's test was negative. The dog was bearing weight 2 weeks postoperatively. Radiographic signs of bone healing were present at the 6-week follow-up examination. No complications were detected. Conclusions Femoral neck lengthening and DAR augmentation were performed in a growing dog affected by severe hip luxation and DAR insufficiency.

Morphometric Study of Proximal end of Femur of Nepalese People

Introduction: The femur is the largest and strongest bone of the body that forms the skeleton of the thigh. The morphometry of proximal end of femur are variable between different individuals with different Nationality. The aims and objective of the study is to find out the morphometric measurements- Femur Length, Femur head diameter, Femur neck shaft angle, and Femur neck length, breadth and thickness.&#x0D; Methods: A total of 75 femurs of both sex were collected from the Department of Anatomy, MCOMS, Pokhara. The parameters on proximal femur were measured manually with the help of measuring scale, thread, protector and vernier calliper. The collected data were analyzed with Microsoft Excel 2007 software and represented graphically.&#x0D; Results: In the present study, the average femoral length for entire femur was 42±2.81 cm, femoral head diameter was13.05±0.9 cm, femoral neck length was 4.12±0.32 cm, femoral neck breadth was 2.94±0.30 cm, and femoral neck thickness was 2.36±0.42 cm. The femur neck shaft angle of left femur was significantly higher than that of right femur (P-value 0.03). There was no difference between other dimensions of proximal end of right and left femur.&#x0D; Conclusion: The results of the present study show that the dimensions of proximal femur in Nepalese Population are different as compared to other countries population. The knowledge of different dimensions of proximal femur will be important in anthropological and medico-legal practice for sex determination and as well as to radiologists and orthopaedic surgeons for diagnosis and planning of treatment.

Gender and disease severity determine proximal femoral morphology in developmental dysplasia of the hip.

In this computed tomography (CT) morphological study we describe the way the proximal femoral morphology differs with worsening degrees of developmental dysplasia of the hip (DDH) and describe gender differences in patients with DDH. Forty-nine male patients with DDH were matched with 49 females with DDH, using age and the Crowe classification of DDH severity. The femoral length, anteversion, neck-shaft angle, offset, neck length, canal-calcar ratio, canal flare index, lateral center-edge angle, alpha angle, pelvic tilt, and pelvic incidence were measured for each patient on their pre-operative CT scans, prior to total hip arthroplasty surgery. Femoral anteversion and neck length were 16° and 47 mm, 25°and 36 mm, 26° and 43 mm, and 44° and 36 mm, for Crowe I and III males and Crowe I and III females, respectively. The mean male anteversion was 22° (±14), compared to 30° (±15.5) in females (p = 0.02, Confidence Interval: 1.6-14.9). Gender differences in femoral length, neck length and offset lost significance when height-normalized and no other significant gender differences were found. In conclusion, femoral neck length reduces with increasing DDH severity, whilst anteversion tends to increase. Male patients with DDH have significantly less femoral anteversion, which has important implications for osteotomy and arthroplasty surgery in DDH. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Meta-Analysis of Genomewide Association Studies Reveals Genetic Variants for Hip Bone Geometry.

Hip geometry is an important predictor of fracture. We performed a meta-analysis of GWAS studies in adults to identify genetic variants that are associated with proximal femur geometry phenotypes. We analyzed four phenotypes: (i) femoral neck length; (ii) neck-shaft angle; (iii) femoral neck width, and (iv) femoral neck section modulus, estimated from DXA scans using algorithms of hip structure analysis. In the Discovery stage, 10 cohort studies were included in the fixed-effect meta-analysis, with up to 18,719 men and women ages 16 to 93 years. Association analyses were performed with ∼2.5 million polymorphisms under an additive model adjusted for age, body mass index, and height. Replication analyses of meta-GWAS significant loci (at adjusted genomewide significance [GWS], threshold p ≤ 2.6 × 10-8 ) were performed in seven additional cohorts in silico. We looked up SNPs associated in our analysis, for association with height, bone mineral density (BMD), and fracture. In meta-analysis (combined Discovery and Replication stages), GWS associations were found at 5p15 (IRX1 and ADAMTS16); 5q35 near FGFR4; at 12p11 (in CCDC91); 11q13 (near LRP5 and PPP6R3 (rs7102273)). Several hip geometry signals overlapped with BMD, including LRP5 (chr. 11). Chr. 11 SNP rs7102273 was associated with any-type fracture (p = 7.5 × 10-5 ). We used bone transcriptome data and discovered several significant eQTLs, including rs7102273 and PPP6R3 expression (p = 0.0007), and rs6556301 (intergenic, chr.5 near FGFR4) and PDLIM7 expression (p = 0.005). In conclusion, we found associations between several genes and hip geometry measures that explained 12% to 22% of heritability at different sites. The results provide a defined set of genes related to biological pathways relevant to BMD and etiology of bone fragility. © 2019 American Society for Bone and Mineral Research.

Characteristics of radiographic morphometries of the lower leg in subjects with progression of knee osteoarthritis in the TOEI cohort

Knee osteoarthritis is one of the most common orthopedic diseases. However, few studies have reported the morphometric characteristics of the lower leg related to the progression of knee osteoarthritis in regional populations. This study aimed to determine the radiographic morphometries of the lower leg in subjects who showed progression of osteoarthritis of the knee in the TOEI cohort. Data were collected from the TOEI study cohort, during the period from 2014 to 2016, to assess osteoarthritis of the knee and radiographic morphometries of the lower leg. The joints were divided into three groups according to osteoarthritis progression over 2years. There were 323 legs of females and 163 legs of males. Knees which did not exhibit osteoarthritis were in group 1; knees with osteoarthritis that remained stable for 2years were in group 2; knees that worsened osteoarthritis over 2years were in group 3. Morphometric parameters in the lower leg were measured by radiographs taken in 2014. In female subjects, group 2 had higher age, lower lever arm ratio and lower hip-knee-ankle angle, and higher height of the hip center compared with group (1). Group 3 had higher age compared with group 1 and lower height of the hip center compared with group (2). In male subjects, group 2 had lower height of the hip center and lower hip-knee-ankle angle compared with group 1. Group 3 had higher patellar shift index compared with group 1, higher height of the hip center and higher femoral neck length compared with group 2. Higher age was the risk of osteoarthritis progression of the knee in female subjects but not significant risk in male subjects. Hip morphometries such as height of the hip center and femoral neck length in which showed a sex difference might be associated with the progression of knee osteoarthritis.

Inferior calcar buttress reduction pattern for displaced femoral neck fractures in young adults: a preliminary report and an effective alternative

BackgroundFracture reduction quality is of paramount importance for osteosynthesis. The aim of this study was to report the outcome of an inferior cortical buttress non-anatomic reduction pattern and internal fixation for displaced femoral neck fractures (Garden types III and IV) in young adults.MethodsA retrospective analysis of 46 displaced femoral neck fractures was performed, which were treated by closed reduction and internal fixation with parallel cannulated screws. There were 20 males and 26 females, with an average age of 50.3 years (19–60). According to the inferior cortical reduction quality seen in recorded intraoperative fluoroscopy, the patients were divided into two groups. Group I (n = 30) was anatomic cortical apposition as the two inferior cortices were smoothly contacted, and group II (n = 16) was buttress cortical apposition as the two inferior cortices were located in positive support contact (Gotfried reduction pattern). With a mean follow-up of 22.0 months, femoral neck length, neck–shaft angle, and clinical outcomes were compared.ResultsThirty-nine patients (84.8%) achieved uneventful fracture union. Complications occurred in seven patients, six in group I (20%) and one in group II (6.3%), including displacement to varus, neck shortening, early fixation failure, nonunion, and avascular necrosis of the femoral head. No significant difference existed in the complication rate between the two groups (p = 0.216). Four patients (13.3%) in group I were converted to prosthetic replacement, but none in group II.ConclusionsFor closed reduction and fixation of displaced femoral neck fractures in young adults, an inferior cortical buttress reduction pattern, though non-anatomic, can produce sustainable fracture stability and predictable clinical outcomes.

Statistical shape modeling of femur shape variability in female patients with hip dysplasia.

Although increasing evidence suggests that abnormal femur geometry in developmental dysplasia of the hip (DDH) may contribute to intra-articular damage and the development of hip osteoarthritis, a comprehensive 3D description of femoral abnormalities in DDH remains incomplete. Statistical shape modeling (SSM) was used to quantify three-dimensional (3D) geometric variation among femurs in female patients with DDH and control subjects. SSM correspondence points (n = 8,192) were placed on each femur using a gradient descent energy function to derive mean DDH and control femoral shapes and principal component analysis (PCA) was then used to describe shape variation. PCA results were associated with common 2D radiographic measures of femur shape using general linear models. For patients with DDH, the first eight principal components (modes) captured 90.9% of the cumulative variance accounted for (VAF). Notably, mode 2 captured 23.6% VAF and described variation in femoral version, the neck-shaft angle, and femoral neck length, while mode 3 captured 16.4% VAF and described variation in femoral version, femoral head size, and femoral offset. SSM captured complex geometric deformities in DDH, which may not be fully described by 2D measures of the acetabulum and proximal femur alone. By determining the primary shape variations among femurs in cases of DDH, SSM may further understanding of pathologies on the femoral side of dysplastic hips, in context with more commonly recognized acetabular deformities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Modified bony landmark measurement to deal with leg length discrepancy during total hip arthroplasty

Objective To evaluate the clinical application of modified bony landmark measurement (MBLM) to deal with leg length discrepancy (LLD) during total hip arthroplasty (THA). Methods We retrospectively analyzed the 36 patients in whom MBLM was used to deal with LLD during THA from January 2014 to May 2015 at Department of Orthopaedics, The Second Hospital of Fuzhou. They were 17 men and 19 women, aged from 42 to 78 years (average, 68.7±10.1 years). They were divided into 3 groups according to their pre-operative LLD value (d): 16 cases in group A with d ≤ 10 mm, 11 cases in group B with 10 mm 20 mm. After the sizes of prosthetic cup and femoral component and the location of implant were determined using preoperative X-ray, a special formula was used to calculate the prosthetic length of femoral head neck and the osteotomy area at the femoral neck. MBLM was used to measure the leg lengths before hip joint dislocation and after placement of the hip implant. The neck length and depth of the femoral component was adjusted according to the measurements. Post-operative X-ray was used to measure the LLD (d＇). The value of MBLM in judgment of LLD during THA was assessed by comparison of d and d＇and analysis of distribution of d＇. Results The postoperative d＇(6.0±3.0 mm) was significantly shorter than the preoperative d (11.0±5.0 mm) (t=5.145, P 20 mm. The cases with d＇≤ 10 mm were significantly more than those with d ≤ 10 mm and the cases with d＇> 20 mm significantly fewer than those with d>20 mm (χ2=15.500, P=0.000). Conclusion MBLM used during THA is a reliable method to judge the leg lengths so that LLD can be effectively reduced after THA. Key words: Arthroplasty, replacement, hip; Hip prosthesis; Retrospective studies; Leg length discrepancy; Bony landmark measurement

A Comparison of Transphyseal Neck-Head Tunneling and Multiple Epiphyseal Drilling on Femoral Head Healing Following Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs.

Two operative procedures are currently advocated to stimulate the necrotic femoral head healing in children with Legg-Calve-Perthes disease: transphyseal neck-head tunneling (TNHT) and multiple epiphyseal drilling (MED). The purpose of this study was to compare the bone healing and physeal function after treatment with TNHT or MED in a piglet model of ischemic osteonecrosis. Eighteen piglets were induced with osteonecrosis by surgically placing a ligature tightly around the right femoral neck. One week later, the piglets were assigned to 1 of 3 treatment groups (n=6/group): (1) local nonweight bearing only (NWB), (2) TNHT plus NWB, or (3) MED plus NWB. The unoperated left femoral heads were used as normal controls. The animals were euthanized at 8 weeks after osteonecrosis induction. Histologic, histomorphometric, radiographic, microcomputed tomography (CT), and calcein-labeling assessments were performed. Statistical analysis included a 1-way ANOVA. Micro-CT analyses showed higher femoral head bone volume in the MED group compared with the TNHT and the NWB groups (P<0.01). The MED group had a higher mean trabecular number (P<0.001) and new bone formation (P=0.001) based on calcein-labeling parameters compared with the TNHT and the NWB groups. In addition, the osteoclast number per bone surface was lower in the MED group compared with the NWB group (P=0.001). Histologic and micro-CT assessments of the proximal femoral physis revealed a larger physeal disruption at the site of physeal drilling in the TNHT group compared with the MED group. However, no significant differences in physeal elongation (P=0.61) and femoral neck length (P=0.31) were observed between the treatment groups. MED produced a higher bone volume and stimulated greater bone formation than the TNHT or the NWB alone. Both procedures did not produce a significant physeal growth disturbance during the study period. This preclinical study provides evidence that MED produces more favorable bone healing than the TNHT in a large animal model of Legg-Calve-Perthes disease.

The outcome of modified Dunn's procedure for moderate and severe slipped capital femoral epiphysis

The aim of this study was to evaluate the outcome of 20 children with moderate-severe slipped capital femoral epiphysis (SCFE) with open physes, treated by the modified Dunn's procedure, as regards: intraoperative findings, clinical and radiographic outcomes, and postoperative complication rate. PATIENTS AND METHODS: A prospective study was executed , between 2012 and 2016, for treating moderate-severe SCFE with modified Dunn procedure in 20 hips of 20 patients, with a mean age of 13.6 ± 3.4 years (range: 10 – 16.5 years). Seven cases were unstable SCFE. We excluded mild SCFE, endocrinopathy and renal cases. RESULTS: The mean follow-up was 19 ± 9.2 months (range: 12 - 36 months). Radiologically . all parameters showed significant improvement; with the mean slip angle corrected from 61o± 14.4 preoperatively to 10o±10.1 postoperatively, the mean alpha angle corrected from 90.2±21o preoperatively to 49.1± 8o postoperatively and the mean femoral neck length difference was 8.1 ± 6 mm. Functionally , the mean Harris hip score (HHS) was 86.2 ± 9.6 and the Heyman and Herndon score was excellent-good in 15 cases (75%), fair in two, poor in two and failed in one. Postoperative major complications occurred in only two cases (10%); AVN in one and secondary FAI in another case

Does fully-threaded Headless Compression Screw provide a length-stable fixation in undisplaced femoral neck fractures?

Femoral neck shortening is a common complication after surgical treatment for intracapsular femoral neck fractures. This study investigated whether fully-threaded Headless Compression Screw (FTHCS) can be a more length-stable implant than partially-threaded cannulated screw (PTCS) in reducing femoral neck shortening. A total of 50 patients with undisplaced femoral neck fractures (17 treated by internal fixation with three FTHCS, and 33 treated by three PTCS) from 2011 to 2014 were enrolled in this study. The radiography of the hips and medical records were reviewed for proximal femur geometry and complications. Significant shortening of the femoral neck length until union were noted in both group (FTHCS group: -2.5mm, p=0.045; PTCS group: -2.4mm, p=0.011). There was no significant difference in the length of femoral neck shortening between groups (p=0.855). Age was the only significant risk factor for >5mm of femoral neck shortening (p=0.041). The femoral neck-shaft angle tended to reduce and become more varus in both groups (FTHCS: -2.7°, SD=4.5, p=0.028; PTCS: -5.0°, SD=8.3, p=0.002), but the differences between groups were nonsignificant (p=0.577). The complication rates were similar between FTHCS and PTCS (17.6% and 21.2%, p>0.999). The FTHCSs may be a substitute for PTCSs, but it cannot prevent femoral neck shortening and varus collapse after fracture fixation. Future studies should focus on how to preserve femoral neck length and hip function after femoral neck fractures.

Bicondylar Angle and its Relation with Length and Neck Length of Human Femur

Introduction: Femoral bicondylar angle has immense importance from anatomical and clinical (forensic and anthropometric) point of view and is the characteristic feature of bipedal gait in humans. It is the angle between axis of femoral shaft and a line perpendicular to its transcondylar axis. The study was carried out to assess bicondylar angle and its relationship with femur length and neck length.&#x0D; Methods: Bicondylar angle, length, and neck length of available dry human femurs of unknown sex and age were measured using osteometric board and vernier caliper. Bicondylar angle between two sides were compared. Similarly, relation between the angle and femoral length and length of femoral neck was studied.&#x0D; Result: Bicondylar angle on right side was 8.65° (SD = 2.03) and on left side was 9.35° (SD = 2.05) and the different was not statistically significant (p = 0.08). On both sides, no significant correlation was found between bicondylar angle with femoral length and length of femoral neck.&#x0D; Conclusion: Mean bicondylar angle of right femur was 8.65° and that of left was 9.35° and the difference was not statistically significant. There was no significant relation between the angle and other two parameters.

Effects of long-term high-load exercise on the anatomy of the hip joints: a preliminary report.

The aim of this study was to assess the impact of different sports on hip joint anatomic parameters in athletes. This was a cross-sectional study of eight male trampolinists, eight male weightlifters, and eight male volunteers enrolled in July 2014. Hip joint anatomic parameters were measured from plain radiographs taken at the level of the lesser trochanter center. Data were compared between groups using the χ-test or one-way analysis of variance with the Bonferroni post-hoc test. There were no significant differences among groups in age, height, or weight. Compared with the controls, trampolinists showed higher pelvic width, femoral neck length, metaphyseal width (T0), width 20 mm above T0 (T+20), width 20 mm below T0 (T-20) and center edge (CE) angle, and lower head-trochanter ratio, joint space, neck-shaft angle, and articular cartilage angle (P<0.05). Compared with the controls, weightlifters showed lower pelvic femoral index, joint space, length of femoral neck, eccentricity, neck-shaft, and AC angle, and higher pelvic width, femoral head radius, and CE angle (P<0.05). Compared with trampolinists, weightlifters showed higher head-trochanter ratio and femoral head radius, and lower pelvic femoral index, femoral neck length, eccentricity, T0, T+20, T-20, neck-shaft angle, CE angle, and articular cartilage angle (P<0.05). Long-term high-intensity training causes adaptive changes in the hip joint structure that differ between trampolinists and weightlifters.

A novel radiographic scoring system for growth abnormalities and structural change in children with juvenile idiopathic arthritis of the hip

BackgroundApproximately 20–50% of children with juvenile idiopathic arthritis (JIA) have hip involvement within 6 years of diagnosis. Scoring systems for hip-related radiographic changes are lacking.ObjectiveTo examine precision of potential radiographic variables and to suggest a scoring system.Materials and methodsWe reviewed a set of 75 pelvic radiographs from 75 children with JIA hip involvement across two European centres. We assessed findings of (1) destructive change and (2) growth abnormality, according to a pre-defined scoring system. All radiographs were scored independently by two sets of radiologists. One set scored the radiographs a second time. We used kappa statistics to rate inter- and intra-observer variability.ResultsAssessment of erosions of the femoral head, femoral neck and the acetabulum showed moderate to good agreement for the same reader (kappa of 0.5–0.8). The inter-reader agreement was, however, low (kappa of 0.1–0.3). There was moderate to high agreement for the assessment of femoral head flattening (kappa of 0.6–0.7 for the same reader, 0.3–0.7 between readers). Joint space narrowing showed moderate to high agreement both within and between observers (kappa of 0.4–0.8). Femoral neck length and width measurements, the centrum–collum–diaphysis angle, and trochanteric–femoral head lengths were relatively precise, with 95% limits of agreement within 10–15% of the observer average.ConclusionSeveral radiographic variables of destructive and growth abnormalities in children with hip JIA have reasonable reproducibility. We suggest that future studies on clinical validity focus on assessing only reproducible radiographic variables.

The Association between Surgery Laterality in Orthopedists and the Choices of Prostheses in Total Knee and Hip Replacement

Background: Most orthopedists are right-handed. However, osteoarthritis occurs with equal frequency over both sides. Does perfect and effective arthroplasty surgery require ambidextrous motor skills? Objectives: In this study, we aimed to investigate the clinical features of arthroplasty for hip and knee joints (THR and TKR) on different sides affected by orthopedist laterality. Patients and Methods: All right-handed orthopedists performed 64 right and 52 left primary THR among 100 patients, and 115 right and 118 left primary TKR among 192 patients. Clinical and surgical features were retrospectively reviewed and analyzed. The body mass index (BMI), inner diameter of acetabular cup liners (ACD), diameter of the femoral head (FHD), diameter of the femoral stem (FSD), and the femoral neck length (FNL) were included in THR-receiving patients. The BMI, femoral component (FC) size, tibial plate (TP) size, and thickness of articular surface inserts (ASI) were included in TKR-receiving patients. Results: No significant differences were observed in ACD, FHD and FSD between patients receiving right and left THR groups (p = 0.16, 0.11, and 0.05, respectively). Similarly, there were no significant differences in FC, TP, and ASI between patients receiving right and left TKR groups (p = 0.06, 0.80, and 0.46, respectively). However, FNL in left THR group was significantly longer than that in right THR group (p = 0.01). Conclusion: This study showed that dexterity or proprioception in handedness had no affect on bone resection and thicknesses of the polyethylene in TKR and acetabular reaming and femoral canal rasping in THR. However, it did lead to differences in femoral neck resection. Right-handed orthopedists significantly tend to perform excessive femoral neck cutting or prefer the larger size of FNL when performing left side THR, while no differences occur when performing TKR.

Treatment of Unstable Slipped Capital Epiphysis Via the Modified Dunn Procedure.

The modified Dunn procedure has been shown to be safe and effective in treating unstable slipped capital femoral epiphysis (SCFE). We present a consecutive series of unstable SCFE managed by a single surgeon with a focus on timing of surgical intervention, postoperative complications, and radiographic results. Thirty-one consecutive unstable SCFEs were treated. Demographics, presentation time to time of operation, surgical times, and complications were recorded. Bilateral hip radiographs at latest follow-up were utilized to record slip angle, α angle, greater trochanteric height, and femoral neck length. Thirty-one consecutive hips in 30 patients were reviewed: 15 males (50%) and 15 females (50%), average age 12.37 years (range, 8.75 to 14.8 y), 20 left hips (65%) and 11 right hips (35%). Mean follow-up was 27.9 months (range, 1 to 82 mo). Time from presentation to intervention averaged 13.9 hours (range, 2.17 to 23.4 h). Two patients (6%) developed avascular necrosis at average 19 weeks postoperative. Three patients (10%) developed mild heterotopic ossification requiring no treatment. Two patients (6%) required removal of symptomatic hardware. One patient had hardware failure and in no patients was nonunion, delayed union, or postoperative hip subluxation/dislocation seen. Three patients (10%) presented with bilateral, stable SCFE requiring contralateral in situ pinning. Five patients (16%) had sequential SCFE requiring treatment with 1 patient having an acute, unstable SCFE 10 months after the previous realignment. Mean postoperative slip angle measured 2.5 degrees (range, +19 to -9.4 degrees) (SD, 7.2), α angle 47.43 degrees (range, 34 to 64 degrees) (SD, 7.49), greater trochanteric height averaged 3.5 mm below the center of femoral head (-17.5 to +25 mm), and mean femoral neck length difference measured -7.75 mm (range, -1.8 to -18.6 mm). A single surgeon series of unstable SCFEs treated by a modified Dunn procedure showed a 6% incidence of avascular necrosis and low complication rates at latest follow-up. Radiographs showed restoration of the slip angle, α angle, femoral neck length, and greater trochanteric height. This series reveals the safety and effectiveness of the modified Dunn procedure for unstable SCFE. Level III-retrospective review.

The Outcome of Modified Dunn's Procedure for Moderate and Severe Slipped Capital Femoral Epiphysis

The aim of this study was to evaluate the outcome of 20 children with moderate-severe slipped capital femoral epiphysis (SCFE) with open physes, treated by the modified Dunn's procedure, as regards: intraoperative findings, clinical and radiographic outcomes, and postoperative complication rate. PATIENTS AND METHODS: A prospective study was executed , between 2012 and 2016, for treating moderate-severe SCFE with modified Dunn procedure in 20 hips of 20 patients, with a mean age of 13.6 ± 3.4 years (range: 10 – 16.5 years). Seven cases were unstable SCFE. We excluded mild SCFE, endocrinopathy and renal cases. RESULTS: The mean follow-up was 19 ± 9.2 months (range: 12 - 36 months). Radiologically . all parameters showed significant improvement; with the mean slip angle corrected from 61º± 14.4 preoperatively to 10º±10.1 postoperatively, the mean alpha angle corrected from 90.2±21º preoperatively to 49.1± 8º postoperatively and the mean femoral neck length difference was 8.1 ± 6 mm. Functionally , the mean Harris hip score (HHS) was 86.2 ± 9.6 and the Heyman and Herndon score was excellent-good in 15 cases (75%), fair in two, poor in two and failed in one. Postoperative major complications occurred in only two cases (10%); AVN in one and secondary FAI in another case

Percutaneous medial hemi-epiphysiodesis using a transphyseal screw for caput valgum associated with developmental dysplasia of the hip

BackgroundThe purpose of this study was to evaluate the radiologic outcome of percutaneous medial hemi-epiphysiodesis using a transphyseal screw for the management of caput valgum associated with developmental dysplasia of the hip (DDH).MethodsEighteen hips (18 patients) having caput valgum treated with screw hemi-epiphysiodesis were followed for more than 2 years, and were included in this study. The mean age at the time of the index operation was 8.3 years (range, 4.3 to 10.7 years) and age at the latest follow-up was 12.2 years (range, 9.4 to 16.4 years). The screw in 5 hips was changed into a longer one at postoperative 21.8 months (range, 14 to 29 months) because the proximal femur outgrew the screw. The screws in 11 hips were removed at the mean age of 10.9 years (range, 8.0 to 14.5 years). We retrospectively analyzed the change in various radiologic parameters over time.ResultsThe mean Hilgenreiner-epiphyseal angle (HEA) of the operated side was 5.1 ± 11.3° preoperatively, and increased to 20.6 ± 11.3° at the latest follow-up (p = 0.001). The mean difference of the HEA between the operated and contralateral sides was 16.9 ± 15.1° preoperatively, which decreased to 2.4 ± 12.4° at the latest follow-up (p = 0.008). The mean articulo-trochanteric distance of the operated side, which was 3.2 ± 5.5 mm longer than that of the contralateral side preoperatively, became 5.6 ± 9.1 mm shorter at the latest follow-up (p = 0.001). The ratio of femoral neck length of the operated side to that of the contralateral side decreased over the follow-up period. Acetabular shape as measured by the Sharp angle and acetabular roof angle and femoral head coverage as measured by lateral center-edge angle did not change significantly by the index operation. The ratio of medial joint space width of the operated side to that of the contralateral side did not change significantly.ConclusionsScrew medial hemi-epiphysiodesis can effectively correct caput valgum associated with DDH. However, this technique remains coxa brevis and does not seem to significantly affect acetabular morphology or reduce subluxation.