A Validation Study for Estimation of Femoral Anteversion Using the Posterior Lesser Trochanter Line

Yun, Ho Hyun; Yoon, Jung Hwan; Yang, Jae Hyuk; Song, Seung Yeop; Park, Sung Bum; Lee, Jee Wun

doi:10.1016/j.arth.2012.10.023

Cited by 26 publications

(38 citation statements)

References 38 publications

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“…There have been some attempts in estimating version using proximal landmarks . These approaches have a superficial similarity to the six proximal axes used in our study, as they attempted to find an axis visible intraoperatively that has a fixed relationship to the posterior condylar line.…”

Section: Discussionmentioning

confidence: 99%

“…CT or MR imaging would permit more accurate measurements by creating 3D models of the femur, however manually selecting the 3D femoral neck axis is challenging. This situation is further hampered in that the scan is limited to the region around the joint to limit radiation exposure, and does not include the distal femur for representation of the posterior condylar line . As such, alternatives to the posterior condylar line must be identified for accurate estimation of version.…”

mentioning

confidence: 99%

“…As such, alternatives to the posterior condylar line must be identified for accurate estimation of version. New axes have been proposed, such as the posterior lesser trochanter line, and the midcortical line . However, correlation of such alternate measures to true anteversion is low …”

mentioning

confidence: 99%

See 2 more Smart Citations

Automated femoral version estimation without the distal femur

Veilleux

Kalore

Wegelin

et al. 2018

Journal Orthopaedic Research

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Femoral version impacts the long-term functioning of the femoroacetabular joint. Accurate measurements of version are thus required for success in total hip arthroplasties and hip reconstructive surgeries. These are impossible to obtain without visualization of the distal femur, which is often unavailable preoperatively as the majority of imaging scans are isolated to the pelvis and proximal femur. We developed an automated algorithm for identifying the major landmarks of the femur. These landmarks were then used to identify proximal axes and create a statistical shape model of the proximal femur across 144 asymptomatic femora. With six proximal axes selected, and 200 parameters (distances and angles between points) from the shape model measured, the best-fitting linear correlation was found. The difference between true version and version predicted by this model was 0.00 ± 5.13° with a maximum overestimation and underestimation of 11.80 and 15.35°, respectively. The mean absolute difference was 4.14°. This model and its prediction of femoral version are a substantial improvement over pre-operative 2D or intra-operative visual estimation measures. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Automated femoral version estimation without the distal femur

Veilleux

Kalore

Wegelin

et al. 2018

Journal Orthopaedic Research

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“…Furthermore, stem version in a press fit stem has been shown to be heavily dependent on the orientation of the neck osteotomy . Prior studies have found a fixed relationship between the lesser trochanteric line and the femoral neck axis as well as the transverse axis of the lesser trochanter and the femoral posterior condylar axis …”

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confidence: 99%

Novel potential marker for native anteversion of the proximal femur

et al. 2016

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Identifying native femoral version from proximal femoral landmarks would be of benefit both for preoperative assessment as well as intraoperatively. To identify potential markers for femoral anteversion, an empirical framework was developed for orientation-independent analysis of the proximal femur from pelvic CT to allow for segmentation of the proximal femur into five constituent regions: Femoral head, femoral neck, greater trochanter, lesser trochanter and femoral shaft. The framework is based on the identification of differences in the radius of curvature at anatomic zones of transition between regions of the proximal femur, followed by non-linear geometric shape fitting. The framework is applied to 86 proximal femurs segmented from pelvic CTs, with at least 2 cm of proximal femur remaining below the lesser trochanter, obtained for non-musculoskeletal pathology to investigate potential proximal femoral markers for native femoral version. The analysis of the proximal femur suggests a fixed relationship between the maximal femoral canal diameter 1 cm proximal to the base of the lesser trochanter from the center of the greater trochanter and the femoral neck axis of 4.13° +/- 4.99°. Further full-length femoral studies are needed to confirm the relationship of the maximal canal diameter as a proxy for native femoral anteversion. Published by Wiley Periodicals, Inc. J Orthop Res 35:1724-1731, 2017.

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“…Several studies have reported that the postoperative antetorsion (AT) measurement for the femoral stem inserted without navigation showed wide variability in the measured values. [2][3][4][5] Recently, the concept of combined anteversion, the sum of acetabular anteversion and femoral AT, has been proposed as a parameter to assess the appropriateness of the overall prosthetic Implant positioning is one of the critical factors influencing postoperative outcomes in total hip arthroplasty (THA). Several studies have reported that the postoperative antetorsion (AT) measurement for the femoral stem inserted without navigation showed wide variability.…”

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confidence: 99%

Use of the G-guide for Measuring Stem Antetorsion During Total Hip Arthroplasty

Fujihara¹,

Fukunishi²,

Fukui³

et al. 2016

Orthopedics

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Implant positioning is one of the critical factors influencing postoperative outcomes in total hip arthroplasty (THA). Several studies have reported that the postoperative antetorsion (AT) measurement for the femoral stem inserted without navigation showed wide variability. The current authors developed a simple instrument, the Gravity-guide (G-guide), for intraoperative assessment of stem AT and adjustment. They evaluated the effectiveness of the G-guide with postoperative computed tomography (CT) examination. Ninety patients (96 hips) who underwent primary THA using the G-guide for stem adjustment were evaluated. The G-guide consists of 2 parts: one attached to the lower leg and the other attached to the handle of the rasp. The G-guide was used to evaluate the AT at the time of inserting the final rasp. In addition, the AT value in the G-guide evaluation system required correction by the angle obtained in the preoperative epicondylar view. Intraoperative stem AT was defined as the sum of the intraoperative G-guide value and the correction angle. Postoperative AT was evaluated by CT examination. The discrepancy between the intra- and postoperative measurements was 4.6°±4.1°. Acceptable accuracy with discrepancy of less than 5° and 10° was achieved in 66 (69%) hips and 85 (89%) hips, respectively. The use of the G-guide could effectively reduce the variability of stem anteversion compared with manual adjustment. This study proved the effectiveness of the newly developed G-guide system in intraoperative stem AT adjustment.

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A Validation Study for Estimation of Femoral Anteversion Using the Posterior Lesser Trochanter Line

Cited by 26 publications

References 38 publications

Automated femoral version estimation without the distal femur

Automated femoral version estimation without the distal femur

Novel potential marker for native anteversion of the proximal femur

Use of the G-guide for Measuring Stem Antetorsion During Total Hip Arthroplasty

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