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Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy
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Above knee socket prosthesis use changes proximal femur morphology.

Galen F Roda1, Jason W Stoneback2, David Gimarc3

  • 1Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America.

Bone
|April 2, 2023
PubMed
Summary

Transfemoral amputation (TFA) alters hip joint loading, leading to bony shape changes like femoral head asphericity and greater trochanter alterations. These morphological changes in the proximal femur may contribute to hip osteoarthritis (OA) development.

Keywords:
Above knee amputationDigitally reconstructed radiographsFemur morphologySocket prosthesisStatistical shape modelingTransfemoral amputation

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Area of Science:

  • Orthopedics
  • Biomedical Engineering
  • Radiology

Background:

  • Patients with transfemoral amputation (TFA) have a significantly higher risk of developing hip osteoarthritis (OA).
  • Altered joint loading due to compensatory movement patterns is the primary suspected cause of OA in TFA patients.
  • The specific effects of altered loading on hip bony morphology and its role in OA etiology remain unclear.

Purpose of the Study:

  • To investigate if altered hip joint loading in transfemoral amputation (TFA) leads to changes in proximal femur bone shape.
  • To compare the 3D morphology of the proximal femur between individuals with TFA and a control group.
  • To assess the relationship between altered bone morphology and established risk factors for hip osteoarthritis.

Main Methods:

  • Retrospective collection of CT images from 31 TFA patients and 29 controls.
  • Creation of 3D proximal femur geometries and quantification of 3D geometric variation using statistical shape modeling (SSM).
  • Quantification of 2D radiographic measures (e.g., alpha-angle, neck shaft angle) and comparison with SSM results and control group using statistical tests.

Main Results:

  • TFA patients exhibited greater femoral head asphericity and greater trochanteric torsion compared to controls.
  • Femoral head asphericity correlated with head-neck offset and alpha-angle; greater trochanteric torsion correlated with a novel measure.
  • The TFA group showed a smaller neck-shaft angle and larger greater trochanter height compared to controls.

Conclusions:

  • Altered loading associated with transfemoral prosthesis use induces significant changes in proximal femur morphology.
  • These bony morphological changes, including femoral head asphericity and greater trochanter alterations, may influence hip biomechanics.
  • The study suggests that chronic altered loading and resulting bony changes contribute to the etiology and progression of hip osteoarthritis in TFA patients.