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Journal articles on the topic 'Proximal femur geometry'

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Author: Grafiati

Published: 14 March 2023

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1

Cornelissen, Andries Johannes, Nando Ferreira, Marilize Cornelle Burger, and Jacobus Daniel Jordaan. "Proximal femur anatomy-implant geometry discrepancies." SICOT-J 8 (2022): 5. http://dx.doi.org/10.1051/sicotj/2022004.

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Objectives: Due to ongoing concern about femur anatomy-implant mismatches, this cross-sectional study aimed to create a geometric femur profile and used it to identify and quantify possible mismatches between femur anatomy and cephalomedullary nail dimensions. The work further aimed to assess whether patient demographics affect anatomy-implant coherence. Methods: One hundred skeletally mature complete femur computer tomography (CT) scans were collected and exported to software enabling landmark placement and measures with multiplanar reconstruction techniques. Results: Clinically relevant anatomy-implant discrepancies included the femur neck and shaft axis offset 6.1 ± 1.7 mm (95% CI [5.7–6.4]), femur radius of curvature 1.2 ± 0.3 m (95% CI [1.1–1.2]), femur anteversion 18.8 ± 9.2 (95% CI [16.9–20.6]). The implants reviewed in this study did not compensate for the femur neck and shaft axis offset and had a larger radius of curvature than the studied population. Clinically significant demographic geometry differences were not identified. Conclusion: There were discrepancies between femur anatomy and cephalomedullary nail implant design; however, no clinically significant femur feature inconsistency was identified among the demographic subgroups. Due to the identified anatomy-implant discrepancies, including the femur neck and shaft axis offset, we suggest that these measurements be considered for future implant design and surgical technique.

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2

Vander Sloten, J., and G. van der Perre. "The Influence of Geometrical Distortions of Three-Dimensional Finite Elements, Used to Model Proximal Femoral Bone." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 209, no. 1 (March 1995): 31–36. http://dx.doi.org/10.1243/pime_proc_1995_209_314_02.

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A realistic three-dimensional finite element model of the proximal femur requires the use of irregularly shaped elements to represent this geometry, unless the geometry is considerably simplified. The authors have investigated the influence of different types of element distortions upon the accuracy of two stresses which are relevant in the proximal femur: the bending stress and the tangential (hoop) stress. While most angular and geometric distortions did not influence the bending stress significantly, the position of the middle node on the edge of a quadratic element was very critical, as were some types of element skewness. The hoop stresses can only be calculated accurately if the geometry is modelled as well as possible by a cylinder, and not by a cone.

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3

Trombetti, Andrea, Laura Richert, François R. Herrmann, Thierry Chevalley, Jean-Daniel Graf, and René Rizzoli. "Selective Determinants of Low Bone Mineral Mass in Adult Women with Anorexia Nervosa." International Journal of Endocrinology 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/897193.

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We investigated the relative effect of amenorrhea and insulin-like growth factor-I (sIGF-I) levels on cancellous and cortical bone density and size. We investigated 66 adult women with anorexia nervosa. Lumbar spine and proximal femur bone mineral density was measured by DXA. We calculated bone mineral apparent density. Structural geometry of the spine and the hip was determined from DXA images. Weight and BMI, but not height, as well as bone mineral content and density, but not area and geometry parameters, were lower in patients with anorexia nervosa as compared with the control group. Amenorrhea, disease duration, and sIGF-I were significantly associated with lumbar spine and proximal femur BMD. In a multiple regression model, we found that sIGF-I was the only significant independent predictor of proximal femur BMD, while duration of amenorrhea was the only factor associated with lumbar spine BMD. Finally, femoral neck bone mineral apparent density, but not hip geometry variables, was correlated with sIGF-I. In anorexia nervosa, spine BMD was related to hypogonadism, whereas sIGF-I predicted proximal femur BMD. The site-specific effect of sIGF-I could be related to reduced volumetric BMD rather than to modified hip geometry.

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4

Sumner, Dale R., Terrance C. Devlin, D. Winkelman, and Thomas M. Turner. "The geometry of the adult canine proximal femur." Journal of Orthopaedic Research 8, no. 5 (September 1990): 671–77. http://dx.doi.org/10.1002/jor.1100080508.

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5

Moulton, Darrell L., Ronald W. Lindsey, and Zbigniew Gugala. "Proximal Femur Size and Geometry in Cementless Total Hip Arthroplasty Patients." F1000Research 4 (June 23, 2015): 161. http://dx.doi.org/10.12688/f1000research.6554.1.

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Introduction:Accurate femoral prosthesis press-fit is essential for successful cementless total hip arthroplasty (cTHA) and dependent upon proximal femur size and geometry. Study objectives were to determine the variability of proximal femur size and geometry in primary cTHA patients and correlate them with patient demographics and body mass index (BMI).Methods:Medical records of 127 consecutive primary cTHA patients were reviewed retrospectively. The demographic (ethnicity, sex, age) and BMI data were collected. Intertrochanteric (IT) distance, inner/outer proximal femur diameters and cortical thickness for the subtrochanteric (ST) and cortical diaphyseal (DP) regions were measured from anteroposterior radiographs. Descriptive statistics were used to correlate patient demographics and BMI with radiographic measurements.Results:The study included 96 cTHA patients (mean age 60 years, range 22-91 years; 34 females; 72 Caucasian, 18 Black, and six Hispanic) with four underweight; 13 normal; 34 overweight, and 45 obese BMI. No correlation existed for patient age or race with radiographic measurements. Males had significantly larger proximal femur dimensions and cortical thickness than females. No BMI correlations existed for IT distance; BMI was directly proportional to outer diameter and cortical thickness in ST and DP regions, and inversely proportional to inner diameter in these regions.Discussion:Greater proximal femur size appears to correlate with gender, but not with age or race. Larger subtrochanteric and diaphyseal outer diameters are significantly associated with higher BMI. A trend exists for larger subtrochanteric and diaphyseal inner diameters to be associated with lower BMI. These findings may have implications for optimal cTHA femoral component design.

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6

Siwach, Ramchander. "Anthropometric Study of Proximal Femur Geometry and Its Clinical Application." Annals of the National Academy of Medical Sciences (India) 54, no. 04 (October 2018): 203–15. http://dx.doi.org/10.1055/s-0040-1712831.

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ABSTRACTThe implants for fixation of proximal femur fractures and joint replacements have been designed taking into consideration of the anthropometry of the western population which vary from other ethnic groups. The present study aimed to study the morphology of the upper end of femur in relation to its various diameters and angles and compare the external and internal geometry of proximal femur as obtained from radiographs, with actual measurements on cadaveric specimens in Indian population. Seventy five pairs (150 bones) of cadaveric femora were studied morphologically and radiologically using standardized techniques to obtain various anthropometrics measurements. These values were compared with those reported in the literature for Hong Kong Chinese, Caucasian, Chinese and Western populations. Data were found to be quite different from them. It is proposed that implants designed for Western populations should be used judiciously and future implants be designed to match the morphology of the Indian bones.

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7

Pisharody, S., R. Phillips, and C. M. Langton. "Sensitivity of proximal femoral stiffness and areal bone mineral density to changes in bone geometry and density." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 222, no. 3 (March 1, 2008): 367–75. http://dx.doi.org/10.1243/09544119jeim307.

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Areal bone mineral density (aBMD) is the most common surrogate measurement for assessing the bone strength of the proximal femur associated with osteoporosis. Additional factors, however, contribute to the overall strength of the proximal femur, primarily the anatomical geometry. Finite element analysis (FEA) is an effective and widely used computer-based simulation technique for modelling mechanical loading of various engineering structures, providing predictions of displacement and induced stress distribution due to the applied load. FEA is therefore inherently dependent upon both density and anatomical geometry. FEA may be performed on both three-dimensional and two-dimensional models of the proximal femur derived from radiographic images, from which the mechanical stiffness may be predicted. It is examined whether the outcome measures of two-dimensional FEA, two-dimensional, finite element analysis of X-ray images (FEXI), and three-dimensional FEA computed stiffness values of the proximal femur are more sensitive than aBMD to changes in trabecular bone density and femur geometry. It is assumed that if an outcome measure follows known trends with changes in density and geometric parameters, then an increased sensitivity will be indicative of an improved prediction of bone strength. All three outcome measures increased non-linearly with trabecular bone density, increased linearly with cortical shell thickness and neck width, decreased linearly with neck length, and were relatively insensitive to neck-shaft angle. For femoral head radius, aBMD was relatively insensitive, with two-dimensional FEXI and three-dimensional FEA demonstrating a non-linear increase and decrease in sensitivity respectively. For neck anteversion, aBMD decreased non-linearly, whereas both two-dimensional FEXI and three-dimensional FEA demonstrated a parabolic-type relationship, with the maximum stiffness being achieved at an angle of approximately 15°. Multi-parameter analysis showed that all three outcome measures demonstrated their highest sensitivity to a change in cortical thickness. When changes in all input parameters were considered simultaneously, three and two-dimensional FEA had statistically equal sensitivities (0.41 ± 0.20 and 0.42 ± 0.16 respectively, p= ns) that were significantly higher than the sensitivity of aBMD (0.24 ± 0.07; p=0.014 and 0.002 for three-dimensional and two-dimensional FEA respectively). This simulation study suggests that since mechanical integrity and FEA are inherently dependent on anatomical geometry, FEXI stiffness, being derived from conventional two-dimensional radiographic images, may provide an improvement in the prediction of bone strength of the proximal femur than currently provided by aBMD.

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8

Laskey, M. A., R. I. Price, B. C. C. Khoo, and A. Prentice. "Proximal femur structural geometry changes during and following lactation." Bone 48, no. 4 (April 2011): 755–59. http://dx.doi.org/10.1016/j.bone.2010.11.016.

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9

Taylor, M., and E. W. Abel. "Finite Element Analysis of Poor Distal Contact of the Femoral Component of a Cementless Hip Endoprosthesis." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 207, no. 4 (December 1993): 255–61. http://dx.doi.org/10.1243/pime_proc_1993_207_304_02.

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The difficulty of achieving good distal contact between a cementless hip endoprosthesis and the femur is well established. This finite element study investigates the effect on the stress distribution within the femur due to varying lengths of distal gap. Three-dimensional anatomical models of two different sized femurs were generated, based upon computer tomograph scans of two cadaveric specimens. A further six models were derived from each original model, with distal gaps varying from 10 to 60 mm in length. The resulting stress distributions within these were compared to the uniform contact models. The extent to which femoral geometry was an influencing factor on the stress distribution within the bone was also studied. Lack of distal contact with the prosthesis was found not to affect the proximal stress distribution within the femur, for distal gap lengths of up to 60 mm. In the region of no distal contact, the stress within the femur was at normal physiological levels associated with the applied loading and boundary conditions. The femoral geometry was found to have little influence on the stress distribution within the cortical bone. Although localized variations were noted, both femurs exhibited the same general stress distribution pattern.

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10

Narloch, Jerzy, and Wojciech M. Glinkowski. "Osteoarthritis Changes Hip Geometry and Biomechanics Regardless of Bone Mineral Density—A Quantitative Computed Tomography Study." Journal of Clinical Medicine 8, no. 5 (May 12, 2019): 669. http://dx.doi.org/10.3390/jcm8050669.

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We aimed to compare proximal femur geometry and biomechanics in postmenopausal women with osteoarthritis (OA) and/or osteoporosis (OP), using quantitative computed tomography (QCT). A retrospective analysis of QCT scans of the proximal femur of 175 postmenopausal women was performed. Morphometric and densitometric data of the proximal femur were used to evaluate its biomechanics. We found, 21 had a normal bone mineral density (BMD), 72 had osteopenia, and 81 were diagnosed with OP. Radiographic findings of hip OA were seen in 43.8%, 52.8%, and 39.5% of the normal BMD, osteopenic, and OP groups, respectively (p < 0.05). OA was significantly correlated with total hip volume (r = 0.21), intertrochanteric cortical volume (r = 0.25), and trochanteric trabecular volume (r = 0.20). In each densitometric group, significant differences in hip geometry and BMD were found between the OA and non-OA subgroups. Hip OA and OP often coexist. In postmenopausal women, these diseases coexist in 40% of cases. Both OA and OP affect hip geometry and biomechanics. OA does so regardless of densitometric status. Changes are mostly reflected in the cortical bone. OA leads to significant changes in buckling ratio (BR) in both OP and non-OP women.

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11

Bergot, C., V. Bousson, A. Meunier, M. Laval-Jeantet, and J. D. Laredo. "Hip Fracture Risk and Proximal Femur Geometry from DXA Scans." Osteoporosis International 13, no. 7 (July 2002): 542–50. http://dx.doi.org/10.1007/s001980200071.

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12

Machado, M. M., P. R. Fernandes, V. Zymbal, and F. Baptista. "Human Proximal Femur Bone Adaptation to Variations in Hip Geometry." Bone 67 (October 2014): 193–99. http://dx.doi.org/10.1016/j.bone.2014.07.001.

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13

Khoo, B., K. Brown, K. Zhu, M. Pollock, S. Gustafsson, R. Price, and R. Prince. "Characterising the bone structural geometry of the proximal femur neck." Bone 48 (May 2011): S175. http://dx.doi.org/10.1016/j.bone.2011.03.401.

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14

Dinçel, V. Ercan, Meltem Şengelen, Vesile Sepici, Turgay Çavuşoğlu, and Behçet Sepici. "The association of proximal femur geometry with hip fracture risk." Clinical Anatomy 21, no. 6 (September 2008): 575–80. http://dx.doi.org/10.1002/ca.20680.

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15

Simões, J. A., and M. A. Vaz. "The influence on strain shielding of material stiffness of press-fit femoral components." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 216, no. 5 (May 1, 2002): 341–46. http://dx.doi.org/10.1243/09544110260216612.

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The investigation and development of hip prostheses that can provoke identical strain patterns with those of the intact femur (physiological strains) are challenging design problems that have been addressed by several researchers. The modification of the physiological femoral strain pattern provokes adverse tissue biological reactions such as bone hypertrophy, as well as possible mechanical failure of the bone-implant construction. Investigators have used numerical and experimental methods to study the influence of the prosthesis material and geometry on physiological strain deviation. Within the present study, same geometry femoral components composed of different materials have been analysed using strain gauges. The effect of stem stiffness on the strain deviation relatively to those obtained with the intact femur was assessed. Five similar Freeman's prostheses made of different materials (steel, aluminium, composite and polyurethane) at the proximal and middle distal regions were manufactured and tested. The results revealed that only at the proximal lateral and proximal medial aspects of the femur were some differences observed between the strain patterns of the prostheses studied.

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16

Stojković, Miloš, Milan Trifunović, Jelena Milovanović, and Stojanka Arsić. "USER DEFINED GEOMETRIC FEATURE FOR THE CREATION OF THE FEMORAL NECK ENVELOPING SURFACE." Facta Universitatis, Series: Mechanical Engineering 20, no. 1 (April 8, 2022): 127. http://dx.doi.org/10.22190/fume200220034s.

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There is a growing demand for application of personalized bone implants (endoprostheses or macro-scaffolds, and fixators) which conform the anatomy of patient. Hence the need for a CAD procedure that enables fast and sufficiently accurate digital reconstruction of the traumatized bone geometry. Research presented in this paper addresses digital reconstruction of the femoral neck fracture. The results point out that User-Defined (geometric) Feature (UDF) concept is the most convenient to use in digital reconstruction of numerous variants of the same topology, such as in this kind of bone region. UDF, named FemoNeck, is developed to demonstrate capability of the chosen concept. Its geometry, controlled by a dozen of parameters, can be easily shaped according to anatomy of femoral neck region of the specific patient. That kind of CAD procedure should use minimally required set of geometric (anatomical) parameters, which can be easily captured from X-ray or Computed Tomography (CT) images. For the statistical analysis of geometry and UDF development we used CT scans of proximal femur of 24 Caucasian female and male adults. The validation of the proposed method was done by applying it for remodeling four femoral necks of four different proximal femurs and by comparing the geometrical congruency between the raw polygonal models gained directly from CT scan and reconstructed models.

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17

Cerckel, Paul-Henri, and Sabri El Banna. "Trabecular bone structure and outer geometry of the proximal human femur." Journal of Biomechanics 21, no. 10 (January 1988): 882. http://dx.doi.org/10.1016/0021-9290(88)90109-1.

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18

Karabulut, Özlen, Mehmet Tuncer, Zülfü Karabulut, Eyüp Hatipoğlu, Hasan Nazaroğlu, and Zeki Akkuş. "Evaluation of the Singh index and femur geometry in osteoporotic women." Open Medicine 5, no. 5 (October 1, 2010): 601–10. http://dx.doi.org/10.2478/s11536-009-0136-0.

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AbstractWe aimed to compare the Singh index with bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), body mass index (BMI) and femur geometry in the right proximal femur of osteoporotic women, using different statistical tests. Radiographs of each patient were assessed to determine the Singh index by five observers. The observers consisted of a consultant radiologist, physical therapist and anatomists who studied the series of radiographs. They were asked to apply the Singh index by comparing the trabecular bone pattern in the proximal right femur with the reference scale published by Singh et al. [1]. This has a six point scale from grade VI to grade I. We evaluated 47 osteoporotic women in this study. The subjects’ mean age, weigth, and height were 63,21 ± 10,106, 66,72 ± 12.523, 154,94 ± 7,026 respectively. We found a significant relationship between the Singh index and BMD. The Singh index correlated significantly with hip axis length, femoral neck diamater and trochanteric width. And, BMD correlated significantly with femoral head and neck diameter, femoral neck cortex width, medial calcar femoral cortex width and femoral shaft cortex width. The evaluation of the Singh index grades in its self, there was a significant relation among them.

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Paramesh, Govindhasamy, Vanga Rajitha, Burute Pushpa, Kaleekal Radhamani Sindhu, and Govindhasamy Rekha. "Radiological Assessment of Proximal Femur Geometry using Picture Archiving and Communication System." International Journal of Current Research and Review 13, no. 23 (2021): 19–25. http://dx.doi.org/10.31782/ijcrr.2021.132304.

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20

Van, S. M., B. Wang, M. Barrett, and M. Chizari. "T-2 Stress Behaviour of the Proximal Femur with Variation in Geometry." Journal of Biomechanics 43 (June 2010): S60. http://dx.doi.org/10.1016/s0021-9290(10)70132-9.

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21

Lam, Justin, Delanie Lynch, Diana Madrid Fuentes, Karan Devane, Marjorie Howard, Kristen Beavers, and Ashley Weaver. "COMPARTMENTAL FEMUR CORTICAL THICKNESS IN OLDER ADULTS DIFFERS BY DEMOGRAPHICS AND PHYSICAL FUNCTION." Innovation in Aging 6, Supplement_1 (November 1, 2022): 784. http://dx.doi.org/10.1093/geroni/igac059.2833.

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Abstract Previous studies have examined the relationship between cortical bone properties and fracture risk in older populations, but they have yet to examine how these properties change within the femur. Most hip fractures are classified by their location: femoral neck, intertrochanteric, or subtrochanteric fractures. Since cortical thickness can vary throughout the femur, a quantitative method of examining thickness by region was developed using a cortical mapping approach applied to computed tomography (CT) scans. Subject-specific finite element (FE) models of proximal femurs were created from baseline CT scans of 107 older adults (ages 60 – 85; 70% White; 72% Female) with obesity as classified by BMI (33.8 ± 4 kg/m2). An existing FE model was morphed to the segmented geometry of each subject’s proximal femur. A nearest neighbor search assigned cortical thickness values to the nearest finite element model node. Cortical thickness was grouped into four femoral compartments: femoral head, femoral neck, intertrochanteric and subtrochanteric regions. Pairwise paired t-tests indicated that cortical thickness differed between femoral compartments (p < 0.05). Multivariate regression models showed greater cortical thicknesses in femoral head, neck, and intertrochanteric regions in African Americans compared to Whites (p < 0.05). Additionally, these models suggest an association between cortical thickness and physical function assessments, such as the timed up-and-go test and leg muscle strength test. Since cortical thickness is not constant throughout the femur, future studies can use the framework developed here to assess each compartment individually and investigate the relationships between cortical thickness, demographics, and functional assessments.

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Kumar, Arvind, N. Venkatesh Kumar, Udayamoorthy S., and Chandan Noel. "Assessment of proximal femur anthropometry in South Indian population through cadaveric bones and radiologically correlating difference if any between other ethnic groups." International Journal of Research in Orthopaedics 3, no. 3 (April 25, 2017): 466. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20171576.

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<p class="abstract"><strong>Background:</strong> The morphology of the proximal femur is a topic of extensive research. The hip joint is one of the most commonly replaced joint. The era of replacement has given rise to various implants that can be used to replace the proximal femur. This present study addresses these issues involving ethnic differences in the geometry of the proximal femur in Indians and its differences between people of various ethnicity.</p><p class="abstract"><strong>Methods:</strong> The total population that was radiographed was 178 (n=178). There were 78 males and 100 females. The age of the participants were spaced from 25-75 years age groups. The parameters were measured.<strong></strong></p><p class="abstract"><strong>Results:</strong> The canal flare index in South-Indians was an average of 3.23 with 70% of the study population having normal CFI (3-4.5), 30% of the population having a stove pipe configuration CFI (<3). Majority of the Indian population favour a un-cemented fixation (70%).</p><p><strong>Conclusions:</strong> In summary all current implants have to be revised on population basis to fit the changing anthropometry of our proximal femur. </p>

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23

Beck, T. J., J. R. Cauley, A. de Papp, L. E. Wehren, and D. T. Baran. "Alendronate Improves the Structural Geometry of the Proximal Femur in Postmenopausal Osteoporotic Women." Journal of Clinical Densitometry 9, no. 2 (April 2006): 250. http://dx.doi.org/10.1016/j.jocd.2006.04.104.

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24

Travison, T. G., T. J. Beck, G. R. Esche, A. B. Araujo, and J. B. McKinlay. "Age trends in proximal femur geometry in men: variation by race and ethnicity." Osteoporosis International 19, no. 3 (November 24, 2007): 277–87. http://dx.doi.org/10.1007/s00198-007-0497-7.

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25

Iolascon, Giovanni, Antimo Moretti, Giovanni Cannaviello, Giuseppina Resmini, and Francesca Gimigliano. "Proximal femur geometry assessed by hip structural analysis in hip fracture in women." Aging Clinical and Experimental Research 27, S1 (July 16, 2015): 17–21. http://dx.doi.org/10.1007/s40520-015-0406-4.

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26

Gnudi, S., C. Ripamonti, G. Gualtieri, and N. Malavolta. "Geometry of proximal femur in the prediction of hip fracture in osteoporotic women." British Journal of Radiology 72, no. 860 (August 1999): 729–33. http://dx.doi.org/10.1259/bjr.72.860.10624337.

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27

Dairaku, Katsuyuki, Masaji Ishii, Shinji Kobayashi, Hiroyuki Kawaji, Kan Sasaki, Yuya Takakubo, and Michiaki Takagi. "Initial Evaluation on Subsidence of Cemented Collarless Polished Tapered Stem Applied to the Patients with Narrow Femoral Medullar Canal." Open Orthopaedics Journal 4, no. 1 (March 16, 2010): 147–51. http://dx.doi.org/10.2174/1874325001004010147.

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Purpose: The geometry of the proximal femur is one of the important factors for choosing the suitable stem. We have been applied cemented collarless polished tapered (CPT) stem to the patients with small femur. Radiographic evaluation was performed to access the clinical feature of the stem in early stage of the follow-up. Methods: One hundred total hip arthroplasties with CPT system were performed between October 2004 to February 2006. This study focused on the 53 cases to whom size 1 or smaller sized stem were implanted, and its post-operative period was 41 months (30-46 months). Morphologic classification of preoperative proximal femur, stem alignment, thickness of the cement mantle, cementing technique, subsidence of the stem, improvement in the bone-cement interface, and stress shielding were assessed. Results: The size of the inserted stem was X-SMALL in one case, SMALL in two cases, SIZE 0 in 12 cases, and SIZE 1 in 38 cases. Canal shape of proximal femur was stovepipe type in five cases, normal type in 43 cases, and champagne-flute type in five cases. There was no subsidence in eight cases. 44 stems subsided within 1 mm, one stem subsided 1 to 2 mm, and no stem subsided over 2 mm. In 39 of 45 cases, subsidence was appeared within six months after operation. Marked progressive and excessive subsidence was not seen after the two years of follow-up. Conclusions: Short term radiographic results of THA with CPT stem to small femur were satisfactory with less unfavorable radiographic findings, which imply contribution to longer survivorship of the stem.

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Djuric, Marija, Petar Milovanovic, Danijela Djonic, Arsa Minic, and Michael Hahn. "Morphological characteristics of the developing proximal femur: A biomechanical perspective." Srpski arhiv za celokupno lekarstvo 140, no. 11-12 (2012): 738–45. http://dx.doi.org/10.2298/sarh1212738d.

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Introduction. In contrast to a plethora of studies on the proximal femur in adults, its external and internal morphology in growing children has not been sufficiently analyzed. Objective. We analyzed changes in external and internal morphology of the proximal femur during growth and development to interpret the links between them and concepts of the human femoral biomechanics. Methods. We assessed external geometry, internal trabecular and cortical arrangement, and bone mineral density (BMD) of the proximal femur in 29 children (age at death from 1 month to 14 years) from archaeological context by using microscopic and radiographic methods. Results. The results showed that both the femoral neck width and length increased with age, with the femoral neck becoming more elongated, while the collo-diaphyseal angle decreased. A strong relationship between age and adjusted areal BMD was found, showing continuous increase during childhood. Parallel trabecular pattern at birth changed to mature three distinct trabecular groups (longitudinal ? principal compressive, transversal ? tensile and randomly scattered) starting from the age of 8 months. In older children the superior and inferior aspects of the femoral neck differently changed with growth, with medial neck having thicker cortex and trabeculae. Conclusion. In the light of bone adaptation principle, the observed changes in external and internal morphology are governed by mechanical forces acting on the developing femur. Our findings on the development of trabecular pattern and cortical distribution are compatible with recent views on the femoral biomechanics which point out the predominance of compressive stresses in the femoral neck, adaptation to shear stresses, multiaxial loading perspective, prevalence of muscle effects over body weight, and existence of adaptational eccentricity.

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Zicat, B., Y. Kukita, S. Grandia, and C. Engh. "Factors Affecting the Design of the Head and Neck Segment of a Contemporary Total Hip Prosthesis." HIP International 4, no. 3-4 (July 1994): 115–26. http://dx.doi.org/10.1177/1120700094004003-402.

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Anthropometric investigation of femoral sizes and femoral pelvic relationships was performed in a group of unilateral total hip arthroplasty patients. Standardized radiographs were used to perform the measurements. The non-operated, contralateral side was used as a standard for endosteal anatomy and the normal femoral pelvic relationship. Analysis of endosteal shape reveals a spectrum ranging from the stovepipe shape of the aged bone that has undergone diaphyseal expansion, to the trumpet shaped proximal femur found in younger patients. There is also a relationship between this shape and the relative varus or valgus position of the head and neck of the femur. Implants can be designed with head and neck geometry corresponding to these relationships. These implants would reconstruct normal anatomy more accurately. Cementless, acetabula placed in a more medial and proximal position should be matched to femoral components with longer neck-length options than cemented acetabular components.

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30

Yosibash, Zohar, Royi Padan, Leo Joskowicz, and Charles Milgrom. "A CT-Based High-Order Finite Element Analysis of the Human Proximal Femur Compared to In-vitro Experiments." Journal of Biomechanical Engineering 129, no. 3 (November 14, 2006): 297–309. http://dx.doi.org/10.1115/1.2720906.

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The prediction of patient-specific proximal femur mechanical response to various load conditions is of major clinical importance in orthopaedics. This paper presents a novel, empirically validated high-order finite element method (FEM) for simulating the bone response to loads. A model of the bone geometry was constructed from a quantitative computerized tomography (QCT) scan using smooth surfaces for both the cortical and trabecular regions. Inhomogeneous isotropic elastic properties were assigned to the finite element model using distinct continuous spatial fields for each region. The Young’s modulus was represented as a continuous function computed by a least mean squares method. p-FEMs were used to bound the simulation numerical error and to quantify the modeling assumptions. We validated the FE results with in-vitro experiments on a fresh-frozen femur loaded by a quasi-static force of up to 1500N at four different angles. We measured the vertical displacement and strains at various locations and investigated the sensitivity of the simulation. Good agreement was found for the displacements, and a fair agreement found in the measured strain in some of the locations. The presented study is a first step toward a reliable p-FEM simulation of human femurs based on QCT data for clinical computer aided decision making.

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31

Kim, Da-Hye, Seong-Jin Ko, Se-Sik Kang, Jung-Hoon Kim, Dong-Hyun Kim, Soo-Young Ye, and Changsoo Kim. "Assessment of the Correlation for Geometry Transition using Bone Mineral Density in Proximal Femur." Journal of the Korea Contents Association 12, no. 12 (December 28, 2012): 335–44. http://dx.doi.org/10.5392/jkca.2012.12.12.335.

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32

Gnudi, S., N. Malavolta, D. Testi, and M. Viceconti. "Differences in proximal femur geometry distinguish vertebral from femoral neck fractures in osteoporotic women." British Journal of Radiology 77, no. 915 (March 2004): 219–23. http://dx.doi.org/10.1259/bjr/79551075.

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33

Slemenda, C. W., C. H. Turner, M. Peacock, J. C. Christian, J. Sorbel, S. L. Hui, and C. C. Johnston. "The genetics of proximal femur geometry, distribution of bone mass and bone mineral density." Osteoporosis International 6, no. 2 (March 1996): 178–82. http://dx.doi.org/10.1007/bf01623944.

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34

Jackowski, Stefan A., Saija A. Kontulainen, David M. L. Cooper, Joel L. Lanovaz, and Adam D. G. Baxter-Jones. "Maturational timing does not predict HSA estimated adult bone geometry at the proximal femur." Bone 49, no. 6 (December 2011): 1270–78. http://dx.doi.org/10.1016/j.bone.2011.08.030.

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35

Khoo, B. C. C., T. J. Beck, K. Brown, and R. I. Price. "Evaluating accuracy of structural geometry by DXA methods with an anthropometric proximal femur phantom." Australasian Physical & Engineering Sciences in Medicine 36, no. 3 (July 9, 2013): 279–87. http://dx.doi.org/10.1007/s13246-013-0209-x.

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36

Ulusoy, H., A. Bilgici, O. Kuru, N. Sarica, S. Arslan, and U. Erkorkmaz. "A new value of proximal femur geometry to evaluate hip fracture risk: true moment arm." Hip International 18, no. 2 (2008): 101–7. http://dx.doi.org/10.5301/hip.2008.4212.

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37

Nissen, N., C. H. Gravholt, B. Abrahamsen, E. M. Hauge, J. E. Bech Jensen, L. Mosekilde, and K. Brixen. "Disproportional geometry of the proximal femur in patients with Turner syndrome: a cross-sectional study." Clinical Endocrinology 67, no. 6 (December 2007): 897–903. http://dx.doi.org/10.1111/j.1365-2265.2007.02984.x.

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38

Zymbal, Vera, Lurdes Rebocho, Graça Cardadeiro, and Fátima Baptista. "Physical Activity, Bone Geometry, and Bone Mass at the Proximal Femur Regions in Young Adults." Medicine & Science in Sports & Exercise 46 (May 2014): 38. http://dx.doi.org/10.1249/01.mss.0000493277.08120.e0.

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39

Petit, Moira A., Thomas J. Beck, Justine Shults, Babette S. Zemel, Bethany J. Foster, and Mary B. Leonard. "Proximal femur bone geometry is appropriately adapted to lean mass in overweight children and adolescents." Bone 36, no. 3 (March 2005): 568–76. http://dx.doi.org/10.1016/j.bone.2004.12.003.

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Ulusoy, H., A. Bilgici, O. Kuru, N. Sarica, S. Arslan, and U. Erkorkmaz. "A new value of proximal femur geometry to evaluate hip fracture risk: True moment arm." HIP International 18, no. 2 (April 2008): 101–7. http://dx.doi.org/10.1177/112070000801800206.

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Manske, S. L., T. Liu-Ambrose, P. M. de Bakker, D. Liu, S. Kontulainen, P. Guy, T. R. Oxland, and H. A. McKay. "Femoral neck cortical geometry measured with magnetic resonance imaging is associated with proximal femur strength." Osteoporosis International 17, no. 10 (July 18, 2006): 1539–45. http://dx.doi.org/10.1007/s00198-006-0162-6.

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42

Nuțu, Emil, and Mihai Tarcolea. "Simulation of Bone Mechanical Adaptation in a 3D Model of the Proximal Femur Using the Stanford Strain Energy Density Approach." Key Engineering Materials 638 (March 2015): 171–76. http://dx.doi.org/10.4028/www.scientific.net/kem.638.171.

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The mathematical theories of bone mechanical adaptation are based on a nonlinear ordinary differential equation which governs the evolution of bone density with respect to the applied loads. If the density distribution achieved within a certain bone model resembles the expected distribution observed in the real bone, then the mathematical theory is usually thought to be suited for such simulations. As test problem, it was extensively used the coronal section of the proximal femur. This section inspired the very creation of the mathematical models following Wolff’s observations regarding trabecular architecture. However, the lack of quantitative data when using the bi dimensional femur model prevents the quantitative validation of the adaptation mathematical models. Using computed tomography is now possible to reconstruct the three dimensional geometry of bones and also to estimate the apparent density based on correlations with the Hounsfield units. This method was already used to quantitatively validate the simulation of bone remodeling into different bones and proved to be efficient. The paper presents the apparent density distributions achieved into the 3D model of the proximal femur by coupling the finite element method with the Stanford bone adaptation equation. The densities obtained in this manner are compared by those determined from the tomographic data of the same bone. The purpose relies on establishing whether the three dimensional end proximity of the femur bone can be used for quantitative validation of remodeling simulations.

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Grujic, Jovan, Slobodan Tabakovic, Milan Zeljkovic, Aleksandar Zivkovic, Zoran Vucinic, Aca Djordjevic, Nikica Mandic, Nenad Lujic, and Jovan Sekulic. "Designing special prosthesis "Spacer"." Acta chirurgica Iugoslavica 60, no. 2 (2013): 109–15. http://dx.doi.org/10.2298/aci1302109g.

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Malignant diseases of the medial part of the femur, humerus and tibia, treated with surgical removal of the affected part of the bone and prosthesis fitting special "Spacer". This type of prosthesis is made in the form of the proximal and distal components that connect by screws. The design of endoprosthesis provides without possible rotation linear relationship and allows the transfer of load from the proximal to the distal bone, but the screws that provide connection are not exposed to stress. For proper sizing and implementation of a special prosthesis is necessary to determine the geometric parameters of bone mass and disease and then develop a computer model of the prosthesis. Designing a special prosthesis "spacer" is a complex procedure based on the processing of diagnostic images (X-ray, CT or MRI) with the use of specialized software digitized picture elements pixels translate into voxels. In this way a geometric model contains a form of external (KORTEX), and the internal geometry of the bone (medullary canal). On the basis of such a developed computer models is possible accurately determine the part of the bone that is necessary to remove, and the size of medullary canal space that is built into proximal or distal component of special endoprosthesis "Spacer".

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Mokrovic, Hrvoje, Simona Komen, Leo Gulan, and Gordan Gulan. "Radiographic analysis of the proximal femoral anatomy in the Croatian population." International Orthopaedics 45, no. 4 (January 13, 2021): 923–29. http://dx.doi.org/10.1007/s00264-021-04942-5.

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Abstract Purpose The goal of total hip endoprosthesis is to achieve painless and functional hip for long term. Accurate reconstruction of hip anatomy largely depends on the implant design. In order to select an implant in correspondence with the native hip, the proximal femoral morphology has been in focus of many studies in the past years. The purpose of this study is to analyze proximal femoral geometry in the Croatian population by radiographic evaluation. Methods We conducted a retrospective study analyzing conventional radiographies of the hip, obtained within the last four years from the database of Clinic for Orthopaedic Surgery Lovran. The number of studied patients was 300,168 women and 132 men. The proximal femoral geometric parameters assessed were as follows: femoral head diameter, femoral neck length, neck-shaft angle, angle of femoral neck anteversion, and lateral femoral offset. The results obtained were compared between genders and with results of other studies. Results Proximal femoral anatomy differed in femoral head diameter and lateral femoral offset between males and females in our group of patients, while femoral neck length, femoral neck shaft angle, and femoral neck anteversion have shown similar values in both genders. Our study also showed specificity of the Croatian population in almost all parameters of proximal femoral anatomy, in comparison with other ethnic groups. Conclusion Our results support the observation on high diversity in the morphology of the proximal femur and the specificity of the proximal femoral anatomy of the Croatian population.

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Giangregorio, Lora M., Colin E. Webber, Stuart M. Phillips, Audrey L. Hicks, B. Catherine Craven, Joanne M. Bugaresti, and Neil McCartney. "Can body weight supported treadmill training increase bone mass and reverse muscle atrophy in individuals with chronic incomplete spinal cord injury?" Applied Physiology, Nutrition, and Metabolism 31, no. 3 (June 1, 2006): 283–91. http://dx.doi.org/10.1139/h05-036.

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This study evaluates the impact of 12 months of body weight supported treadmill training (BWSTT) on muscle and bone in individuals with spinal cord injury (SCI). Fourteen individuals who sustained an incomplete SCI at least 12 months before the study were recruited to participate in BWSTT 3 times/week for a total of 144 sessions. Thirteen individuals completed the study. The average age of subjects was 29 y, average time post-injury was 7.70 y (range: 1-24 y). Areal bone densities of the proximal and distal femur, proximal tibia, spine, and whole body were measured using dual-energy X-ray absorptiometry. Muscle cross-sectional area (CSA), volumetric bone density, and bone geometry at mid-femur and proximal tibia were measured using computed tomography. Serum osteocalcin and urinary deoxypyridinoline were measured at baseline and after 6 and 12 months of training. All other measures were made before and after training. Participants experienced significant increases in whole-body lean mass, from 45.9 ± 8.7 kg to 47.8 ± 8.9 kg (mean ± SD; p < 0.003). Muscle CSAs increased by an average of 4.9% and 8.2% at the thigh and lower leg sites, respectively. No significant changes occurred in bone density or bone geometry at any site, or in bone biochemical markers. Whole-body bone density exhibited a small but statistically significant decrease (p < 0.006). BWSTT may therefore be a promising intervention for increasing muscle mass. Although 12 months of BWSTT did not increase bone density in individuals with chronic incomplete SCI, it did not appear to decrease bone density at fracture-prone sites.Key words: spinal cord injury, bone density, muscle mass, osteoporosis, body weight support.

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Gnudi, S., C. Ripamonti, L. Lisi, M. Fini, R. Giardino, and G. Giavaresi. "Proximal Femur Geometry To Detect and Distinguish Femoral Neck Fractures from Trochanteric Fractures in Postmenopausal Women." Osteoporosis International 13, no. 1 (January 1, 2002): 69–73. http://dx.doi.org/10.1007/s198-002-8340-2.

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47

Op Den Buijs, Jorn, and Dan Dragomir-Daescu. "Validated finite element models of the proximal femur using two-dimensional projected geometry and bone density." Computer Methods and Programs in Biomedicine 104, no. 2 (November 2011): 168–74. http://dx.doi.org/10.1016/j.cmpb.2010.11.008.

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48

Kumar, Vishnu Senthil. "Fracture neck of femur in severe coxa-vara – Challenging management in an Achondroplasia patient." IP International Journal of Orthopaedic Rheumatology 8, no. 1 (July 15, 2022): 29–32. http://dx.doi.org/10.18231/j.ijor.2022.007.

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Achondroplasia is a skeletal dysplasia of autosomal dominant inheritance. Fibroblast growth factor receptor 3 mutation at p16.3 locus of chromosome 4 leads to inhibition of sub-chondral growth. Middle aged achondroplastic patient with left fracture neck of femur following a fall of heavy object. It was a challenging case because of coxa-vara and meticulous templating is needed. 38 year old male sustained fracture neck of left femur in severe coxa-vara. Closed reduction with 16 mm partially threaded cannulated cancellous screw perpendicular to native neck- shaft angle. At regular follow up, mild lysis was seen around the screw and implant removal was done. Now with neck of femur non-union, walking full weight bearing with walker. The future course included excision arthroplasty or custom made prosthesis. Achrondroplasia characterised by defects in en-chondral bone formation leading to retarded cartilage growth. Literature search on peri-articular fracture management showed peadiatric disatal femur fracture fixed with percutaneous screws. In adult, neck of femur fracture is managed by percutaneous screw, DHS or prosthesis. Due to altered geometry of proximal femur DHS and Prosthesis was deferred.Early failure of CC screws in our case is due to perpendicular placement of screws which increased strain due to altered bio-mechanics. Achondroplastic dwarfs live a normal life. They are prone to peri-articular fractures because of anatomical variations. We wanted to highlight the difficulties and importance of pre-op planning and implant choice of fracture fixation in an adult achondroplasia patient.

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FALCINELLI, CRISTINA, ENRICO SCHILEO, FABIO BARUFFALDI, LUCA CRISTOFOLINI, and FULVIA TADDEI. "THE EFFECT OF COMPUTED TOMOGRAPHY CURRENT REDUCTION ON PROXIMAL FEMUR SUBJECT-SPECIFIC FINITE ELEMENT MODELS." Journal of Mechanics in Medicine and Biology 17, no. 01 (February 2017): 1750012. http://dx.doi.org/10.1142/s0219519417500129.

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Many studies have addressed the modulation of computed tomography (CT) parameters, and particularly of tube current, to obtain a good compromise between the X-ray dose to the patient and the image quality for diagnostic applications. This study aimed at evaluating the influence of dose reduction by means of tube current reduction on the CT-based subject-specific finite element (FE) modeling. To this aim, CT scans at stepwise reduced values of tube current from 180[Formula: see text]mAs to 80[Formula: see text]mAs were performed on: (i) a densitometric phantom, to quantify the changes in the calibration equation; (ii) a fresh-frozen, water submersed, human cadaver femur, to quantify changes in geometry reconstruction and material mapping from CT, as well as strain prediction accuracy, based on the in vitro strain measurements available; (iii) a fresh-frozen human cadaver thigh with soft tissues attached, to quantify FE results changes in conditions similar to those found in vivo. The results showed that the tube current reduction does not affect the 3D modeling and the femur FE analysis. Our pilot study highlights the possibility of performing CT scans with reduced dose to generate biomechanical models, although a confirmation by performing larger studies with clinical CT data is needed.

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Weeks, Benjamin K., Conor Lambert, Amy T. Harding, Steven L. Watson, Sally F. Dzera, Rossana C. Nogueira, and Belinda R. Beck. "Bone-specific Physical Activity Questionnaire (BPAQ) Score Associations with Proximal Femur Geometry from DXA-derived 3D Analysis." Medicine & Science in Sports & Exercise 49, no. 5S (May 2017): 395–96. http://dx.doi.org/10.1249/01.mss.0000517963.80003.fe.

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