Citation Information :
Ho D, Liu RW, McClure PK. Correlation between Femoral Neck Version, Sagittal Femoral Bowing Angle and Sagittal Offset of the Femoral Head from the Distal Femur Axis in an Osteological Collection. 2023; 18 (1):12-15.
Aim: Radiographic analysis of lower limb alignment is crucial for the planning and evaluation of deformity correction. Assessment in the sagittal plane is often overlooked compared with the coronal plane for a variety of reasons. We aimed to investigate the relationship between the femoral head in the sagittal plane and femoral neck version in the axial plane, and how sagittal femoral bowing angle (sFBA) may contribute.
Materials and methods: Twenty-five each of high (1–2 standard deviations above mean), normal (2.5° below to 2.5° above the mean), and low (1–2 standard deviations below the mean) version femurs were randomly selected from an osteological collection database, photographed and measured for sFBA and sagittal offset of femoral head from the distal femur axis. Lines were drawn within the proximal and distal quartiles of the shaft to create sFBA. The offset of the distal quartile line and the femoral head was also measured. High intra- and inter-observer correlations were established. The relationship between parameters was assessed using the Pearson coefficient (r).
Results: Sagittal offset of the femoral head from the distal femur axis was found to be highly correlated with sFBA (r = 0.78), and only mildly with femoral neck version (r = 0.52). Sagittal femoral bowing angle and femoral neck version share no relationship (r = 0.05).
Conclusions: Neither the sFBA nor sagittal femoral head offset is strongly associated with femoral neck version.
Clinical significance: Our data reinforce the need for long leg lateral films to include the femoral head in sagittal deformity analysis, as imaging limited to the knee will not account for the effect of bowing on femoral head position.
Paley D. Sagittal plane deformities. Princ Deform Cor 2005;6:155–174. DOI:10.1007/978-3-642-59373-4_6.
Weinberg DS, Park PJ, Liu RW. Association between tibial malunion deformity parameters and degenerative hip and knee disease. J Orthop Trauma 2016;30(9):510–515. DOI: 10.1097/BOT.0000000000000603.
Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, et al. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 2004;124(9):575–584. DOI: 10.1007/s00402-004-0728-8.
Palmu SA, Lohman M, Paukku RT, et al. Childhood femoral fracture can lead to premature knee-joint arthritis. 21-year follow-up results: A retrospective study. Acta Orthop 2013;84(1):71–75. DOI: 10.3109/17453674.2013.765621.
Klek M, Dhawan A. The role of high tibial osteotomy in ACL reconstruction in knees with coronal and sagittal plane deformity. Curr Rev Musculoskelet Med 2019;12(4):466–471. DOI: 10.1007/s12178-019-09589-9.
Kremen TJ Jr, Haggerty E, Chahla J, et al. Comparative analysis of sagittal-plane radiographic landmarks used to identify the femoral attachments of lateral knee structures. Arthroscopy 2020;36(11):2888–2896. DOI: 10.1016/j.arthro.2020.07.006.
Ziegler CG, Fulkerson JP, Edgar C. Radiographic reference points are inaccurate with and without a true lateral radiograph: The importance of anatomy in medial patellofemoral ligament reconstruction. Am J Sports Med 2016;44(1):133–142. DOI: 10.1177/0363546515611652.
Solayar GN, Chinappa J, Harris IA, et al. A comparison of plain radiography with computer tomography in determining coronal and sagittal alignments following total knee arthroplasty. Malays Orthop J 2017;11(2):45–52. DOI: 10.5704/MOJ.1707.006.
Khalifa AA, Mullaji AB, Mostafa AM, et al. A protocol to systematic radiographic assessment of primary total knee arthroplasty. Orthop Res Rev 2021;13:95–106. DOI: 10.2147/ORR.S320372.
Solomin LN, Skomoroshko PV. Identification of femoral reference lines and angles in sagittal plane (preliminary report). J Bone Rep Recomm 2017;3:2. DOI: 10.4172/2469-6684.100041.
Vilenskiy VA, Solomin LN, Utekhin AI. Femur deformity correction planning in sagittal plane using mechanical axis. J Limb Lengthen Reconstr 2021;7:8–13. DOI: 10.4103/jllr.jllr_14_21.
Chung BJ, Kang YG, Chang CB, et al. Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA. Clin Orthop Relat Res 2009;467(9):2403–2413. DOI: 10.1007/s11999-009-0762-5.
Müller M, Crucius D, Perka C, et al. The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty. Inter Ortho 2011;35:981–987. DOI: 10.1007/s00264-010-1047-z.
Kingsley PC, Olmsted KL. A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg 1948;30(3): 745–751. PMID: 18109784.
Yau, WP, Chiu, KY, Tang, WM, et al. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong) 2007;15:32–36. DOI: 10.1177/230949900701500108.
Lee YK, Yeom J, Jang BW, et al. Reliability of measuring lateral bowing angle of the femur in patients with atypical femur fractures. J Orthop Surg (Hong Kong) 2019;27(3). DOI: 10.1177/2309499019881475.