Table of Contents    
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 3-6  

Comparative anthropometry analysis of the digital X-rays of the right and left hip joints in an Indian population


Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital, The Tamil Nadu Dr. M.G.R. Medical University, Tamil Nadu, India

Date of Submission09-Sep-2019
Date of Decision09-Sep-2019
Date of Acceptance27-Sep-2019
Date of Web Publication11-Mar-2020

Correspondence Address:
Vetrivel Chezian Sengodan
16 H, Housing Unit, Mettupalayam, Coimbatore - 641 301, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsbm.JNSBM_177_19

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   Abstract 


Background: Population-specific anthropometric analysis of hip joints has vital clinical and surgical implications including adoption of optimal preventive measures and selection of effective prosthesis. Hence, in this study, we determined the anatomical variance between the right and left hip of the patients referred to our orthopedic unit. Materials and Methods: Five hundred patients with a normal hip joint attending the Institute of Orthopedics and Traumatology Unit of Coimbatore Medical College Hospital, Coimbatore, India, were included in this study. Plain radiographs were taken to measure the neck-shaft angle (NSA), head diameter (HD), neck width (NW) of the right and left femur, and the values were compared with data reported in the literature for various other population. Results: The mean value of NSA (134.2°), HD (42.9 mm), and NW (28.2 mm) in the study population differed when compared with data reported in the literature for the Western and other Indian population. Significant changes were also observed between the right and left sides of the hip joint in the study population. Conclusion: This study concludes that significant differences exist between the right and left side of hip joint in the study population. Further the values observed in our study population were considerably different from the values reported in the literature for the Western population.

Keywords: Head diameter, neck-shaft angle, neck width


How to cite this article:
Sengodan VC, Appusamy N. Comparative anthropometry analysis of the digital X-rays of the right and left hip joints in an Indian population. J Nat Sc Biol Med 2020;11:3-6

How to cite this URL:
Sengodan VC, Appusamy N. Comparative anthropometry analysis of the digital X-rays of the right and left hip joints in an Indian population. J Nat Sc Biol Med [serial online] 2020 [cited 2020 Apr 4];11:3-6. Available from: http://www.jnsbm.org/text.asp?2020/11/1/3/280130




   Introduction Top


Significant geometric modifications are observed in the proximal part of femur during standing posture.[1] Perhaps, these geometric modifications are influenced by phenotypic variations. Hence, anthropometric analysis of hip joint offers great clinical and surgical values, specifically considering the potential phenotypic differences between the Western and Indian populations.[2] Population-specific morphological analysis help us to understand the proximal femur and hip joint anatomy and its biomechanics, which becomes the basis for selecting optimal measures for correcting hip disorders such as osteoarthritis of the hip, avascular necrosis of the femur neck, femur fractures, and trochanteric fractures.[1],[2],[3]

Fractures around the hip are most commonly encountered among elderly people which more often needs surgical corrections using commercially available implants to attain a good range of functional mobility.[4],[5] The commercially available implants are developed based on population-specific morphological analysis available in the literature. Siwach and Dahiya, study compared the parameters measured from cadavers of Indian origin with those of the Western and Chinese population and reported considerable differences in the measured hip joint parameters. These differences resulted in the use of implants which were oversized consequently leading to splintering and secondary fractures.[2] The commonly used implants and procedures for proximal femur fractures are dynamic hip screws, proximal femur nail, replacement arthroplasty (total hip replacement, hemiarthroplasty), and cancellous screw fixation. These implants are mainly designed based on the measurement of hip joints from the Western population and hence will need modification when intended to be used for Indian patients.[6]

Patient population-specific modification of surgical implants can potentially help to reduce the intra-operative complications such as splintering, secondary fractures, and postoperative complications such as mismatched load distribution, loosening of implants, stress fractures, and eventually implant failure.[6],[7],[8],[9] Its also vital to design optimal prosthesis through which adequate loads can be transferred to bone to prevent stress shielding.[1],[6],[10] The design of implants that will optimally fits among the Indian population to achieve effective functional outcome requires anthropometric measurement of hip joints. While these measurements can be obtained from cadavers, the reliability of such data is often questionable. Hence, in this study, we have used plain digital radiographs to reliably measure the hip joint parameters. Specifically, in this study, we have compared the right and the left side hip joint parameters from the same patient to assess if the right versus left implant design needs any specific considerations among the Indian population.


   Materials and Methods Top


This study was performed at the Institute of Orthopedics and Traumatology, Coimbatore Medical College Hospital, Coimbatore, India, from 2017 to 2018 after obtaining approval from the Institutional Ethical Committee. One thousand hips were analyzed in the age group 18–80 years and patients with normal hip morphology were included in the study. Patients with hip pathology, previous fractures, congenital deformities, spine abnormalities were excluded from the study. Plain radiograph of both hip in anteroposterior view were taken in supine position with hip in neutral position using 200 mA Seimens Multiphos 15R X-ray machine. Neck-shaft angle (NSA), head diameter (HD), and neck width (NW) of the femur were calculated using the “full-screen” view, and the images were magnified to maximize resolution and accuracy.

Neck-shaft angle

It is the angle intersected between the long axis of the femur and the long axis of the neck of the femur. The femoral shaft axis is a line drawn by extending through two equidistant points from the mediolateral surface of femoral shaft in the center of the medullary canal. Neck axis is drawn by joining the two points equidistant from the superior and inferior surface of the femoral neck[1],[10] [Figure 1].
Figure 1: Neck Shaft angle (NSA)

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Head diameter

A perfect circle is drawn over the ideally spherical femoral head, and circle diameter is measured[1] [Figure 2].
Figure 2: Head Diameter (HD)

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Neck width

A perpendicular line to the neck axis at the narrowest part of the femoral neck is measured[1],[11],[12] [Figure 3].
Figure 3: Neck Width (NW)

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The obtained values were statistically analyzed using the Chi-square test.


   Results Top


Neck-shaft angle

The mean value of the NSA in our study was 134.2°. The NSA values ranged from 121° to 147° on the right side and 122°–145° on the left side. The mean value was 135.6° on the right side and 134.7° on the left side. Statistical analysis was performed, and P value was statistically significant [Table 1] and [Table 2].
Table 1: Morphometric analysis of the hip joint

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Table 2: Analysis of various parameters as per side of the hip

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Femoral head diameter

The mean value of the femoral HD in our study was 42.9 mm. The FD values ranged from 37 mm to 51 mm on the right side and 36 mm to 50 mm on the left side. The mean value was 41.55 mm on the right side and 41.1 mm on the left side [Table 1] and [Table 2].

Neck width

The mean value of the NW in our study was 28.2 mm. The NW values ranged from 19 to 38 mm on the right side and 19–36.9 mm on left side. The mean value was 27.85 mm on the right side and it was 28.1 mm on the left side. Statistical analysis was performed, and P value was statistically significant [Table 1] and [Table 2].


   Discussion Top


The Indian subcontinent consists of various populations with different genetic, morphological, and cultural characteristics, which are likely to impart variable bone anatomy. Knowledge of these anatomical differences is essential to understand the etiology of disease and achieve good surgical outcomes.[1],[13] The Indian population is also anatomically different from the Western population as our population is adapted to floor level activities which require increased external rotation of hip.[13] Previously, Husmann et al. and Noble et al. have reported anthropometric data on bone anatomy using plain radiographs,[11],[14] while computed tomography (CT) scan data were used by Sengodan et al.,[1] Rubin et al.,[14] and Mahaisavariya et al.[15]

The NSA values observed in our study were compared with values reported in the literature for the Western population.[6],[14],[16] In our study, the NSA was 135.1°, which is higher compared with the values reported for the Western population. Our study was also compared with other Indian studies.[1],[6],[13] The NSA among the South Indian population was higher than the values reported in the Rawal et al.'s study done in New Delhi, whereas the NSA values observed in our study and South Indian study done by Sengodan et al. was less than the values reported by Saikia et al. involving patients from North Eastern Region [Table 2]. The femoral neck forms an angle with the shaft which is usually 135° ±7° in the normal adult and the functional significance of this angle is that the displacement of femoral shaft away from the pelvis facilitates freedom of hip joint motion. The neck stem angle of the standard femoral prosthesis in arthroplasty is 131°[1] which is considerably lower than the mean NSA observed in our study (134.2°). Such a difference in anatomical morphometry between natural bone versus artificial implants may potentially interfere with normal hip biomechanics and lead to suboptimal prognosis postsurgery.

In our study, the femoral HD was 42.90 mm, which is less than that reported in the Western population [Table 3]. The femoral HD among the South Indian population is observed to be lower than the SWISS,[14] and Caucasian population.[16] The femoral HD of our study was also compared with other studies reported from India.[1],[6] and were found to be lower. The studies by Sengodan et al.[1] (South Indian population) and Rawal et al.,[6] used CT scans which is more accurate than measuring parameters from an X-ray image.
Table 3: Comparative morphometric analysis of the hip joint from various studies reported in literature

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In our study, the NW was 28.2 mm which is higher when compared to the values reported by Sengodan et al.[1] (South Indian population), which used CT scan images for analyzing the hip joint anthropometry which is more accurate. Normally, a minimum of three cancellous screws is necessary, while fixing the fracture at neck of femur. The diameter of the cancellous screw is 6.5 mm. The lowest value of the NW in our study was 19 mm; hence, considering this NW, fixation with three screws will be practically difficult,[1] and perhaps, two screws will be ideal for fixing the fracture. [17,18]


   Conclusion Top


Anthropometric analysis of hip joints using plain digital radiographs is a simple and cost-effective method to establish bone biometrics in a local population. This study concludes that significant differences exist in the right and left hips of a person and these biometric values vary significantly when compared with the Western populations. Due to these biometric variations between different populations, for smaller built Indian population proximal femur implant available in market does not match the biomechanics of hip as its being designed based on Western population. Further the commercially available implants must account for population-specific variations in the left and the right as observed in this study. Hence, this study results can be utilized for designing proximal femur implants, which are tailored for South Indian population. However, one of our study limitations is the collection of anthropometric data from only 500 people, which may not be representative of the general population. Hence, a large multicentric study in South India is necessary to confirm and validate our results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sengodan VC, Sinmayanantham E, Kumar JS. Anthropometric analysis of the hip joint in South Indian population using computed tomography. Indian J Orthop 2017;51:155-61.  Back to cited text no. 1
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2.
Siwach RC, Dahiya S. Anthropometric study of proximal femur geometry and its clinical application. Indian J Orthop 2003;37247-51.  Back to cited text no. 2
    
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Jasty M, Henshaw PM, O'Connor DO. Strain Alterations in the Proximal Femur with an Uncemented Femoral Prosthesis Emphasizing the Effect of Component Fix. Atlanta, GA: Proceeding Orthopaedic Research Society Meeting; 1988. p. 335.  Back to cited text no. 10
    
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Pathrot D, Ul Haq R, Aggarwal AN, Nagar M, Bhatt S. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects. Indian J Orthop 2016;50:269-76.  Back to cited text no. 11
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Calis HT, Eryavuz M, Calis M. Comparison of femoral geometry among cases with and without hip fractures. Yonsei Med J 2004;45:901-7.  Back to cited text no. 12
    
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Saikia KC, Bhuyan SK, Rongphar R. Anthropometric study of the hip joint in northeastern region population with computed tomography scan. Indian J Orthop 2008;42:260-6.   Back to cited text no. 13
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Rubin PJ, Leyvraz PF, Aubaniac JM, Argenson JN, Estève P, de RoguinB. The morphology of the proximal femur. A threedimensional radiographic analysis. J Bone Joint Surg Br 1992;74:28-32.  Back to cited text no. 14
    
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Mahaisavariya B, Sitthiseripratip K, Tongdee T, Bohez EL, Vander Sloten J, Oris P. Morphological study of the proximal femur: A new method of geometrical assessment using 3dimensional reverse engineering. Med Eng Phys 2002;24:617-22.  Back to cited text no. 15
    
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Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res 1988;235;148-65.  Back to cited text no. 16
    
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Husmann O, Rubin PJ, Leyvraz PF, de Roguin B, Argenson JN. Threedimensional morphology of the proximal femur. J Arthroplasty 1997;12:444-50.  Back to cited text no. 17
    
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Ravichandran D, Muthukumaravel N, Jaikumar R, Das H, Rajendran M. Proximal femoral geometry in Indians and its clinical applications. J Anat Soc India 2011;60:612.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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