USING COMPUTER ASSISTANCE TO DETERMINE IF LINEA ASPERA CAN BE USED AS FRAME OF REFERNCE FOR HIP AND KNEE ARTHROPLASTIES

Abstract

Various frames of reference are routinely used for hip and knee arthroplasty. We hypothesised that the linea aspera is a constant anatomical feature which can be used as a frame of reference.

Twenty cadaveric femora were CT scanned with high resolution 1mm slices. Robin 3D software was used to manipulate the CT data. Three points were identified on the posterior aspect of the lesser trochanter, medial and lateral femoral condyles to position the femora in similar positions based on the posterior femoral plane (PFP). Centres of the femoral head and neck were derived by surface markers placed on the head and around the neck respectively. Joining the 2 centres gave head neck axis (HNA). The most prominent point on the linea aspera was identified at a level midway along the length of the femur. At that level the centre of the canal was derived by placing surface markers. Joining the most prominent point on the linea aspera to the centre of the canal identified our plane, linea aspera – centre plane (LCP). Angle measurements were made between PFP to HNA, PFP to LCP and LCP to HNA.

PFP to HNA is the traditional method for measuring anteversion angle which in our series had a mean of 13°, SD of 5 (range 5–24). PFP to LCP gave very similar results with mean 101°, SD 6 (range 92–112). However it was noted that there is weak correlation between PFP to HNA angle and PFP to LCP angle for each femur. LCP to HNA measurements were more variable with mean 89°, SD 8 (range 76–108).

From these data we conclude that the proximal half of the femur has more variable torsion compared to the distal half. This study shows that the linea aspera should not be used as a frame of reference for hip nor knee arthroplasties. However, further studies are needed to evaluate the linea aspera in-vivo where it is expected to be more prominent and easier to identify.