Summary. Anatomical variations in hip joint anatomy are associated with both the presence and location of tibiofemoral osteoarthritis (OA). Introduction. Variations in hip joint anatomy can alter the moment-generating capacity of the hip abductor muscles, possibly leading to changes in the magnitude and direction of ground reaction force and altered loading at the knee. Through analysis of full-limb anteroposterior radiographs, this study explored the hypothesis that knees with lateral and medial knee OA demonstrate hip geometry that differs from that of control knees without OA. Patients and Methods. This cross-sectional study is an ancillary to the Multicenter Osteoarthritis Study (MOST), an observational cohort study of incident and progressive knee OA in community-dwelling men and women, ages 50–79 years. We report on 160 knees with lateral OA (LOA), 168 knees with medial OA (MOA), and 336 controls. All participants with LOA at the baseline MOST visit were included. An equal number of knees with MOA, and twice the number of control knees were then randomly selected. In participants with bilateral eligibility, a single knee was randomly selected so that all participants contributed only one case or one control knee to the analysis. Case knees were identified as having Kellgren/Lawrence (K/L) ≥ 2 with joint space narrowing (JSN) ≥ 1 in the specified compartment with no JSN in the adjoining compartment. Controls had no radiographic OA (K/L=0 or 1 and JSN=0) in either compartment. Hip joint anatomy parameters were assessed from full-limb standing radiographs using custom OsiriX software by an author (AB) blinded to knee OA status, and unreadable radiographs (N = 8) were discarded prior to unblinding. We measured parameters that influence the abductor moment arm of the hip, including: abductor lever arm, femoral offset, femoral neck length, femoral neck-shaft angle, height of hip centre, body weight lever arm, acetabular version, and abductor angle. All hip measurements were taken from the ipsilateral side of the knee in interest. Each variable was then compared independently among the three groups via analysis of covariance (ANCOVA), controlling for age, sex, and body mass index (BMI), and followed up with a post-hoc Bonferroni analysis to distinguish pairwise group differences. Results. The ANCOVA analysis showed a significant difference in height of hip centre (p=0.001), femoral neck-shaft angle (p=0.009), and abductor angle (p=0.001). Compared to controls, knees with LOA had an increased height of hip centre (p=0.001) and knees with MOA had a decreased abductor angle (p=0.046). Compared to knees with MOA, those with LOA had a more valgus neck-shaft angle (p=0.007) and increased abductor angle (p=0.001). Conclusion. Our study demonstrates that variations in hip geometry that affect the moment-generating capacity of the hip abductors are associated with the presence and compartmental distribution of tibiofemoral OA in the ipsilateral knee. Anatomical arrangements that reduce the hip abductor moment arm are more strongly associated with LOA than with MOA

In order to evaluate the relationship between acetabular and proximal femoral alignment in the initiation and evolution of osteoarthritis of the dysplastic hip, the acetabular and femoral angles were calculated geometrically from radiographs of 62 patients with pre-arthrosis and early osteoarthritis. The sum of the lateral opening angle of the acetabulum and the neck-shaft angle was defined as the lateral instability index (LII), and the sum of the anterior opening angle of the acetabulum and the anteversion angle of the femoral neck as the anterior instability index (AII). These two indices were compared in dysplastic and unaffected hips. A total of 22 unilateral hips with pre-arthrosis were followed for at least 15 years to determine whether the two indices were associated with the progression of osteoarthritis. The LII of the affected hips (197.4 (. sd. 6.0)) was significantly greater than that of the unaffected hips (1830 (. sd. 6.9)). A follow-up study of 22 hips with pre-arthrosis showed that only the LII was associated with progression of the disease, and an LII of 196 was the threshold value for this progression

The morphology of the proximal part of the humerus varies largely. Morphometric features characterizing the three-dimensional geometry of the proximal humerus have revealed a wide difference within individuals. These parameters include head size, radius of curvature, inclination angle, retroversion angle, offsets and neck-shaft angle. Different implant designs have been adapted so as to make provision for these anatomical variations. However, the optimal design criteria are yet to be established. Implant design is one of the main factors determining the success of Total Shoulder Arthroplasty (TSA) since slight modifications in the implant anatomy could have significant biomechanical effects. Therefore, this study investigates the three-dimensional morphometric parameters of the South African proximal humerus which will serve as a basis for designing a new Total Shoulder Prosthesis for the South African population. Sixteen South African (SA) fresh cadaveric humeri (8 left, 8 right; 8 paired) were used in this study. The data consisted of 6 men and 2 women with ages ranging from 32 to 55 years (43.13 ±8.51). The humeri were scanned using a Computer Tomography (CT) scanner. The Digital Imaging and Communications in Medicine (DICOM) files from the CT data were imported into medical modelling software, MIMICS for reconstruction. The 3D reconstructed model of the humeri as an STL file was used for further processing. The STL data were generated as a cloud of points in a CAD software, SolidWorks. These were then remodeled by defining the detailed Referential Geometric Entities (RGEs) describing the anatomical characteristics. Anatomical reference points were defined for the anatomical neck plane, the epiphyseal sphere and the metaphyseal cylinder. Also, axes were defined which comprises of the humeral head axis and the metaphyseal axis. Thereafter, the posterior offsets medial offsets and the inclination angles were measured based on the RGEs. The posterior offset varied from 0.07 mm to 2.87 mm (mean 1.20 mm), the medial offset varied from 4.40 mm to 8.45 mm (mean 6.50 mm) while the inclination angle varied from 114.00º to 133.87º (mean 121.05º). The outcome of the study showed that the shape and dimensions of the proximal humerus varies distinctively. The articular surface is not a perfect sphere and differs independently with respect to the inclination angles. In addition, variations were noticeable in the medial and lateral offsets. The morphometric data on the African shoulder is very limited and this study will significantly contribute to the shoulder data repository for the SA population. The morphometric parameters measured in this study will be useful in designing a South African shoulder prosthesis that mimics the native shoulder hence eliminating post-surgical complications

There is continued concern over complication rates (20–30% of cases) in locked proximal humeral plating. The most common sequelae of this is screw penetration of the humeral head. This is associated with natural settling of the fracture, malreducition in varus, insufficent medial support of the fracture. The proximity of the screws to the articular surface can also be influential on outcome if collapse occurs. Our operative technique is to establish the rotation of the humeral head where the drill appears closest to the articular margin (by sequential xray screening) and subtract from this to avoid intra-articular penetration of the humeral head. 55 Consecutive patients of average age 56.4 years (14.7–86.1), 17 male and 38 females, who underwent PHILOS plating were identified using Bluespier database. Xrays were analysed for fracture pattern, restoration of neck-shaft angle, plate positioning, number and configuration of screws and presence of screw penetration both intra-operatively and at postoperative follow-up. There were 6.07 screws used per head (total 330). There was one intraoperative screw penetration and 3 patients had evidence of screw penetration at follow-up, which required implant removal (total screw penetration rate of 7%). There was one case of AVN. The mean neck shaft angle was 137 degrees (anatomical 135 degrees). Accurate reduction of fractures and placement of screws in the humeral head using image intensifier can act to minimise risk of screw penetration and make some of the complications of locked proximal humeral plating avoidable

The aim of our study was to investigate whether placing of the femoral component of a hip resurfacing in valgus protected against spontaneous fracture of the femoral neck. We performed a hip resurfacing in 20 pairs of embalmed femora. The femoral component was implanted at the natural neck-shaft angle in the left femur and with a 10° valgus angle on the right. The bone mineral density of each femur was measured and CT was performed. Each femur was evaluated in a materials testing machine using increasing cyclical loads. In specimens with good bone quality, the 10° valgus placement of the femoral component had a protective effect against fractures of the femoral neck. An adverse effect was detected in osteoporotic specimens. When resurfacing the hip a valgus position of the femoral component should be achieved in order to prevent fracture of the femoral neck. Patient selection remains absolutely imperative. In borderline cases, measurement of bone mineral density may be indicated

A total of 20 pairs of fresh-frozen cadaver femurs were assigned to four alignment groups consisting of relative varus (10° and 20°) and relative valgus (10° and 20°), 75 composite femurs of two neck geometries were also used. In both the cadaver and the composite femurs, placing the component in 20° of valgus resulted in a significant increase in load to failure. Placing the component in 10° of valgus had no appreciable effect on increasing the load to failure except in the composite femurs with varus native femoral necks. Specimens in 10° of varus were significantly weaker than the neutrally-aligned specimens.

The results suggest that retention of the intact proximal femoral strength occurs at an implant angulation of ≥ 142°. However, the benefit of extreme valgus alignment may be outweighed in clinical practice by the risk of superior femoral neck notching, which was avoided in this study.

A cadaver study using six pairs of lower limbs was conducted to investigate the accuracy of computer navigation and standard instrumentation for the placement of the Birmingham Hip Resurfacing femoral component. The aim was to place all the femoral components with a stem-shaft angle of 135°.

The mean stem-shaft angle obtained in the standard instrumentation group was 127.7° (120° to 132°), compared with 133.3° (131° to 139°) in the computer navigation group (p = 0.03). The scatter obtained with computer-assisted navigation was approximately half that found using the conventional jig.

Computer navigation was more accurate and more consistent in its placement of the femoral component than standard instrumentation. We suggest that image-free computer-assisted navigation may have an application in aligning the femoral component during hip resurfacing.