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ORIGINAL ARTICLE |
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Year : 2016 | Volume
: 9
| Issue : 2 | Page : 200-203 |
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Anthropometric study of angle of femoral torsion in Maharashtrian population
Anil Kumar Dwivedi1, Rajan Bhatnagar2
1 Department of Anatomy, Veer Chandra Singh Garhwali Government Medical Science and Research Institute, Srinagar Garhwal, Uttarakhand, India 2 Department of Anatomy, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair - 744 104, Andaman, India
Date of Web Publication | 1-Mar-2016 |
Correspondence Address: Anil Kumar Dwivedi Department of Anatomy, Veer Chandra Singh Garhwali Government Medical Science and Research Institute, Srinagar Garhwal, Uttarakhand India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.177664
Introduction: Angle of femoral torsion is a normal torsion or twist present in femur that plays an important role in stability and function of the hip joint. The angle of femoral torsion can be defined as the angle formed by femoral condyle's plane (bicondylar plane) and a plane passing through center of neck and femoral head. Abnormal angle of femoral torsion has been implicated in the etiology of hip osteoarthrosis and developmental dysplasia of hip joint. Materials and Methods: This study was carried out on unpaired 280, adult human femora devoid of any gross pathology, 139 male (65 right and 74 left), and 141 female (71 right and 70 left) from bone banks of three medical colleges of Maharashtra. The gender of each specimen was determined by the established practice. Femora were evaluated by Kingsley Olmsted method, and data were tabulated and statistically analyzed. Results: The average angle of femoral torsion 13.39° and 11.23° on the right and left side respectively in male, 16.21° and 13.23° on the right and left side, respectively, in female. Statistical analysis using Student's "t"-test revealed significant difference (P < 0.05), greater angle of femoral torsion in female and on the right side. Conclusion: Knowledge of angle of femoral torsion is becoming significant nowadays with an increase in demand for total hip replacement, as the angle of femoral torsion is crucial to attain a normal activity of the replaced joint. Keywords: Angle of femoral torsion, bicondylar plane, femur, hip joint, total hip replacement
How to cite this article: Dwivedi AK, Bhatnagar R. Anthropometric study of angle of femoral torsion in Maharashtrian population. Med J DY Patil Univ 2016;9:200-3 |
Introduction | | |
The angle of femoral torsion (AFT) can be defined as angle formed by femoral condyle's plane (bicondylar plane) and a plane passing through the center of the neck and femoral head. If the axis of the neck inclines forward to transcondylar plane the AFT is called femoral neck anteversion (FNA), if it points posterior to transcondylar plane it is called retroversion, and if axis of neck is in the same line as of transcondylar plane it is known as neutral version. [1] A significant difference in normal AFT has been noted in different ethnic population, between male and female and also between right, and left sides. [2]
The FNA is first identifiable at 7 weeks of gestation when it has been reported to be −10°. [3] FNA gradually increases with the advancement of gestational age and become 0° at the 3 rd month, +12° at 4 th month, and +24.4° at birth. [4] It changes throughout by reverse torsion during childhood and adolescence until the adult average angle of +12° is reached. [5]
The average adult femoral anteversion has been reported to range between 7° and 16°, whereas Damany et al. [5] quoted it to range from -25° to +37°. It is a result of multiple factors, such as-evolution, heredity, fetal development, intrauterine position, and mechanical forces. [1] Abnormal AFT can be associated with osteoarthritis, dysplasia of hip and impingement and instability in total hip arthroplasty. [6],[7]
The objective of this study is to measure AFT in adult male and female femora of Maharashtrian population and to analyze statistically significant difference if any among population under study, and compare it with values reported in literature.
Materials and Methods | | |
Unpaired 280 dry adult femora, 141 of female (71 right and 70 left) and 139 of male (65 right and 74 left) devoid of any gross pathology, were used to measure AFT. Angle was measured by Kingsley Olmsted method [8] by placing specimen at the edge of a glass horizontal surface so that femoral condyles rest on the surface. The horizontal limb of a goniometer was fixed at the edge of the experimental table. The vertical limb was held parallel along the axis of head and neck of the femur. The horizontal surface represents retrocondylar axis against, which angle is measured with the help of axis of head and neck of the femur. The angle subtended was recorded [Figure 1]. All measurements repeated twice by two independent observers to identify any intra and inter-observer variability of these techniques. Data collected was tabulated according to gender and sides and statistically analyzed. | Figure 1: Kingsley Olmsted method of measurement of angle of femoral torsion
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Results | | |
Cross-sectional study on unpaired 280 adult dry femora was done. Average anteversion in males was found to be 11.23° and 13.39° on left and right sides, respectively and in female femora 13.23° and 16.21° on the left and right sides, respectively [Table 1].
Statistical analysis using Student's "t"-test revealed significant (P < 0.05) greater average anteversion in female bones and right left variation being greater on right side [Table 2].
In this study, none of the femora showed neutral version. Retroversion was observed in 2.2% (6 bones) samples [Table 3]. 0.4% of bones were in the range of 1-5°, 17.1% in range of 6-10° and 53.9% bones in range of 11-15° [Graph 1 [Additional file 1]].
Discussion | | |
The knowledge of the normal AFT is of extreme importance in the selection of prosthesis and preoperative planning for total hip replacement and in anthropological studies. [1] Determining AFT is important for diagnostic and therapeutic planning of patients with various pathologies such as hip displasias, thigh varum, congenital club foot, slipped upper femoral epiphysis, and other developmental abnormalities related to hip and knee joint. According to literature, AFT was found to be consistently higher in patients with Idiopathic Osteoarthrosis of the hip. [7]
AFT develops due to twists of the femur from torsional forces applied perpendicular to the epiphyseal growth plate. [9] According to Heuter Volkmann law of epiphyseal pressure, an increase in pressure across epiphysis decreases its growth and vice versa. [10] Wolff's law explains remodeling in adult bones. It states that every change in the function of bone is followed by a change in its internal and external architecture. Various muscles attached to femur create torsional forces by their contractile forces and passive elastic nature. Resection of medial or lateral rotator muscles of hip results in a change in the AFT. [9] Habitual sleeping and sitting postures, in which hip is held at the end of the medial or lateral rotation, may produce a change in the AFT. Maintaining an extreme hip posture produces change in soft tissues surrounding the hip, shortening the hip joint capsule and muscles on one side and lengthening on other side, these asymmetrical changes in soft tissues around the hip will create uneven torsional forces placed on femur. [9],[10] Staheli et al. [4] found increased AFT on the hemiplegic side, during his study on the hemiplegic hip of children. This has further supported the theory that changes in hip muscles force are related to an abnormal AFT.
The AFT has been measured by various researchers using plain radiography (biplanar X-ray method), computed tomography (CT), clinical methods, digital photographs with image tool software, and dry specimens. [7],[11] Although newer methods using CT scan have been shown to be ±1° accurate, there is no universal consensus for locating the femoral neck axis and the femoral condylar axis. Hence, estimation of the AFT on dry bones is still considered to be the most accurate method. [1]
The mean anteversion in male bones was 11.23° and 13.39° on the left and right side respectively (average -12.24°). In females, it was 13.23° and 16.21° on the left and right side respectively (average-14.73°). This significant bilateral limb asymmetry discourages the tendency of viewing lower limb as a mirror image of one another. Statistical analysis revealed sexual dimorphism in anteversion [Table 1], being greater in females as compared to males. A statistically significant difference was found for the angle of anteversion between male and female bones and right and left sided bones [Table 2]. Parsons et al. [12] has also documented greater anteversion in females. Kingsley and Olmsted [8] observed a very minor difference (0.081), and Yoshioka et al. [13] found a difference of 1°.
Jain et al. [14] and Maheshwari et al. [15] have done studies in Northern India, and found FNA to be 8.4° and 10.6° respectively, which is lower than this study (13.49°) in the population of Maharashtra, which lies in peninsular India. Siwach and Dahiya [6] recorded FNA to be 13.6° in the population of Haryana, which is almost similar to the value found in the present study.
Varlekar et al. [16] studied FNA in Western India (Gujarat), and found it to be 16.8°, Ravichandran et al. [7] found FNA of 18.9° in the population of Andhra Pradesh (Southern India). These values of FNA are greater than angle recorded in this study. Vidyadhara and Rao. [17] found FNA of 14° in Karnataka, South India, which is almost similar to that in the present study. Saikia et al. [11] have done work in Assam (North-East India) and found FNA of 20.4° which is much greater than results of the present study (13.49°). The Indian subcontinent comprises of a vast collection of people with different morphological, genetic, cultural, and linguistic characteristics. While much of this variability is indigenous, a considerable fraction of it has been introduced through large scale immigration into India during historical times.
In the present study, we observed femoral neck retroversion (FNR) in 2.2% of femora, in which head neck axis of femur inclined posterior to the retro condylar plane. In literature, there is only limited information regarding FNR. The value of FNR in the present study is near to the value of Ravichandran et al. [7] AFT is formed due to chronic external rotator contractions of hip musculature resulting from intrauterine positioning. [18]
Dunlap et al. [19] and Kingsley and Olmsted [8] reported FNA of 8.70° and 8.02° in Western population. Results obtained from the present study done on Indians differ from those obtained from Western population because Indians are more apt for floor level activities. Therefore, AFT of Indians evolutionarily became different from theirs. Thus, the same procedure produces a different outcome in our population. A femoral component of total hip replacement should be in an anteversion that closely represents the anteversion angle for Indian population to achieve the best surgical results.
The present study is an attempt to evaluate the normal anteversion in adult Maharashtrian population, to add to the preexisting data. The parameters and its values in our study show differences when compared to the other Western literature. It may be useful in the field of orthopedic surgery for various hip pathologies and in anthropology to determine the racial differences in AFT. The limitation of this study has been a small sample size hence a study with a larger sample size is warranted.
Acknowledgment
We thank head of Department of Anatomy, B J Medical College Pune and Government Medical College Aurangabad, for their assistance during data collection for this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
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[Figure 1]
[Table 1], [Table 2], [Table 3]
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