Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 200-203  

Anthropometric study of angle of femoral torsion in Maharashtrian population


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 Publication1-Mar-2016

Correspondence Address:
Anil Kumar Dwivedi
Department of Anatomy, Veer Chandra Singh Garhwali Government Medical Science and Research Institute, Srinagar Garhwal, Uttarakhand
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.177664

Rights and Permissions
  Abstract 

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

How to cite this URL:
Dwivedi AK, Bhatnagar R. Anthropometric study of angle of femoral torsion in Maharashtrian population. Med J DY Patil Univ [serial online] 2016 [cited 2024 Mar 29];9:200-3. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2016/9/2/200/177664


  Introduction Top


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 Top


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

Click here to view



  Results Top


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].
Table 1: Statistical comparison of AFT (degrees) in male and female

Click here to view


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].
Table 2: Statistical comparison of AFT in adult dry femora by t-test

Click here to view


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]].
Table 3: Distribution of AFT

Click here to view



  Discussion Top


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 Top

1.
Zalawadia A, Ruparelia S, Shah S, Parekh D, Patel S, Rathod SP, et al. Study of femoral neck anteversion of adult dry femora in Gujarat region. NJIRM 2010;1:1-5.  Back to cited text no. 1
    
2.
Eckhoff DG, Kramer RC, Watkings JJ, Alongi CA, Greven DP. Variation infemoral anteversion. Clin Anat 1994;7:71-5.  Back to cited text no. 2
    
3.
Crelin ES. Development of the musculoskeletal system. Clin Symp 1981;33:1-36.  Back to cited text no. 3
    
4.
Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 1985;67:39-47.  Back to cited text no. 4
    
5.
Damany L. Les torsions osseuses leur role dans la transformation des members. J Anat Physiol 1903;39:246-450.  Back to cited text no. 5
    
6.
Siwach RC, Dahiya S. Anthropometric study of proximal femur geometry and its clinical application. Indian J Orthop 2003;37:247-51.  Back to cited text no. 6
  Medknow Journal  
7.
Ravichandran D, Sankar KD, Bhanu PS, Manjunath KY, Shankar R. Angle of femoral neck anteversion in Andhra Pradesh population of India using image tool software. JIMSA 2014;27:199-200.  Back to cited text no. 7
    
8.
Kingsley PC, Olmsted KL. A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg Am 1948;30A:745-51.  Back to cited text no. 8
    
9.
LeVeau BF, Bernhardt DB. Developmental biomechanics. Effect of forces on the growth, development, and maintenance of the human body. Phys Ther 1984;64:1874-82.  Back to cited text no. 9
    
10.
Swanson AB, Greene PW Jr, Allis HD. Rotational deformities of the lower extremity in children and their clinical significance. Clin Orthop Relat Res 1963;27:157-75.  Back to cited text no. 10
    
11.
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. 11
[PUBMED]  Medknow Journal  
12.
Parsons FG. The characters of the English thigh-bone. J Anat Physiol 1914;48(Pt 3):238-67.  Back to cited text no. 12
    
13.
Yoshioka Y, Siu D, Cooke TD. The anatomy and functional axes of the femur. J Bone Joint Surg Am 1987;69:873-80.  Back to cited text no. 13
    
14.
Jain AK, Maheshwari AV, Singh MP, Nath S, Bhargava SK. Femoral neck anteversion: A comprehensive Indian study. Indian J Orthop 2005;39:137-44.  Back to cited text no. 14
  Medknow Journal  
15.
Maheshwari AV, Jain AK, Singh MP, Bhargava SK. Estimation of femoralneck anteversion in adults - A comparosion between preoperative,clinical and biplane X-rays methods. Indian J Orthop 2004;38:151-7.  Back to cited text no. 15
  Medknow Journal  
16.
Varlekar P, Gosai BB, Nagar SK, Mehta CD. Study of angle of femoral torsion in Western region of India. NJIRM 2011;2:60-4.  Back to cited text no. 16
    
17.
Vidyadhara S, Rao SK. Uncemented primary press-fit total hip arthroplasty: A 3 to 6 years of experience. J Orthop Surg (Hong Kong) 2007;15:50-5.  Back to cited text no. 17
    
18.
Wagner R, Barcak EA. Simultaneous proximal femoral rotational and distal femoral varus osteotomies for femoral retroversion and genu valgum. Am J Orthop (Belle Mead NJ) 2012;41:175-8.  Back to cited text no. 18
    
19.
Dunlap K, Shands AR Jr, Hollister LC Jr, Gaul JS Jr, Streit HA. A new method for determination of torsion of the femur. J Bone Joint Surg Am 1953;35-A:289-311.  Back to cited text no. 19
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 Cross sectional analytical study – Analytical morphometric study of dry femur in South Gujarat
Utsavi Devang Desai, Alka Udania, Purvi Desai, Haripriyanka Kotha, Shino Shajan
Indian Journal of Clinical Anatomy and Physiology. 2023; 9(4): 252
[Pubmed] | [DOI]
2 CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures
Jakub Malér,Valér Džupa,Michal Buk,Martin Michna,Jirí Marvan,Jirí Skála-Rosenbaum
Archives of Orthopaedic and Trauma Surgery. 2021;
[Pubmed] | [DOI]
3 Spinal dysraphism at the Syrian Neolithic site of Dja’de el-Mughara
F. Estebaranz-Sánchez,L. M. Martínez,M. Alrousan,Bérénice Chamel,M. Molist,E. Coqueugniot,A. Pérez-Pérez
Archaeological and Anthropological Sciences. 2017;
[Pubmed] | [DOI]
4 A STUDY ON FEMORAL ANTEVERSION IN ADULT DRY FEMORA OF SOUTH INDIAN POPULATION
Sushma Korukonda,Jami Sagar Prusti,Purna Chandra Maharana
Journal of Evidence Based Medicine and Healthcare. 2017; 4(4): 178
[Pubmed] | [DOI]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed11743    
    Printed112    
    Emailed0    
    PDF Downloaded327    
    Comments [Add]    
    Cited by others 4    

Recommend this journal