Varus Morphology And Its Surgical Implication In Osteoarthritic Knee And Total Knee Arthroplasty

Background Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial-femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty (TKA) to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a TKA. Methods We retrospectively evaluated 140 patients operated for TKA due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation (MAD), hip-knee-ankle (HKA), anatomical-mechanical Angle (AMA), medial neck-shaft angle (MNSA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle (LPFA), lateral distal tibial angle (LDTA), femoral bowing and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data. Results The greatest contributor to arthritic varus (R=0,444) was MPTA. Minor contributors were mLDFA (R= 0.076), JLCA (R = 0,1554), LDTA (R = 0.065), Femoral Bowing (R= 0,049). We recorded an average of 7,6 mm in lateral tibial cut thickness to restore neutral alignment. Conclusions The radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing TKA, the majority of the correction should therefore be made on tibial cut.

Comparing Two Different Automatic Methods to Measure Femoral Neck-Shaft Angle Based on PointNet++ Network

Bacnground: Accurate measurement of the femoral neck-shaft angle (NSA) is of great significance for diagnosing hip joint diseases and preoperative planning of total hip arthroplasty. However, the fitting lines of the femoral neck and femoral shaft did not always intersect in 3D space. Thus, it is unclear whether there is a difference between 2D and 3D methods for measuring NSA. Methods: The femoral point cloud datasets from 310 subjects were segmented into three regions, including the femoral head, femoral neck, and femoral shaft using PointNet++. We created a projection plane to simulate the hip anteroposterior radiograph and fitted the femoral neck axis and femoral shaft axis to complete the 2D measurement, while we directly fitted the two axes in space to complete the 3D measurement. Also, we conducted the manual measurement of the NSA. We verified the accuracy of the segmentation and compared the results of the two automatic and manual methods. Results: The Dice coefficient of femoral segmentation reached 0.9746, and MIoU of that was 0.9165. No significant difference was found between any two of the three methods. While comparing the 2D and 3D methods, the average accuracy was 98.00%, and the average error was 2.58°. Conclusion: This paper proposed two accurate and automatic methods to measure the NSA based on a 2D plane and a 3D model respectively. Although the femoral neck and femoral shaft axes did not intersect in 3D space, the NSAs obtained by 2D and 3D methods were basically consistent.

Assessment of Femoral Neck-shaft Angle on Plain X-rays and its Clinical Implications

Background: Femoral neck-shaft angle is an important parameter for evaluating the biomechanics of the hip joint. It plays a pivotal role in surgeries for developmental dysplasia of the hip, neuromuscular disorders of the lower limb, proximal femoral fractures, Total Hip Arthroplasty, Perthes disease etc., It is also considered to hold an extensive bearing while designing orthopaedic implants. Aim: This study aimed to evaluate the femoral neck-shaft angle of proximal femur on plain radiographs of our local population Study Design: Retrospective study Methods: This cross-sectional study was done at Saveetha medical college hospital, a tertiary care institute in Chennai. 50 pelvic X-rays of patients aged between 30 to 70 who presented to the outpatient or emergency care department were used in the study. Using a goniometer the femoral neck shaft angle was measured in the plain X - ray. Results: The mean age of the population in our study was 47.12. And the mean femoral neck shaft was 132.6 in males and 124.9 in females.

The role of AIHIP in Preoperative Planning of Total Hip Arthroplasty to Different Surgeons.

BackgroundPreoperative planning with computed tomography (CT)-based three-dimensional templating has been achieved more precise placement of hip components. This study investigated the value of the software for preoperative planning (artificial intelligence hip system, AIHIP) in primary total hip arthroplasty (THA) for surgeons with different experience levels.MethodsWe performed a retrospective study of 240 hips in 240 patients who underwent cementless primary THA. The patients were divided into four groups: A1) senior surgeon without AIHIP, A2) senior surgeon with AIHIP, B1) junior surgeon without AIHIP, and B2) junior surgeon with AIHIP. All preoperative planning evaluations were completed using the AIHIP software. We analysed the accuracy of stem size prediction and cup size prediction, the absolute value of postoperative discrepancy in leg length, discrepancy of neck-shaft angle and femoral offset between the healthy side and the affected side from the anteroposterior radiographic view of the hip, intraoperative and postoperative complications, operative times, the reduction in the haemoglobin (Hb) level during the first 24 hours and the number of intraoperative radiations.ResultsThe sizes of 95% were accurately estimated to be within one stem size, and 97% of the cup size estimates were accurate to within one cup size in group A2. A total of 87% were accurately estimated to be within one stem size, and 85% were accurate to within one cup size in group B2. There was a significant difference in radiological indicators (P<0.050), postoperative complications (overall P=0.035), operation duration (P<0.001), decrease in Hb per 24 hours (P=0.046) and intraoperative radiation frequency (P<0.050) among the patients in group B. There was also a significant difference in postoperative complications (overall P=0.01) between groups A1 and B1.ConclusionOur results suggest that the AIHIP is a favourable tool for young surgeons, and the accuracy is good.

Impact of Wedge Effect on Outcomes of Intertrochanteric Fractures Treated with Intramedullary Proximal Femoral Nail

The purpose of this study is to investigate the risk factors for wedge effect and its relevance between blade cut-out in patients with intertrochanteric fractures (ITF) treated with proximal femoral nail antirotation II (PFNA-II). A total of 113 patients with ITF treated with PFNA-II between 2012 and 2016 were retrospectively analyzed. Radiographic variables including preoperative fracture pattern, fracture classification, lateral wall fracture, and postoperative neck–shaft angle (NSA), femoral offset (FO), blade cut-out, and Parker’s ratio were measured for analysis. An average of 4.16° of varus malalignment in NSA and 5.5 mm of femoral shaft lateralization in FO was found post-operatively. The presence of lateral wall fracture was significantly related to post-operative varus change of NSA (p < 0.05). After at least one year of follow up, the blade cut-out rate was 2.65% (3/113), and Parker’s ratio was significantly higher in patients with blade cut-out (p = 0.0118). This study concluded that patients with ITF-present preoperative lateral wall fracture and postoperative higher Parker’s ratio in AP radiography showed higher incidence of wedge effect that might increase risk of blade cut out.

Significance and Clinical Effect of Anteromedial Support Plate Assisted Reduction and Fixation in The Treatment of Complex Proximal Humeral Fractures

Background There are more and more complex consolidated proximal fractures, and the postoperative effect is not very satisfactory. Therefore, we propose a surgical method and evaluate its effect. Method A total of 77 patients with complicated proximal humeral fractures who underwent surgical treatment in the Affiliated Hospital of Nantong University from June 2015 to January 2019 were collected. Among them, the internodal groove medial support plate assisted reduction and fixation technique and the lateral locking plate were used. A total of 15 cases of complicated proximal humeral fractures were used as the study group, and 62 patients with the same type of proximal humeral fractures treated with traditional reduction methods and internal fixation with lateral locking plates during the same period were used as the control group.The operation time of the two groups; intraoperative blood loss; number of effective intraoperative fluoroscopy; postoperative humeral neck shaft angle loss after reduction; postoperative shoulder joint Constant-Murley score; upper limb function DASH score and postoperative complications were retrospectively reviewed comparative analysis. Results The number of effective intraoperative fluoroscopy was (6.18±1.869) times in the control group, more than (3.93±1.387) times in the study group, and the difference between the two was statistically significant (P<0.05);The operation time of the study group was longer than that of the control group, and the intraoperative blood loss of the study group was more than that of the control group, but the difference between the two was not statistically significant (P>0.05).In the first 1, 3, 6, and 12 months after surgery, in terms of imaging measurement, the loss angle after reduction of the humeral neck shaft angle in the control group and the study group increased with the increase in postoperative time. There was no significant difference in the lost angle after reduction of the humeral neck shaft angle between the two groups at month and 3 months (P>0.05).At the 6th and 12th months after surgery, the lost angle after reduction of the humeral neck shaft angle in the study group was smaller than that in the control group, and the difference between the two groups was statistically significant (P<0.05).For the recovery of shoulder joint function after surgery, the Constant-Murley score of the shoulder joint and the DASH score of upper limb function of the control group and the study group increased with the increase of postoperative time, while the Constant score and DASH score of the two groups were 1 after surgery. There was no significant difference at months, 3 months, 6 months and 12 months (P>0.05). Conclusion The anteromedial support plate assisted reduction of the internodal groove can be used as a single locking plate for the treatment of complex proximal humeral fractures with medial column instability. It is an option when reduction is difficult or it is difficult to maintain stable reduction, which improves the quality of reduction and reduces surgery. Loss of posterior fracture reduction.

Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals

<p class="abstract"><strong>Background:</strong> Proximal humeral fracture is 3rd most common fracture in elderly population. Selection of appropriate implant is always challenging to get optimum results in these osteoporotic bones. Though locking plates are gold standard, major complications range from 9% to 36%. To study clinical and radiological outcome of J nail technique for Neer’s three or four part proximal humeral fractures in patients more than 60 years age.</p><p class="abstract"><strong>Methods:</strong> We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, &gt;60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip Lambrinudi wires. At final follow-up, clinical outcome was assessed using constant score and radiological evaluation was done according to the Bahr criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean constant score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up to 2 years.</p><p class="abstract"><strong>Conclusions:</strong> Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections.</p>

A comparative study of sex determination using femoral parameters

Introduction and Aim: Extensive examination of the femoral anthropometry has been commonly accepted to disclose sexual differentiation. The current study was carried out to evaluate various measurements of the pathologically fit femora of the unknown sex to differentiate the sex of the femora. Materials and Methods: Each femur was meticulously assessed and analyzed for six specific parameters such as maximal length, proximal breadth, and head circumference, mid-shaft circumference, vertical diameter, and neck-shaft angle of the femur bone. All the measurements were statistically analyzed and tabulated. Results:The results were highly significant to all the parameters thereby concluding that an individual’s sex can be determined by examining the femora. Conclusion:The results leave a huge scope for validation over a larger sample size focussing on an extensive human race.