The Proximal Femoral Bone Geometry in Plain Radiographs

Document Type : RESEARCH PAPER


1 University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany- Cologne Center for Musculoskeletal Biomechanics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany

2 University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany

3 Vulpius Klinik, Department for hand surgery, Vulpiusstraße 29, 74906 Bad Rappenau, Germany

4 Vulpius Klinik, Department for hand surgery, Vulpiusstraße 29, 74906 Bad Rappenau, Germany - Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany


Background: Osteoporosis represents the most common bone disease and has to be respected in planning total hip
replacement, especially against the background of increasing uncemented total hip replacement. In this context, the
radiographic geometry of the proximal femur got into focus and is controversially discussed.
The aim of the presented study was to find any difference regarding known indices for proximal femur bone geometry
between patients with high-grade osteoarthritis and patients suffering from a femoral neck fracture caused by low
impact trauma.
Methods: Retrospective matched-paired analysis of 100 plane pelvic radiographs from 50 patients who suffered from
high-grade hip osteoarthritis and 50 patients who suffered from femoral neck fracture was performed. Measurement of
Canal-Bone Ratio (CBR), Canal-Calcar Ratio (CCR), Mineral Cortical Index (MCI) and Canal Flare Index (CFI) were
Results: CBR was significantly higher in the fracture-group (0.45 +/- 0.06 vs. 0.41 +/- 0.08) (P-value= 0.008). Moreover,
the femoral thickness 10 cm below the trochanter minor [F] was significantly higher in the osteoarthritis-group (34.68
+/- 4.14 vs 32.11 +/- 3.43) (P-value 0.001).
Conclusion: In conclusion, patients with a femoral neck fracture demonstrated a higher CBR, which indicates a poorer
bone quality. In case of planning a THA, the CBR is an index which can easily be measured and can be seen as one
decision criterion in THA regarding fixation technique.
Level of evidence: III


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Volume 8, Issue 6
November and December 2020
Pages 675-681
  • Receive Date: 10 December 2019
  • Revise Date: 18 February 2020
  • Accept Date: 02 May 2020