Open Access Peer-reviewed

Structural Peculiarities of the Proximal Femur Meta-Epiphysis in the Idiopathic Coxarthrosis According to Localization

Ali A Samaha1, 2, Alexander V Ivanov3, Irena N Yashina3, Rana A Samaha4, Dimetry A Ivanov3, John J Haddad5,

1Department of Anatomy, Faculty of Public Health, Lebanese University, Zahle, Lebanon

2Departments of Internal Medicine and Surgery, Makassed General Hospital, Beirut, Lebanon

3Department of Anatomy, Kursk State Medical University, Russia

4Clinical Laboratory, Faculty of Public Health, Lebanese University, Zahle, Lebanon

5Cellular and Molecular Physiology and Immunology Signaling Research Group, Biomedical Laboratory and Clinical Sciences Division, Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon

American Journal of Medical and Biological Research. 2013, 1(3), 86-90. DOI: 10.12691/ajmbr-1-3-5
Published online: August 25, 2017

Abstract

Background: The hip essentially represents the major weight-bearing joint of the human organism. It is conspicuously characterized by its mobility and complex origination, specific organization and development. The anatomic structures referred to as acetabulum and femoral head arise from the same primitive mesenchymal cells and, by the end of the 11th week of gestation, the hip joint becomes fully formed and continues to develop throughout intrauterine life. During embryonic life, the femoral head grows at a faster rate than the acetabulum, and at the end of gestation the femoral head is approximately less than 50% covered, and after birth, the growth rate of the acetabular cartilage surpasses that of femoral head thus resulting in progressively increased coverage. Methods: Cartilaginous at birth, the ossification of acetabulum is set at around a three-month age period, while ossification centers of the proximal femur start to appear at 4 to 7-months. Several developmental abnormalities regarding the relationship between femoral head and acetabulum are therein described; all of those anatomic aberrations may technically result in hip instability, manifested by dislocation, subluxation, dysplasia and arthrosis. Results: From a biomechanical standpoint, three pathological conditions are shown to have arisen mainly at the region of the femoral neck: i) congenital coxa vara, ii) pseudoarthrosis of the neck of the femur and iii) coxarthrosis. All of the aforementioned conditions are caused and maintained by different types of mechanical stress and, in advanced stages, they may necessitate surgical interventions to alter the angle of the femoral neck in order to relieve the pressure at the level of the affected joint mainly during movement. Furthermore, we indicate that there is no standard to adopt regarding the surgical change of the femoral neck angle, though biomechanical assessment has to be worked out and established in each of the affected individual. Conclusion: Plain film radiography plays an important role in the assessment of a dysplastic hip, especially in adults, where operative management is essentially based on various radiographic measurements. Several average values of stresses and strains of the proximal femur were identified on the basis of Wolff’s trajectorial hypothesis, where they revealed a trabecular architectural changes and structural remodeling in response to mechanical stress. It is concluded that these pathological conditions (congenital coxa vara, pseudoarthrosis of the neck of the femur and coxarthrosis) that were shown to have arisen mainly at the region of the femoral neck may contribute to understanding pathophysiologic and patho-anatomic peculiarities of the femoral bone.

Keywords:

coxarthrosis, proximal femur meta-epiphysis, pseudoarthrosis, system asymmetry
[1]  Cummings RG, Cauley JA, Palermo L, Ross PD, Wasnich RD, Black D, Faulkner KG: Racial differences in hip axis length might explain racial differences in rates of hip fracture. Study of osteoporotic oractures oesearch group. Osteoporosis Int 1994, 4:226-229.View Article  PubMed
 
[2]  Novacheck TF: Developmental dysplasia of the hip. Pediatr Clin North Am 1996, 43:829.View Article
 
[3]  Livshits G, Yakovenko K, Kletselman L, Karasik D, Kobyliansky E: Fluctuating asymmetry and morphometric variation of hand bones. Am J Phys Anthropol 1998, 107:125-136.View Article
 
[4]  Auerbach BM, Ruff CB: Limb bone bilateral asymmetry: Variability and commonality among modern humans. J Hum Evol 2006, 50:203-218.View Article  PubMed
 
[5]  Mayhew PM, Thomas CD, Clement JG, Loveridge N, Beck TJ, Bonfield W, Burgoyne CJ, Reeve J: Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 2005, 366:129-135.View Article
 
[6]  Wagner A, Sachse A, Keller M, Aurich M, Wetzel WD, Hortschansky P, Schmuck K, Lohmann M, Reime B, Metge J, Arfelli F, Menk R, Rigon L, Muehleman C, Bravin A, Coan P, Mollenhauer J: Qualitative evaluation of titanium implant integration into bone by diffraction enhanced imaging. Phys Med Biol 2006, 51:1313-1324.View Article  PubMed
 
[7]  Meltiz M, Guenther K-P, Gunkel S, Puhl W: Reliability of radiological measurements in the assessment of hip dysplasia in adults. Br J Radiol 1999, 72:331-334.
 
[8]  Spruijt S, van der Linden JC, Dijkstra PD, Wiggers T, Oudkerk M, Snijders CJ, van Keulen F, Verhaar JA, Weinans H, Swierstra BA: Prediction of torsional failure in 22 cadaver femora with and without simulated subtrochanteric metastatic defects: A CT scan-based finite element analysis. Acta Orthop 2006, 77:474-481.View Article  PubMed
 
[9]  Theodorou SJ, Theodorou DJ, Resnick D: Imaging findings in symptomatic patients with femoral diaphyseal stress injuries. Acta Radiol 2006, 47:377-384.View Article  PubMed
 
[10]  Neame R, Zhang W, Deighton C, Doherty M, Doherty S, Lanyon P, Wright G: Distribution of radiographic osteoarthritis between the right and left hands, hips, and knees. Arthritis Rheum 2004, 50:1487-1494.View Article  PubMed
 
[11]  Reis P, Nahal-Said R, Ravaud P, Dougados M, Amor B: Are radiological joint space widths of normal hips asymmetrical? Ann Rheum Dis 1999, 58:246-249.View Article  PubMed
 
[12]  Harcke HT, Lee MS, Sinning L, Clarke NM, Borns PF, MacEwen GD: Ossification center of the infant hip: sonographic and radiographic correlation. AJR Am J Roentgenol 1986, 147:317- 321.View Article  PubMed
 
[13]  Samaha AA, Ivanov AV, Haddad JJ, Kolesnik AI, Baydoun S, Yashina IN, Samaha RA, Ivanov DA: Biomechanical and system analysis of the human femoral bone: Correlation and anatomical approach. J Orthop Surg Res 2007, 2:8.View Article  PubMed
 
[14]  Farmer ME, White LR, Brody JA, Bailey KR: Race and differences in hip fracture incidences. Am J Public Health 1984, 74:1374-1380.View Article  PubMed
 
[15]  Bass SL, Saxon L, Daly RM, Turner CH, Robling AG, Semaan E, Stuckey S: The effect of mechanical loading on the size and shape of bone in pre-, peri-, and postpubertal girls: A study tennis players. J Bone Miner Res 2002, 17:2274-2280.View Article  PubMed
 
[16]  Gonzalez MH, Barmada R, Fabiano D, Meltzer W: Femoral shaft fracture after hip arthroplasty: A system for classification and treatment. J South Orthop Assoc 1999, 8:240- 248. PubMed
 
[17]  Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR: Dislocation after total hip replacement arthroplasty. J Bone Joint Surg 1978, 60:217-220. PubMed
 
[18]  Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS: The anatomic basis of femoral component design. Clin Orthop Relat Res 1988, 235:148-165. PubMed
 
[19]  L’ubusky M, Mickova I, Prochazka M, Dzvincuk P, Mala K, Cizek L, Janout V: Discrepancy of ultrasound biometric parameters of the head (HC - head circumference, BPD - biparietal diameter) and femur length in relation to sex of the fetus and duration of pregnancy. Ceska Gynekol 2006, 71:169-172. PubMed
 
[20]  Collins EH: The concept of relative limb dominance. Hum Biol 1961, 33:293-317. PubMed
 
[21]  Samaha AA, Ivanov AV, Haddad JJ, Kolesnik AI, Baydoun S, Arabi MR, Yashina IN, Samaha RA, Ivanov DA: Asymmetry and structural analysis of the proximal femur meta-epiphysis: Osteoarticular anatomical pathology. J Orthop Surg Res 2008, 3:11.View Article  PubMed
 
[22]  Upadhyay SS, Burwell RG, Moulton A, Small PG, Wallace WA: Femoral anteversion in healthy children, application of a new method using ultrasound. J Anat 1990, 169:49-61. PubMed
 
[23]  Turner RS: Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic, factors and management. Clin Orthop 1994, 301:196-204. PubMed
 
[24]  Wisniewski SJ, Grogg B: Femoroacetabular impingement: An overlooked cause of hip pain. Am J Phys Med Rehabil 2006, 85:546-549.View Article  PubMed
 
[25]  Estok DM, Harris WH: Long-term results of cemented femoral revision surgery using second- generation technique. An average 11, 7-year follow-up evaluation. Clin Orthop 1994, 299:190- 202. PubMed
 
[26]  McCollum DE, Gray WJ: Dislocation after total hip arthroplasty. Clin Orthop 1990, 261:159- 170. PubMed
 
[27]  Morrey BF: Instability after total hip arthroplasty. Orthop Clin N America 1992, 2:237-248.
 
[28]  Noble PC: Proximal femoral geometry and the design of cementless hip replacements. Orthop Rel Sci 1990, 1:86-92.
 
[29]  Takada J,Beck TJ, Iba K, Yamashita T: Structural trends in the aging proximal femur in Japanese postmenopausal women. Bone 2007, 41:97-102.View Article  PubMed
 
[30]  Chiu FY: The native femoral sulcus as the guide for the medial/lateral position of the femoral component in knee arthroplasty: Normal patellar tracking in 690/700 knees--a prospective evaluation. Acta Orthop 2006, 77:501-504.View Article  PubMed
 
[31]  Bell KL, Loveridge N, Reeve J, Thomas CD, Feik SA, Clement JG: Super-osteons (remodeling clusters) in the cortex of the femoral shaft: Influence of age and gender. Anat Rec 2001, 264:378-386.View Article  PubMed
 
[32]  Hernandez-Vaquero D, Suarez-Vazquez A: Knee arthrodesis with navigation: A new indication for computer-assisted surgery? A case report. Knee 2007, 14:162-163.View Article  PubMed
 
[33]  Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S: Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 2007, 457:156-162. PubMed
 
[34]  Weidow J, Karrholm J, Saari T, McPherson A: Abnormal motion of the medial femoral condyle in lateral knee osteoarthritis. Clin Orthop Relat Res 2007, 454:27-34.View Article  PubMed
 
[35]  Manner HM, Radler C, Ganger R, Grill F: Knee deformity in congenital longitudinal deficiencies of the lower extremity. Clin Orthop Relat Res 2006, 448:185-192.View Article  PubMed
 
[36]  Li G, Zayontz S, DeFrate LE, Most E, Suggs JF, Rubash HE: Kinematics of the knee at high flexion angles: An in vitro investigation. J Orthop Res 2004, 22:90-95.View Article
 
[37]  O’Neill TW, Grazio S, Spector TD, Silman AJ: Geometric measurements of the proximal femur in UK women: Secular increase between the late 1950s and early 1990s. Osteoporos Int 1996, 6:136-140.View Article  PubMed
 
[38]  Cooperman DR, Wallensten R. Stulberg SD: Acetabular dysplasia in the adult. Clin orthop 1983, 175:79-85. PubMed
 
[39]  Harcke HT: Developmental dyslasia of the hip: A spectrum of abnormality. Pediatrics 1999, 103:152.View Article  PubMed
 
[40]  Weinberg H, Frankel M, Makin M: Familial epiphyseal dysplasia of lower limbs. J Bone Joint Surg 1960, 42:313-332.
 
[41]  Doberti A, Manhood J: A new radiological sign for early diagnosis of congenital hip dysplasia. Ann Radiol 1968, 2:276-281.
 
[42]  Farmer ME, White LR, Brody JA, Bailey KR: Race and differences in hip fracture incidences. Am J Public Health 1984, 74:1374-1380.View Article  PubMed
 
[43]  Livshits G, Yakovenko K, Kletselman L, Karasik D, Kobyliansky E: Fluctuating asymmetry and morphometric variation of hand bones. Am J Phys Anthropol 1998, 107:125-136.View Article
 
[44]  Blumenfeld TJ, Glaser DA, Bargar WL, Langston GD, Mahfouz MR, Komistek RD: In vivo assessment of total hip femoral head separation from the acetabular cup during 4 common daily activities. Orthopedics 2011, 34:1.
 
[45]  Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW: Femoral antetorsion: Comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 2012, 263:475-483.View Article  PubMed
 
[46]  Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW: How useful is the alpha angle for discriminating between symptomatic patients with cam-type femoroacetabular impingement and asymptomatic volunteers? Radiology 2012, 264:514-521.View Article  PubMed
 
[47]  Maier C, Zingg P, Seifert B, Sutter R, Dora C: Femoral torsion: Reliability and validity of the trochanteric prominence angle test. Hip Int 2012, 22:534-538.View Article  PubMed
 
[48]  Sutter R, Zanetti M, Pfirrmann CW: New developments in hip imaging. Radiology 2012, 264:651-667.View Article  PubMed