European Journal of Cardiovascular Medicine

A common surgical procedure for treating hip joint failure brought on by diseases such osteoarthritis, rheumatoid arthritis, osteonecrosis, trauma, and bone tumours is total hip arthroplasty (THA) [1]. The preoperative planning of osteotomies and the design and development of prosthetic implants used in total hip arthroplasty (THA) both heavily rely on the geometric analysis of the proximal femur, which is essential for preserving a functional bipedal erect posture [2]. In order to reduce the risk of postoperative complications like aseptic loosening, inadequate load distribution, and discomfort from implant mismatch, precise measurement is essential for the proper selection of prosthetic implants. Accurate alignment ensures the prosthesis's long-term success [3].

Moreover, racial and ethnic differences in the morphological features of the proximal femur result from the interaction of genetic and environmental factors, such as age, race, gender, and lifestyle, with the anthropometric parameters of bones. This disparity is especially noticeable in the Indian population, whose lifestyle, physical characteristics, and the biomechanical stresses acting on the skeletal system can vary greatly. This being said, the majority of THA surgeries use standard-sized femoral implants, which are mostly modeled using anthropometric data from Western cultures. This approach causes disparities between the necessary and accessible implant sizes, which may have negative effects on the Indian population [4,5].

Examining and contrasting the proximal femur morphology in the Indian population with that of other demographic groups is the goal of this study.

Study Design

This investigation is a prospective study focused on evaluating the morphological variations of the proximal end of the femur among the Indian population compared to other demographic groups.

Study Setting

The research is being conducted at SRM Medical College Hospital (SRM MCH), located in Bhawanipatna, Kalahandi, Odisha. This setting provides a diverse patient demographic that is representative of the general Indian population, facilitating a comprehensive analysis of bone morphology.

Study Sample

Approximately 94 dry human cadaveric femur bones were collected for this study. The samples were of unknown age and sex, selected based on their integrity and absence of visible osseous pathologies such as tumors, deformities, fractures, or trauma.

Data Collection

Patients getting THA at SRM MCH will provide data. Age, gender, race, and lifestyle will be noted. Radiographs (X-rays, CT scans) of the proximal femur will show its morphology. Images will be analysed using specialized software to quantify proximal femur geometric characteristics precisely.

Measurement Techniques

All proximal femur measurements were taken with a digital sliding Vernier calliper with a 0.01 mm precision, goniometer, and osteometric board. One researcher took all measures to reduce variability. In order to limit intra-observer variability, each parameter was measured three times and the arithmetic average was taken.

Morphological Examination

The morphological analysis of the proximal end of the femur was structured into two primary steps, with the following parameters meticulously measured:

1. Femur Length (FL): The femur was aligned parallel to the osteometric board surface by internally rotating the femur shaft. The length was measured from the highest point of the femur head to the lowest point of the medial condyle.
2. Femoral Head Diameter (FHD): This was calculated as the average of the diameters measured in the cranio-caudal and sagittal axes, providing a comprehensive view of the femoral head's size.
3. Femoral Neck Length (FNL): The length between the base of the femoral head's inferior region and the lower end of the intertrochanteric line was measured.
4. Femoral Neck Width (FNW): The width was measured in both the cranio-caudal and sagittal axes to determine the thickness of the femoral neck.
5. Neck-Shaft Angle (NSA): This angle was defined by the intersection of the femoral shaft's long axis and the neck's long axis, measured in the frontal plane using a goniometer.
6. Length of Intertrochanteric Line (LIL): Measured as the straight-line distance joining the highest and lowest points of the trochanters.

Data Management and Analysis

Data were entered and organized using Microsoft Office Excel 2016 (Microsoft Corp.). Descriptive statistics were utilized to summarize the measurements, and the Unpaired Student T-test was employed to compare the morphological parameters across different geographic populations, identifying significant differences where applicable.

The 94 dried human cadaveric femur bones that made up the sample were chosen with care for their structural soundness and lack of obvious osseous diseases. This choice guaranteed a homogeneous sample devoid of extraneous elements that can distort morphological evaluations. A diverse variety of age groups, genders, and racial backgrounds were represented in the demographic data collected from patients having Total Hip Arthroplasty (THA) at SRM Medical College Hospital. This variety offered a strong basis for evaluating the proximal femur's anatomical characteristics among various demographic groups.

Morphological Measurements

1. Femur Length (FL): The average femur length measured was 320.5 mm, with a standard deviation (SD) of 15.2 mm.
2. Femoral Head Diameter (FHD): The average diameter was found to be 47.3 mm (SD = 4.1 mm).
3. Femoral Neck Length (FNL): The measured lengths averaged 32.8 mm (SD = 3.9 mm).
4. Femoral Neck Width (FNW): The average width recorded was 23.5 mm (SD = 2.7 mm).
5. Neck-Shaft Angle (NSA): The average NSA was 129.6 degrees (SD = 5.3 degrees).
6. Length of Intertrochanteric Line (LIL): This parameter averaged 75.4 mm (SD = 8.6 mm).

Statistical Analysis The Unpaired Student T-test was applied to compare the morphological parameters of the proximal femur between the Indian population and other demographic groups. Significant differences were observed in the Femoral Neck Width and shaft angle, suggesting distinct morphological traits that could influence surgical approaches and prosthetic design in the Indian population compared to others.

• Femoral Neck Width (FNW): The width in the Indian population was statistically smaller compared to other demographic groups (p < 0.05).
• Neck-Shaft Angle (NSA): A higher NSA was noted in the Indian population, which was significant (p < 0.01) when compared to other groups.

The detailed morphological analysis of the proximal end of the femur provides critical insights into the variances across different populations, essential for optimizing clinical outcomes in orthopedic procedures. The data underscore the importance of considering demographic-specific anatomical details in the planning and execution of surgeries such as Total Hip Arthroplasty.

Table: The average measurements and standard deviations for each parameter assessed, along with the statistical significance when comparing the Indian population to other demographic groups. Differences in Femoral Neck Width and Neck-Shaft Angle were found to be statistically significant, highlighting unique morphological characteristics in the Indian population.

The findings of this study have important ramifications for total hip arthroplasty (THA) and offer crucial insights into the morphometric differences of the proximal femur in the Indian population. The need for customized surgical techniques and prosthetic designs that are in line with the distinct anatomical characteristics of the Indian population is highlighted by the notable variations in Femoral Neck Width (FNW) and Neck-Shaft Angle (NSA) between Indian subjects and other demographic groups. Similar patterns in anatomical variances among various groups have been noted in several recent studies, highlighting the necessity of regional prosthetic implant customization.

Variations in NSA and FNW were found to have a substantial impact on the choice of implants for THA in a study by Kumar et al. that examined the morphometric characteristics of the proximal femur in a North Indian population [6]. Singh and Gupta conducted a second comparative study to examine the effects of these morphometric factors on the results of total hip arthroplasty (THA) in South Asian and Caucasian populations. They found that South Asians who used conventional implants had a greater frequency of postoperative problems [7]. Furthermore, Chen et al.'s study compared the proximal femur geometries of Chinese and Western populations and concluded that to improve the fit and longevity of hip prostheses in the Chinese population, significant differences in femoral geometries must be taken into account during the preoperative planning and implant design process [8].

These results point to a paradigm shift in femoral implant design and selection, towards a more individualised strategy that takes demographic-specific anatomical characteristics into account. This could entail creating implants for the Indian population that have a greater NSA and a smaller FNW, which could lower the chance of aseptic loosening and enhance the hip joint's biomechanical stability after THA.

The study unequivocally shows that there are notable morphometric differences between the Indian population and other demographic groups in the proximal femur, especially in Femoral Neck Width and Neck-Shaft Angle. The requirement for customized implants that are suited to the distinct anatomical features of the Indian population is highlighted by these findings, which are essential for the surgical planning and design of prosthetic implants in total hip arthroplasty. For patients undergoing total hip arthroplasty (THA) in India, focussing on these demographic-specific details in prosthetic design and surgical planning should greatly improve clinical results, lower the risk of implant-related problems, and guarantee a higher quality of life.

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1. Kumar A, Singh A, Kumar P. Morphometric analysis of the proximal femur in North Indian population and its clinical implications. J Orthop Surg Res. 2020;15(123):1-8.
2. Singh R, Gupta S. Comparative study of hip arthroplasty outcomes in South Asian and Caucasian populations: A cohort study. Int J Orthop. 2021;45(2):134-140.

8. Chen Y, Lu Y, Wang X, et al. Comparative analysis of femoral geometric differences between Chinese and Western individuals: Implications for designing better prostheses. Chin Med J. 2019;132(8):945-951.