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Femoral neck version in the spinopelvic and lower limb 3D alignment: a full-body EOS® study in 400 healthy subjects

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Abstract

Background

The goal of this study was to better understand the variation of femoral neck version according to spinopelvic and lower limb 3D alignment using biplanar X-rays in standing position.

Methods

This multicentric study retrospectively included healthy subjects from previous studies who had free-standing position biplanar radiographs. Subjects were excluded if they presented spinal or any musculo-skeletal deformity, and reported pain in the spine, hip or knee. Age, sex, and the following 3D-reconstructed parameters were collected: spinal curvatures, pelvic parameters, sagittal vertical axis (SVA), T1 pelvic angle (TPA), spino-sacral angle (SSA), femoral torsion angle (FTA), sacro-femoral angle (SFA), knee flexion angle (KA), ankle angle (AA), pelvic shift (PS) and ankle distance. Femoral neck version angle (FVA) was calculated between horizontal plane projection of the bi-coxo-femoral axis and the line passing through the femoral neck barycenter and femoral head center. Analysis according to age subsets was performed.

Results

A total of 400 subjects were included (219 females); mean age was 29 ± 18 years (range: 4–83). Subjects with high pelvic tilt values presented significantly higher FVA than average and low-PT individuals, respectively, 7.8 ± 7.1°, 2 ± 9° and 2.1 ± 9.5° (p < 0.001). These subjects also presented lower lumbar lordosis values and higher acetabulum anteversion in the horizontal plane than the two other groups. SVA correlation with FVA was weaker (r = 0.1, p = 0.03) than SSA and TPA (r = − 0.3 and r = 0.3, respectively, p < 0.001). A strong correlation was found with femoral torsion (r = 0.5, p < 0.001). SFA (r = − 0.3, p < 0.001), pelvic shift (r = 0.2, p < 0.001) and ankle distance (r = 0.3, p < 0.001) were also significantly correlated. Multivariate analysis confirmed significant association of age, pelvic tilt, lumbar lordosis, pelvic shift, ankle distance and femoral torsion with FVA.

Conclusion

Patients with lower lumbar lordosis present pelvic retroversion which induces a higher femoral neck version. This finding may help positioning implants in total hip replacement procedures. Higher pelvic shift, age, male gender and increased femoral torsion were also correlated with higher FVA.

Level of evidence

II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).

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Funding

No funding was used for this study.

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Authors and Affiliations

  1. Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France

    Marc Khalifé, Emmanuelle Ferrero & Pierre Guigui

  2. Université Paris-Cité, Paris, France

    Marc Khalifé, Emmanuelle Ferrero & Pierre Guigui

  3. Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France

    Marc Khalifé, Claudio Vergari, Guillaume Rebeyrat & Wafa Skalli

  4. Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon

    Ayman Assi

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  1. Marc Khalifé
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Correspondence to Marc Khalifé.

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Conflict of interest

Khalifé: Holds share of the NovaSpine company, which presents no competing interests with the present study. Skalli: Personal royalties from EOS imaging. No other conflicts of interest to disclose.

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Khalifé, M., Vergari, C., Rebeyrat, G. et al. Femoral neck version in the spinopelvic and lower limb 3D alignment: a full-body EOS® study in 400 healthy subjects. Eur Spine J (2023). https://doi.org/10.1007/s00586-023-07915-x

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  • DOI: https://doi.org/10.1007/s00586-023-07915-x

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