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Anatomy of the iliopsoas notch and its relationship with morphology of the proximal femur

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Abstract

Purpose

Discrepancy between the morphology of the acetabular margin and the design of hemispheric acetabular cups used in total hip arthroplasty may produce postoperative hip pain due to an iliopsoas impingement at the iliopsoas notch. This study aimed to determine the anatomical features of the iliopsoas notch in the Central European sample, and to test whether the morphology of the proximal femur affects the size of the iliopsoas notch.

Methods

The sample was composed of 40 matched pairs of dry hip bones and corresponding femora. The depth and length of the iliopsoas notch were measured and correlated with the available demographic data. The anthropometric parameters of the proximal femur were calculated using image-analysis software, and their association with the measurements of the iliopsoas notch was tested.

Results

The iliopsoas notch was present in all specimens and featured four morphological configurations: curved (61.3%), angular (16.2%), irregular (16.2%), and straight (6.3%). Its size was found to be larger in males (P = 0.014 for depth, P < 0.001 for length). No significant difference existed between the sides. The height and age of the specimens did not correlate with the size of the iliopsoas notch. Furthermore, neither the femoral neck version, the lesser trochanteric version, nor the angle between the neck of the femur and the lesser trochanter influenced the dimensions of the iliopsoas notch.

Conclusion

The iliopsoas notch is a consistent landmark of the acetabulum, although its anatomical appearance is widely variable. The iliopsoas notch arrangement cannot be predicted perioperatively based on the morphology of the proximal femur. The various shapes and sex-related differences detected in this study could be used for designing new hip implants or could be utilized during cup positioning in total hip arthroplasty.

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Availability of data and materials

All data that support the findings of the current study are accessible upon reasonable request from the corresponding author.

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

Funding

This study was supported by the Charles University Grant Agency (GAUK, No. 174523).

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Authors and Affiliations

  1. Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic

    Michal Benes, Vojtech Kunc, Ondrej Nanka & David Kachlik

  2. Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Michal Benes, Vojtech Kunc & David Kachlik

  3. Clinic of Trauma Surgery, Masaryk Hospital, Usti Nad Labem, Czech Republic

    Vojtech Kunc

  4. Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic

    Ondrej Nanka

  5. 1st Department of Orthopaedics, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic

    Vladislav Bartak

Authors
  1. Michal Benes
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  2. Vojtech Kunc
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  3. Ondrej Nanka
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  4. David Kachlik
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  5. Vladislav Bartak
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Contributions

MB: protocol development, data collection and analysis, manuscript writing. VK: interpretation of data, manuscript editing. ON: data collection, manuscript editing. DK: interpretation of data, manuscript editing. VB: protocol development, data interpretation, supervision, manuscript editing.

Corresponding author

Correspondence to Michal Benes.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was approved by the Ethics Committee for Multi-Centric Clinical Trials of the University Hospital Motol and Second Faculty of Medicine, Charles University in Prague (No. EK-1107/22).

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Benes, M., Kunc, V., Nanka, O. et al. Anatomy of the iliopsoas notch and its relationship with morphology of the proximal femur. Surg Radiol Anat 46, 51–57 (2024). https://doi.org/10.1007/s00276-023-03263-z

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  • DOI: https://doi.org/10.1007/s00276-023-03263-z

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