Background: Accurate reconstruction of hip joint biomechanics is the key stone in total hip arthroplasty. Although proximal femur morphology is known to vary with both age and gender, few studies investigated this in the very elderly (ie, >= 80 years). The purpose of this study was to compare basic morphological parameters describing the position of the femoral head between very elderly and middle-aged subjects.
Methods: Computed tomographic scans of the femur of 90 very elderly (mean 84 years, range 80-105 years) and 58 middle-aged subjects (mean 52 years, range 20-79 years) were made. After 3-dimensional reconstruction, the neck-shaft angle, femoral neck anteversion angle, femoral head height, femoral neck length, and mediolateral offset (ML-offset) were determined.
Results: The neck-shaft angle was on average 3.6 degrees less in elderly males (125.9 degrees +/- 5.0 degrees) than in middle-aged males (129.5 degrees +/- 5.1 degrees) (P <.001). The femoral neck anteversion angle was not significantly different between both age and gender groups. The femoral head height was -12.3 mm in elderly females compared to -10.5 mm (Delta 17%) in elderly males (P = .284) and even -8.0 mm (Delta 54%) in middle-aged males. The ML-offset was 10% (4.1 mm) larger in elderly compared to middle-aged males (P <.001).
Conclusion: These findings suggest that the femoral neck and head shift in a relative varus position during aging. Femoral prostheses with increased ML-offset and a lower caput-collum-diaphyseal angle are needed to accommodate the morphology of the femur in the very elderly. Care must be taken not to lengthen the operated leg, particularly in very elderly females. (C) 2016 Elsevier Inc. All rights reserved.
|Number of pages||6|
|Journal||Journal of Arthroplasty|
|Publication status||Published - Feb 2017|
- very elderly
- total hip arthroplasty
- femur morphology
- neck-shaft angle
- mediolateral offset
- femoral head height
- TOTAL HIP-ARTHROPLASTY
- ABDUCTOR MUSCLE STRENGTH
- LEG LENGTH DISCREPANCY
- PROXIMAL FEMUR