Analysis of X-Ray Anthropometric Parameters of the Proximal Femur from the Position of Planning Hip Joint Arthroplasty

Abstract: In the structure of morbidity of modern society, diseases of bones and joints occupy one of the leading positions. In the surgical treatment of severe forms of hip joint diseases, hip arthro-plasty is a radical method of treatment. At the same time, the number of total hip arthroplasties in the world is increasing annually. Preoperative planning of the implantation of the femoral component of the endoprosthesis is performed by analyzing the radiographic anthropometric parameters of the proximal femur. Objective. Based on a comparative assessment of radiographic anthropometric characteristics of the proximal femur, to develop an algorithm for planning implantation of the femoral component of a hip joint endoprosthesis. Materials and methods. An assessment of radiographic anthropometric parameters was performed in 232 patients (258 joints) with various nosological forms of hip joint diseases who underwent total hip arthroplasty; 26 patients underwent bilateral staged hip arthroplasty. Idiopathic coxarthrosis of the III degree (IC) was diagnosed in 42 patients, dysplastic coxarthrosis of the III degree (DC) – in 46 patients, aseptic necrosis of the femoral head of the IV degree (ANFH) – in 62, medial femoral neck fracture (MF) – in 48 patients, rheumatoid arthritis (RA) – in 32 patients, traumatic coxarthro-sis (TC) – in 2 patients. Cementless fixation of endoprostheses was used in 187 cases (72.5%), in the remaining cases – in 71 (27.5%), cement fixation of the stem was used, while a total cement endo-prosthesis was installed in 33 cases (12.8%), and in 38 cases (14.7%) an endoprosthesis with hybrid fixation was implanted. The following methods were used for qualitative and quantitative assess-ment of the structure of the proximal femur: cortical index (CI), morpho-cortical index (MCI), No-ble medullary canal narrowing index, Spotorno–Romagnoli index, assessment of the proximal femur according to Dorr L. et al. Results. Based on the analysis of descriptive and calculated radiographic anthropometric indicators in various nosological forms of hip joint involvement, analysis of the dependence of radiographic anthropometric indicators and the designs of the installed stems of endoprostheses, an algorithm was developed for selecting the design of the femoral component of the endoprosthesis and the type of its fixation. Discussion. Radiographic anthropometric indicators in IC revealed a decrease in bone mass in the area of implantation of the endoprosthesis stem and a tendency to a straight shape of the proximal femoral canal. In DC, the structure of the proximal femoral canal tends to a conical shape, while the loss of bone mass in the area of implantation of the endoprosthesis stem is less pronounced than in IC. In ANFN, the “normal” type of canal prevailed, which indicated the possibility of cementless fixation of the endoprosthesis stem, and in RA, the structure of the canal indicated the likelihood of cement fixation of the stem. In MF, the greatest loss of bone mass was established according to ra-diographic anthropometric indicators, which indicated a tendency to a “pipe” type of canal and ce-ment fixation of the endoprosthesis stem. Conclusions. Descriptive and calculated methods for assessing of radiographic anthropometric pa-rameters of the proximal femur should be effectively used in combination. To obtain a full-fledged characteristic, it is necessary to assess at least one descriptive and at least two calculated radiographic anthropometric parameters of the proximal femur, which, together with the determination of the Spotorno-Romagnoli integral index, will allow to optimize plan the choice of the stem design and the type of its fixation. The developed algorithm allows to standardize the determination of radio-graphic anthropometric parameters of the proximal femur and optimize approaches to the selection of the endoprosthesis stem design and the type of its fixation, and to ensure both high-quality primary stability of the femoral component and subsequent operational longevity of the hip joint endo-prosthesis.