Normal Korean Femoral Neck Anteversion, Acetabular Anteversion and Combined Anteversion Measured with Computed Tomography

Kim Bum-Soo; Kim Seong-Tae; Myung Wi Seung; Rak Choi Won; Suk Kim Dong

doi:10.4055/jkoa.2019.54.3.261

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Bum-Soo, Seong-Tae, Seung, Won, and Dong: Normal Korean Femoral Neck Anteversion, Acetabular Anteversion and Combined Anteversion Measured with Computed Tomography

Original Article

J Korean Orthop Assoc 2019;54(3):261-268.

DOI: https://doi.org/10.4055/jkoa.2019.54.3.261

Normal Korean Femoral Neck Anteversion, Acetabular Anteversion and Combined Anteversion Measured with Computed Tomography

Kim Bum-Soo, M.D., Kim Seong-Tae, M.D., Myung Wi Seung, M.D., Rak Choi Won, M.D., Suk Kim Dong, M.D.

Department of Orthopedic Surgery, Cheju Halla General Hospital, Jeju, Korea

Correspondence to: Seong-Tae Kim, M.D. Department of Orthopedic Surgery, Cheju Halla General Hospital, 65 Doryeong-ro, Jeju 63127, Korea TEL: +82-64-740-5410 FAX: +82-64-743-3110 E-mail: ulsanos@naver.com ORCID: https://orcid.org/0000-0003-2787-5475

Received 24 June 20181 October 201814 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The authors measured the anteversion of the femoral neck and acetabulum and the sum of the two values in normal Korean people by computed tomography. The authors examined the normal range of the values to analyze the difference in sex and sides as well as the relationship between the femoral neck and acetabular anteversion.

Materials and Methods:

The authors measured the anteversion of the femoral neck and acetabulum in 118 normal Korean adult males and 114 females aged between 21 and 49 on both the right and left sides by computed tomography and calculated the sum of anteversion. The authors analyzed the mean and standard deviation, and investigated the sex differences and side differences, as well as the relationship between the acetabular anteversion and femoral neck anteversion statistically.

Results:

The anteversion of the acetabulum in males was 15.3°±6.1° on the right side and 15.3°±6.6° on the left side. The anteversion of the femoral neck in males was 5.3°±7.6° on the right side and 1.5°±9.2° on the left side according to the Hernandez et al. method. The anteversion of acetabulum in females was 16.8°±5.4° on the right side and 16.3°±5.8° on the left side. The anteversion of femoral neck in females was 10.3°±8.2° on the right side and 7.9°±8.2° on the left side according to Hernandez et al. method. No difference in acetabular anteversion, and a significant difference in the femoral neck anteversion on both the right and left sides were observed between males and females. No difference of acetabular anteversion was observed between the right and left sides, but a significant difference in femoral neck anteversion was noted between the right and left sides measured by either the Hernandez et al. method or Weiner et al. method. The Pearson coefficient revealed no correlation between the femoral neck anteversion and acetabular anteversion.

Conclusion:

No difference in the acetabular anteversion was observed, but there was a significant difference in femoral neck anteversion between males and females. A significant difference in femoral neck anteversion was observed between the right and left sides. No correlation was noted between the anteversion of the femoral neck and acetabulum.

Keywords: femur neck, acetabulum, anteversion

References

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Figure 1.

Method of measuring the acetabular anteversion. Line AB is drawn by connecting the most posterior point of the posterior column of the acetabulum. Line CD is perpendicular to line AB. Line EF is drawn by connecting the anterior and posterior acetabular edge. The angle between line CD and line EF is the acetabular anteversion.

Figure 2.

Method of measuring the femoral neck anteversion. A is the angle between the horizontal line and the line of the femoral neck axis, B is the angle between the horizontal line and the line connecting the posterior surface of the distal femoral medial condyle and lateral condyle. A minus B is the femoral neck anteversion.

Figure 3.

Defining the axis of femoral neck: (A) The Hernandez et al. method⁹⁾ is defining the femoral neck axis as the line which connects the center of the femoral head and that of the isthmus of the neck. (B) The Weiner et al. method¹⁰⁾ is defining the femoral neck axis as the midline between the ventral and dorsal cortices of the femoral neck.

Table 1.

Demographic Data of the Study

Age range (yr)	Male (case)	Female (case)
21–29	16	10
30–39	43	26
40–49	59	78
Total	118	114

Values are presented as number only.

Table 2.

The p-value of Paired T-Test for the Interobserver and Intraobserver Difference

Variable	Interobserver	Intraobserver
Right AA	0.323	0.342
Right FA (H)	0.323	0.401
Right FA (W)	0.223	0.315
Left AA	0.290	0.320
Left FA (H)	0.401	0.255
Left FA (W)	0.057	0.318

AA, acetabular anteversion; FA, femoral neck anteversion; H, Hernandez et al. method⁹⁾; W, Weiner et al. method¹⁰⁾.

Table 3.

Intra-Class Correlation Coefficients in the Interobserver and Intraobserver Measurements, with Their 95% Confidence Intervals

Variable	Interobserver	Intraobserver
Right AA	0.949	0.953
Right FA (H)	0.972	0.944
Right FA (W)	0.977	0.962
Left AA	0.959	0.942
Left FA (H)	0.971	0.965
Left FA (W)	0.977	0.972

AA, acetabular anteversion; FA, femoral neck anteversion; H, Hernandez et al. method⁹⁾; W, Weiner et al. method¹⁰⁾.

Table 4.

Descriptive Statistics of Males

Variable	Right AA	Right FA (H)	Right FA (W)	Left AA	Left FA (H)	Left FA (W)	Right CA (H)	Right CA (W)	Left CA (H)	Left CA (W)
No. of subject	118	118	118	118	118	118	118	118	118	118
Mean±SD	15.3±6.1	5.3±7.6	8.9±8.5	15.3±6.6	1.5±9.2	6.1±9.1	20.6±9.1	24.2±10.0	16.8±11.3	21.4±11.0
Range	-1.6–27.2	-20.1–32.3	-23.6–35.4	0.1–27.1	-18.0–33.6	-21.0–35.8	-0.5–48.3	-5.9–51.5	-13.8–44.5	-7.9–52.5
Percentile (%)
25	10.7	2.1	5.0	10.9	-6.0	1.8	14.2	18.4	8.4	15.2
50	15.8	5.1	10.1	15.4	3.0	6.0	20.9	25.3	17.3	22.4
75	20.2	10.1	15.1	20.9	6.3	11.4	26.0	30.5	25.0	29.4

AA, acetabular anteversion; FA, femoral neck anteversion; H, Hernandez et al. method⁹⁾; W, Weiner et al. method¹⁰⁾; SD, standard deviation.

Table 5.

Descriptive Statistics of Females

Variable	Right AA	Right FA (H)	Right FA (W)	Left AA	Left FA (H)	Left FA (W)	Right CA (H)	Right CA (W)	Left CA (H)	Left CA (W)
No. of subject	114	114	114	114	114	114	114	114	114	114
Mean±SD	16.8±5.4	10.3±8.2	12.3±10.4	16.3±5.8	7.9±8.2	10.4±8.4	27.1±10.2	29.1±12.3	23.6±10.8	26.7±11.1
Range	1.6–30.4	-14.5–28.8	-15.8–47.5	-3.7–31.7	-9.8–29.2	-7.9–38.4	-4.3–51.0	-0.2–69.8	-2.0–66.4	-2.3–64.7
Percentile (%)
25	13.2	5.3	6.7	12.6	3.7	5.6	21.2	22.8	2.4	20.1
50	16.2	10.2	12.8	16.2	8.2	10.2	27.1	29.5	26.0	25.9
75	20.5	16.2	17.7	20.3	14.1	16.3	34.0	37.1	33.3	32.8

AA, acetabular anteversion; FA, femoral neck anteversion; H, Hernandez et al. method⁹⁾; W, Weiner et al. method¹⁰⁾; SD, standard deviation.

Table 6.

Difference between Males and Females

Variable	Category	Mean AA	p-value	Mean FA (H)	p-value	Mean FA (W)	p-value	Mean CA (H)	p-value	Mean CA (W)	p-value
Right	Male (n=118)	15.3	0.055	5.3	<0.001	8.9	0.007	20.6	<0.001	24.2	0.001
	Female (n=114)	16.8		10.3		12.3		27.1		29.1
Left	Male (n=118)	15.3	0.224	1.5	<0.001	6.1	<0.001	16.8	<0.001	21.4	<0.001
	Female (n=114)	16.3		7.9		10.4		23.6		26.7

AA, acetabular anteversion; FA, femoral neck anteversion; H, Hernandez et al. method⁹⁾; W, Weiner et al. method¹⁰⁾.

Table 7.

Difference between Right Side and Left Side

Variable	Category	Mean AA	p-value	Mean FA (H)	p-value	Mean FA (W)	p-value	Mean CA (H)	p-value	Mean CA (W)	p-value
Male	Right (n=118)	15.3	0.962	5.3	0.000	8.9	0.000	20.6	0.000	24.2	0.005
	Left (n=118)	15.3		1.5		6.1		16.8		21.4
Female	Right (n=114)	16.8	0.263	10.3	0.001	12.3	0.023	27.1	0.031	29.1	0.015
	Left (n=114)	16.3		7.9		10.4		23.6		26.7

AA, acetabular anteversion; FA, femoral neck anteversion; H, Hernandez et al. method⁹⁾; W, Weiner et al. method¹⁰⁾.

Table 8.

Pearson Correlation Coefficient

Variable	Male	Female
Right AA-FA (H)	-0.129	0.101
Right AA-FA (W)	-0.077	0.130
Left AA-FA (H)	-0.015	0.144
Left AA-FA (W)	-0.056	0.206

AA, acetabular anteversion; FA, femoral neck anteversion; H, Hernandez et al. method⁹⁾; W, Weiner et al. method¹⁰⁾.

Table 9.

Comparison of the Measurements of Acetabular Anteversion with Previous Studies

Study	Both sex (degrees)	Male (degrees)	Female (degrees)
McKibbin¹⁾	16.5	14.0	19.0
Maruyama et al.¹¹⁾	19.9±6.6	18.5	21.3
Vandenbussche et al.¹²⁾	20.9±9.1	15.7±8.8	24.1±7.8
Köhnlein et al.¹³⁾	18.6±5.5	17.0±4.7	21.7±6.6
Zeng et al.¹⁴⁾		Right 17.5±5.73	18.1±5.5
		Left 16.0±5.74	17.6±4.8
Chang et al.¹⁵⁾	17.5±6.0
Jamali et al.¹⁶⁾	20.1±6.4
Zeng et al.¹⁷⁾		21.0±4.62	23.19±8.4
Our results		Right 15.3±6.1	Right 16.8±5.4
		Left 15.3±6.6	Left 16.3±5.8

Values are presented as mean only or mean±standard deviation.

Table 10.

Comparison of the Measurements of Femoral Neck Anteversion with Previous Studies

Study	Both sex (degrees)	Male (degrees)	Female (degrees)
Reikerås et al.³⁾	17±6	11±7	14±7
Zeng et al.¹⁷⁾		16.81±7.09	20.57±6.40
Khang et al.¹⁸⁾	17.9±7.4
Toogood et al.¹⁹⁾	9.73
Our results		Right 8.9±8.5	Right 12.3±10.4
		Left 6.0±9.1	Left 10.4±8.4

Values are presented as mean±standard deviation.

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