Indmedica - Journal of the Anatomical Society of India

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Anatomical Parameters Of North Indian Hip Joints - Cadaveric Stud

Author!s"# Chauhan$ %&$ 'Paul$ S&$ '(haon$ )&*& +ol& ,-$ No& - !.//.-/- - .//.-/0"
(istance Measurement '''"mt"com2measurement(sensors METT3E4 T53ED5 measurement sensors to calculate len%t!, 'idt! & !ei%!t Ne3 I+4 Center in (ubai '''"firstfertility"com USA 3icensed I/6 E7perts2icsi2p%s2 Call 89:;.<.9:=>>289:;-==.;9<-; 4ree Online Journals '''"%lo+et!ics"net2li+rary Searc! t!e %lo+al online li+rary on et!ics" Si%n up for free" November )ab -5uc6 )ab lifecellinternational"com2&o)em+er E7pectin% in &o)em+er? 3et your Ba+y 'in 6ree stem cell +an,in%

Department of Anatomy, UCMS & GTB ospital, S!a!dra, Del!i" #Maulana A$ad Medical Colle%e and Associated ospitals, &e' Del!i ( I&DIA

Abstract
In t!e recent years measurements on t!e cada)eric !ip *oints !a)e not +een carried out" As t!e en)ironment plays an important role in t!e de)elopment of !uman +ein% it 'as t!ou%!t t!at t!e c!an%e in t!e en)ironment mi%!t !a)e led to some ,ind of c!an%e in t!e parameters of t!e +ony component of t!e !ip *ont" T!erefore, -. cada)eric !ip *oints 'it! soft tissue in situ 'ere studied" Dimensions of aceta+ulum and femoral !ead 'ere o+tained 'it! /ernier scale" It 'as o+ser)ed t!at t!ese dimensions 'ere %reater in males

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when compared with that of females but the difference was statistically insignificant. On the left side the parameters measured were greater than those of the right side in both the sexes but of no statistical significance. Acetabular diameter was greater than the diameter of femoral head in both the genders. Clinically, this knowledge plays an important role in understanding the rarity of occurence of primary osteoarthrosis in Indians. The present study is of value to the forensic experts, orthopaedicians and prosthetists as it gives the dimensions of acetabulum and femoral head in the present era. *e 3ords# Acetabulum, femoral head, iameters, measurements.

Introduction#
The hip !oint which was originally referred to as a ball and socket !oint is now being described theoretically as a rotational conchoid "#enschik $%&'( #enschik $%%)*. The work of #enschik "$%%'* also shows that hip !oint is more of a conchoid than a ball and socket type. To understand the hip !oint mechanics the knowledge of anatomy of proximal femur is a pre+re,uisite. Also, knowledge of various bony components of hip !oint will not only help the radiologists but will also be of immense importance to the orthopaedicians and prosthetists. As race, clime, heredity and geographical areas have strong influence over the anthropometeric parameters of bone therefore, the present study was undertaken to note the average diameter of the femoral head and the average diameter - depth of acetabulum in .orth Indian cadaveric hip !oints. Although various dimensions of acetabulum and femoral head have been measured by several investigators but all such studies have been conducted on dry specimen. This study is uni,ue in measuring the parameters with soft tissues in situ. Availability of such data can help in constructing best possible prostheses for patients of total hip replacement in .orth India. .o such study on .orth Indian hip !oints is available since nearly four decades. Any deviations of these dimensions from normal have strong correlation with development of various kinds of pathologies of hip !oint. /ifty four cadaveric hip !oints were dissected in the Anatomy department of #aulana A0ad #edical College, .ew elhi. All measurements were taken with 1ernier scale, and the data obtained was scruplously analy0ed and interpreted.

Materials and Methods#

This study was conducted in the department of Anatomy, #aulana A0ad #edical College and associated hospitals, .ew elhi. /ifty four cadaveric hip !oints belonging to the age group of 23+'3 years of both sexes were dissected. The specimens were grossly inspected for the presence of any osteoarthritic changes which if present would alter the geometry of the !oint. The hip !oints were considered normal when "a* the articular cartilage of femoral head was smooth and was of uniform appearance till the margin where it disappeared with no evidence of marginal ossification "b* the acetabulum was hemispherical and cartilage lining it was smooth and horse shoe shaped, ending abruptly at the inner margin framing the acetabular fossa as unbroken line. Outer edge of cartilage and labrum blended without any distinctive demarcation. Acetabular fossa was filled with fibrofatty tissue with a smooth surface. 4ix hip !oints were excluded from the study because of the presence of irregularity in the cartilage and osteophytes. 1arious parameters of the acetabulum and the upper end of femur of the remaining forty+eight !oints ")5 male, $6 female( 67 right, 67 left* were measured as following 8 $. epth of acetabulum 8 A thin metallic strip was placed across the diameter of the acetabulum. epth of the acetabulum was measured in millimeters using vernier scale from the center of the acetabulum to the metallic strip "fig. $*. #easurements could be made as accurate as $9$3 of a millimeter by this scale. 6. iameter of acetabulum 8 #aximum transverse diameter of the acetabulum was measured using vernier scale "fig. 6*. ). 1ertical diameter of femoral head 8 1ernier scale was used to measure the vertical diameter of the femoral head. It was taken at right angle to the long axis of the neck of femur which meant the straight distance between the most superior to the most inferior points of the femoral head "fig. )*.

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-bout Indmedica Intraobserver variation was avoided by measuring each parameter three * 5onditions of times by each of the three investigators and mean of the reading obtained was recorded. 6sage * -dvertise !n Indmedica * Observations and Results: 5ontact 6s Fifty four hip joints were dissected and grossly inspected. Six of these displayed osteoarthritic changes in the form of erosion of cartilage and presence of osteophytes. The remaining hip joints which grossly appeared normal were measured. The data obtained was analysed in the following manner: a. measurements of right side in males were compared with measurements of right side in females b. measurements of left side in males were compared with left side measurements in females and c. right side measurements were compared with left side measurements in males d. right side measurements of females were compared with left side measurements. It was observed that the depth of the acetabulum was greater in males than females both on right and left side (table I . !n the right side the difference being statistically significant (right p"#.#$% left &"#.#' . It was noticed that the depth of the left acetabulum was greater than that of the right side in both sexes but the difference was

Table: I Depth Of Acetabulum (n = 48; ri ht = !4" left = !4#

$ale (%=&'# ri ht = )8 (ange of depth of acetabulum (in mm -verage depth of acetabulum (in mm S34 $).#*)+.# left = )8 $+.)*)+.# (emale (n = )!# ri ht = ' $).#*$'.# left = ' $).#*$,.#

$..+/0$..# $,.1,0$.2, $+.',01.$# $2..#0$.11 #.'+ #.'1 #.+/ #.,'

Table : II Diameter Of Acetabulum (n = 48; ri ht = !4" left = !4#

$ale (%=&'# ri ht = )8 (ange of diameter of acetabulum (in mm -verage diameter of acetabulum (in mm S34 +#.#*2$.) left = )8 +#.#*2$.+ (emale (n = )!# ri ht = ' )/.#*+,.# left = ' +).#*+/.#

+..1#0$./# +..+,0).#2 ++.),0).#1 +'.#0$.$, #.', #..$ 1.$$ #./)

Table : III *ertical Diameter Of (emoral +ead (n = 48; ri ht = !4" left = !4#
$ale (%=&'# ri ht = )8 (ange of femoral head diameter (in mm -verage diameter of femoral head (in mm S34 left = )8 ),*2$ (emale (n = )!# ri ht = ' ),*+' left = ' +1*+,

+2.++0).#. +2.,+0).$# +).,.0$.// ++.'.0$.,# #..$ #..2 1.$$ 1.12

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statistically insignificant (male p=0.34, female p=0.20). The diameter of acetabulum was greater in males than females as can be depicted by table . !n the right side there was marginal statistically significant difference in the diameter of acetabulum between the two se"es (right p=0.04#, left p=0.22). n both the genders left acetabulum had greater diameter than that of right side but of no statistical significance (male p=0.$%, female p=0.0&). The 'ertical diameter of femoral head was greater in males than in females both on right and left sides (table ) but was statistically insignificant (right p=0.42, left p=0.42). t was also noticed that in both se"es the 'ertical diameter was more on the left side than the right side though the difference was statistically non significant (male p=0.$(, female p=0.2)).

Discussion:
*ip +oint is one of the ma+or +oints of the body. Though described con'entionally as a ball and soc,et 'ariety of syno'ial +oint, -enschi, ((##$) reports it to be a rotational conchoid. .nowledge of the anatomical parameters of the bony components of hip +oint is 'ery essential as it will open new hori/ons into better understanding of etiopathogenesis of diseases li,e primary osteoarthrosis of hip +oint. 0n incongruous +oint is more prone to de'elop degenerati'e changes than a +oint ha'ing normal anatomy (-urray (#&%) 0wareness of the a'erage dimensions of the bones of the hip +oint in both se"es will also help in early detection of disputed se" by 1orensic e"perts. 0s total hip replacement is a common surgery performed now a days a ,nowledge of the dimensions of acetabulum and femoral head will assist, prosthetists to construct suitable prostheses for 2orth ndians. To the best of our ,nowledge not much literature is a'aialble on these parameters of 2orth ndian hip +oints therefore the need for the present study to be carried out was felt. 3tudying cada'eric hip +oints is of immense importance as 'arious dimensions are ta,en with the soft tissues in place. This gi'es the a'erage 'alues of 'arious parameters to near normal situations as would be encountered in the patients at operation table. 0ssessment of these parameters to detect the se" by radiographs, 4T scans and -5 would include magnification errors and may not be cost effecti'e for a de'eloping nation li,e ours. 3tudy conducted on the femora of 2igerians re'ealed that the mean 'ertical diameter of the head of femur on the right and left sides in males is %4.23 mm and %4.0) mm respecti'ely and in females it is 4$.(4 mm and 4&.)3 mm (0sala, -ba+iorgu and 6apandro, (##)). t was noticed by 6rasad, 7etti'el, 8eyaseelan, saac and 4handi ((##&) that the 'ertical diameter of the head of dry femora had an a'erage 'alue of 43.0 mm in males and 3#.( mm in females in 3outh ndian population. 8a'ade,ar ((#&() was of the opinion that the a'erage diameter in males is 4%.2& mm and in females is 40.3$ mm. n contrast according to the present study the femoral head diameter on an a'erage is 4%.44 mm and 43.)$ mm in males and females respecti'ely on the right side and 4%.)4 mm and 44.&$ mm respecti'ely on the left side. 0ccording to saac, 7etti'el, 6rasad, 8eyaseelan and 4handi ((##$) short statured ha'e smaller diameter of femoral head which can be easily appreciated when the present study is compared with that of 0sala et al ((##)). 2igerians are taller than a'erage ndians and so their femoral heads are bigger than that of ndians. There is not much of difference in the measurement of femoral head diameter amongst 2orth and 3outh ndians as the study conducted on bones belonging to 3outh ndians were on dried specimens whereas the study in 9uestion included soft tissues as well while measuring 'arious parameters. 4artilage adds 3 mm to the diameter (8a'ade,ar (#&(). 0'erage 'ertical diameter of femoral head is nearly the same as seen by -u,hopadhaya and :arooah ((#&$) though minor 'ariations may persist as they ha'e not segregated the +oints according to se". 0 particular se" can not be determined only by 'isual e"amination of the bone as reported by .rogman ((#4&) and (3tewart ((#4)) though to some e"tent it can be possible by seeing the hip bone as reported by 0sala et al. ((##)). Therefore, in addition to the already e"isting ,nowledge on the hip bone for determining se" of an indi'idual it would be benificial if the dimensions of acetabulum could also be incorporated. -easurements of acetabulum are scarcely found in literature as far as our ,nowledge e"tends. 0'erage depth of acetabulum according to -u,hopadhaya and :arroah ((#&$) on right and left sides are 24.$ mm and 24.% mm respecti'ely. ;ifference in their obser'ations when compared with the present study e"ists as they included

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)opyright D 5++; Indmedica

the dimensions of both the sexes while calculating the mean. Also, they worked upon fresh specimens where as the study in question was on preserved specimens. It is likely that in preserved materials, the soft tissues shrink and therefore the emergence of higher values in the present study. Average diameter of acetabulum was respectively (Mukhopadhaya and arooah !"#$% which is nearly the same as seen in our study. It would be noticed that in the &orth Indian hip 'oints belonging to males or females, the average diameter of femoral head is smaller than the average diameter of accetabulum impressing upon the fact that the femoral head is snugly fitted into the acetabulum which is one of the ma'or reasons why primary osteoarthrosis of hip 'oint is so uncommon in Indians. (arious parameters measured had a higher value on left side than right. )hhibber and *ingh (!"$+%, *ingh (!"$+%, -ogra and *ingh (!"$!% suggest that left limb is dominant. .hether a person is right handed or left handed more people use left lower limb for weight bearing. ()hhibber and *ingh !"$+%. /herefore, the dimensions of the bones forming the hip 'oint of left side should be more so as to bear greater loading force on femur. /hough, in the present study left hip 'oint dimensions are greater than the right yet they are statistically insignificant. /here should not be much of a difference between the sides otherwise everyone would be walking with an abnormal gait0 /he present study hence provides valuable parameters which would help the forensic anthropoligists, orthopaedicians and prosthetists to deliver excellent performance in their respective specialities. It was concluded from this study that the regional variations in the parameters measured do exist when the data of two different countries are considered but within a country there is not much variation. Moreover, in last four decades the dimensions of the bony components of the hip 'oints studied have not changed much.

References:
!. Asala, *.A., Mba'iorgu, 1.2., 3apandro, .A. (!""4%, A comparative study of femoral head diameters and sex differentiation in &igerians. Acta Anatomica. !#5 6 575857$. 5. )hhibber, *.9., *ingh, I. (!"$+%, Assymetry in muscle weight and one side dominance in the human lower limbs. :ournal of Anatomy. !+# (7%6 pp. ;;78;;#. 7. -ogra, *.<., *ingh, I. (!"$!%6 Asymmetry in bone weight in the human lower limbs Anatomischer An=eiger. !546 pp. 5$454+. >. Isaac, ., (ettivel, *., 3rasad, 9., :eyaseelan, ?., )handi, @. (!""$%6 3rediction of the femoral neck shaft angle from the length of the femoral neck. )linical Anatomy. !+6 pp. 7!48757. ;. :avadekar, .*. (!"#!%6 A *tudy of measurements of the femur with special references to sex. A peliminary report. :ournal of Anatomical *ociety of India. !+6 pp. 5;85$. #. <rogman, ..M. (!">#%6 *keleton in 1orensic medicine. /ransactions of Institute of Medicine )hicago. !#6 pp. !;>!#$. $. Menschik, A. (!"4$%6 iometric, *pringer, erlin, Aeidelberg, &ew Bork. 4. Menschik, 1. (!""7%6 /he shape and <inematics of the hip 'oint. :ournal of one and :oint *urgery ( ritish% $;(5%6 pp !!!. ". Menschik, 1. (!""$% /he hip 'oint as a conchoid shape. :ournal of iomechanics. 7+("%6 pp "$!8"$7. !+. Mukhopadhaya, ., arooah, . (!"#$%6 Csteoarthritis of hip in Indians. An anatomical and clinical study. Indian :ournal of Crthopaedics !(!%6 pp ;;8#5. !!. Murray, 9.C., (!"#;%6 /he aetiology of primary osteoarthritis of the hip. ritish :ournal of 9adiology. 746 pp 4!+845>. !5. 3rasad, 9., (ettivel, *., :eyaseelan, ?., Isaac, ., )handi, @. (!""#%6 9econstruction of femur length from makers of its proximal end. )linical Anatomy. "6 54877. !7. *ingh I. (!"$+% 1unctional asymmetry in the lower limbs. Acta Anatomica. $$ pp6 !7!8!74. !>. *tewart, /.-. (!">4%6 Medicolegal aspects of *keleton, I, Age, *ex, 9ace and *tature. American :ournal of 3hysical Anthropology. #6 pp 7!>875!.

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Fig 1: Method of measurement of depth of acetabulam

Fig 2: Method of measurement of diameter of acetabulam

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Fig 3: Measurement of diameter of femoral head

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