The Geometry of the Proximal Femoral Medullary Canal in German Shepherd and Kangal Dogs

Abstract

    The proximal femur has morphological variability that is related to its functional and biomechanical properties. Therefore, researchers have long been interested in these variations especially associated with the femoral implant design and implantation in total hip arthroplasty. The positions of the femoral head and the geometrical variations in the medullary canal are evaluated in particular to understand the proximal femoral morphology. The position of head or neck of the dog has already been studied in detail. There are incomplete data to evaluate variations in the geometry of the medullary canal of proximal femur in dog. Proximal femoral morphology of the medullary canal has been evaluated only at the coronal plane in dog studies using plain radiography. The morphometric data on the sagittal plane are also need to innovations in femoral implants. The purpose of this study is to indicate the detailed geometric data about proximal femoral canal of dog using three-dimensional morphometric methods to provide a database for the orthopedic studies. The effect of the breed with different pelvic limb conformation was also studied in this study. The cleaned femora from 16 German shepherd and 16 Kangal dogs were used. The three-dimensional images were reconstructed from the computed tomographic images. The femoral length, the anteversion angle and neck angles, the isthmus position and the widths on medio-lateral and cranio-caudal directions of the cross-sections of proximal femur were measured. The cortico-medullary indices, the isthmus position index and the canal flare indices were also calculated to detailed investigation of medullary canal of the proximal femur. According to our study results, it must be considered in stem design that the level of the isthmus might change in response to different conformations of the dog breeds, whilst the flare indices are similar in the dogs. The flare of the medullary canal was firstly evaluated with the cranio-caudal diameters on the three-dimensional images in this study. The cortico-medullary index shows some variation between the dog breeds across the levels and the directions of the cross-sections of the proximal femur. Nowadays, three-dimensional images can be acquired and morphometric measurements can be done easily by tomography in a lot of veterinary clinics. The data from three-dimensional morphometric analysis may contribute to the optimization of the design and preoperative selection of femoral implants by surgeons.

Keywords

• Medullary canal,Femur,Geometry,Dog

Kangal ve Alman Çoban Köpeklerinin Proximal Femur Bölümünde Cavum Medullare’nin Geometrik Özellikleri

Abstract

    Proximal femur, fonksiyonel ve biyomekanik özellikleri nedeniyle morfolojik varyasyonlar gösterebilir. Bu varyasyonlar, total kalça protezinin femoral implant uygulamaları ve tasarım çalışmalarında araştırıcılar için önemlidir. Proximal femur’un morfolojik özelliklerine ilişkin olarak, caput femoris pozisyonu ve cavum medullare’nin geometrik varyasyonları öncelikli olarak incelenir. Köpeklerde caput femoris pozisyonuna ilişkin çalışmalar daha çok görülmekle birlikte cavum medullare’nin geometrik özelliklerine ilişkin çalışmalar yetersizdir. Ayrıca bu bölgeye ilişkin morfometrik ölçümler sadece dorsal (coronal) düzlemde yapılmıştır. Yeni femoral implant tasarımları için yapılacak çalışmalar için bölgenin sagittal düzlemde de elde edilmiş morfometrik verilerine ihtiyaç vardır. Bu çalışmada da ortopedik çalışmalar için veri tabanına katkıda bulunmak amacıyla proximal femoral kanalın, bilgisayar ortamında üç boyutlu modelleri kullanılarak detaylı geometrik ve morfometrik verilerin sunulması amaçlanmıştır. Ayrıca, farklı arka bacak konformasyonlardaki iki ırktan elde edilen veriler de karşılaştırılmıştır. Çalışmada 16 adet Kangal ve 16 adet Alman çoban köpeğine ait femur’lar kullanıldı. Bilgisayarlı tomografi kesitleri kullanılarak kemiklerin üç boyutlu modelleri hazırlandı. Bu modellerden femur uzunluğu, anteversiyon açısı, collum femoris açısı, isthmus pozisyonu ve proximal femur bölgesinden alınan kesitlerde medio-lateral ve cranio-caudal çaplar ölçüldü. Ayrıca proximal femoral kanalın detaylı incelenmesi için kesitlerin cortico-medullar oranlar, isthmus pozisyonu oranı ve medullar kanal genişleme oranları hesaplandı. Çalışma sonuçlarına göre medullar kanal genişleme oranları benzerlik gösterse de isthmus mesafesinin köpek ırkları arasında farklılık gösterebileceği dikkati çekti. Köpeklerde, proximal medullar kanalın yukarı doğru açılmasına ilişkin cranio-caudal yönlü hesaplanan oran ilk defa değerlendirilmiştir. Cortico–medullar oranlar bazı seviyelerde veya yönlerde iki ırk arasında farklılık göstermiştir. Günümüzde bir çok klinikte bulunan tomografi cihazları ile kemiklerin üç boyutlu modelleri rahatlıkla elde edilebilir ve morfometrik değerlendirmeler yapılabilir. Bu çalışmada elde edilen morfometrik verilerin, klinisyenlerin uygun femoral implant seçiminde ve yeni tasarımların yapılabilmesinde yardımcı olabileceği düşünülmektedir.

Keywords

• Canalis medullaris,femur,geometri,köpek

References

1. Abadie, P., Lebel, B., Pineau, V., Burdin, G., Vielpeau, C., 2010. Cemented total hip stem design influence on adaptive cortical thickness and femoral morphology. Orthopaedics & Traumatology, Surgery & Research 96, 104-110.
2. Ammann, P., Rizzoli, R., 2003. Bone strength and its determinants. Osteoporosis International 14, 13-18.
3. Baharuddin, M.Y., Salleh, Sh-H., Zulkifly, A.H., Lee, M.H., Noor, A.M., 2014. Morphological study of the newly designed cementless femoral stem. BioMed Research International 1-11.
4. Baumgärtner, R., Heeren, N., Quast, D., Babst, R., Brunner, A., 2015. Is the cortical thickness index a valid parameter to assess bone mineral density in geriatric patients with hip fractures? Archives of Orthopaedic and Trauma Surgery 135, 805–810.
5. Breusch, S.J., 2005. Bone Preparation: Femur. In: Breusch, S.J; Malchau, H. (Eds.) The Well-Cemented Total Hip Arthroplasty. Theory and Practice. Springer Medizin Verlag, Germany, pp: 125-132.
6. Chantarapanich, N., Mahaisavariya, B., Siribodhi, P., Sitthiseripratip, K., 2011. Geometric mismatch analysis of retrograde nail in the asian femur. Surgical and Radiologic Anatomy 33, 755-761.
7. Casper, D.S., Kim, G.K., Parvizi, J., Freeman, T.A., 2012. Morphology of the proximal femur differs widely with age and sex: relevance to design and selection of femoral prostheses. The Journal of Orthopaedic Research 30, 1162-1166.
8. Conzemius, M.G, Vandervoort, J., 2005. Total joint replace-ment in the dog. Veterinary Clinics Small Animal Practice 35, 1213-1231.

9. Dudley, R.M., Kowaleski, M.P., Drost, W.T., Dyce, J., 2006. Radiographic and computed tomographic determination of femoral varus and torsion in the dog. Veterinary Radiology & Ultrasound 47, 546-552.
10. Dyce, K.M., Sack, W.O., Wensing, C.J.G., 2002. Textbook of Veterinary Anatomy. 3rd ed. Elsevier, USA, p: 467.
11. Evans, H.E., 1993. The Skeleton. In: Evans HE (Ed.) Miller’s Anatomy of the Dog, W.B. Saunders Comp., Philadelphia, p: 122.
12. Franklin, S.P., Franklin, A.L., Wilson, H., Schultz, L., Sonny Bal, B., Cook, J.L., 2012. The relationship of the canine femoral head to the femoral neck: an anatomic study with relevance for hip arthroplasty implant design and implantation. Veterinary Surgery 41, 86-93.
13. Ganz, S. M., Jackson, J., VanEnkevort, B., 2010. Risk factors for femoral fracture after canine press-fit cementless total hip arthroplasty. Veterinary Surgery 39, 688-695.
14. Husmann, O., Rubin, P.J, Leyvraz, P.F., deRoguin, B., Argenson, J.N., 1997. Three-dimensional morphology of the proximal femur. The Journal of Arthroplasty 12, 444-450.
15. Kim, J.S., Park, T.S., Park, S.B., Kim, J.S., Kim, I.Y., Kim, S.I., 2000. Measurement of femoral neck anteversion in 3D. Part 1: 3D modelling method. Medical & Biological Engineering & Computing 38, 603-609.
16. Kuo, T.Y., Skedros, J.G., Bloebaum, R.D., 1998. Comparison of human, primate, and canine femora: implications for biomaterials testing in total hip replacement. Journal of Biomedical Materials Research 40, 475-489.
17. Laine, H.J., Lehto, M.U., Moilanen, T., 2000. Diversity of proximal femoral medullary canal. The Journal of Arthroplasty 15, 86-92.
18. Liska, W.D., 2004. Femur fractures associated with canine total hip replacement. Veterinary Surgery 33, 164-172.
19. Madsen, J.S., Svalastoga, E., 1994. Inclination and anteversion of collum femoris in hip dysplasia and coxarthritis. Acta Veterinaria Scandinavica 35, 115-119.
20. Marcellin-Little, D.J., DeYoung, B.A., Doyens, D.H., DeYoung, D.J., 1999. Canine uncemented porous-coated anatomic total hip arthroplasty: results of a long-term prospective evaluation of 50 consecutive cases. Veterinary Surgery 28, 10-20.
21. Marsolais, G.S., Peck, J.N., Berry, C., Johnson, A., 2009. Femoral medullary infarction prevalence with the zurich cementless canine total hip arthroplasty. Veterinary Surgery 38, 677-680.
22. Noble, P.C., Alexander, J.W., Lindahl, L.J., Yew, D.T., Granberry, W.M., Tullos, H. S., 1988. The anatomic basis of femoral component design. Clinical Orthopaedics and Related Research 235, 148-165.
23. Noble, P.C., Kamaric, E., Sugano, N., Matsubara, M., Harada, Y., Ohzono, K., Paravic, V., 2003. Three-dimensional shape of the dysplastic femur: implications for THR. Clinical Orthopaedics and Related Research 417, 27-40.
24. Özdamar, K., 2015. SPSS ile Biyoistatistik. Nisan Kitapevi, Eskişehir.
25. Palierne, S., Asimus, E., Mathon, D., Meynaud-Collard, P., Autefage, A., 2006. Geometric analysis of the proximal femur in a diverse sample of dogs. Research in Veterinary Science 80, 243-252.
26. Palierne, S., Mathon, D., Asimus, E., Concordet, D., Meynaud-Collard, P., Autefage, A., 2008. Segmentation of the canine population in different femoral morphological groups. Research in Veterinary Science 85, 407-417.
27. Peck, J.N., Liska, W.D., DeYoung, D. J., Marcellin-Little, D.J., 2013. Clinical application of total hip replacement. In: Peck J.N., Marcellin-Little D.J. (Eds.), Advanced In Small Animal Total Joint Replacement, Wiley-Blackwell, pp: 89-104.
28. Peck, J. N., Marcellin-Little, D.J., 2013. Revision Strategies for Total Hip Replacement. In: Peck J.N., Marcellin-Little D.J. (Eds.), Advanced In Small Animal Total Joint Replacement, Wiley-Blackwell, pp: 109-131.
29. Pugliese, L.C., 2014. Proximal femoral morphology and bone quality assessment in dogs. Master thesis, The Ohio State University, USA.
30. Rashmir-Raven, A.M., DeYoung, D.J., Abrams, C.F. Jr., Aberman, H.A., Richardson, D.C., 1992. Subsidence of an uncemented canine femoral stem. Veterinary Surgery 21, 327-331.
31. Rawal, B., Ribeiro, R., Malhotra, R., Bhatnagar, N., 2012. Anthropometric measurements to design best-fit femoral stem for the indian population. Indian Journal of Orthopaedics 46, 46-53.
32. Rumph, P.F., Hathcock, J.T., 1990. A symmetric axis-based method for measuring the projected femoral angle of inclination in dogs. Veterinary Surgery 19, 328-333.
33. Rubin, P.J., Leyvraz, P.F., Aubaniac, J.M., Argenson, J.N., Estève, P., deRoguin, B., .1992. The morphology of the proximal femur. A three dimensional radiographic analysis. Journal of bone and joint surgery. British Volume 74: 28-32.
34. Sabanci, S.S., 2015. Köpeklerde arka bacağın morfometrik ölçümleri ve eklem hareket aralığı arasındaki ilişkinin araştırılması. PhD thesis, Adnan Menderes University, Aydin.
35. Sarierler, M., 2004. Comparison of femoral inclination angle measurements in dysplastic and nondysplastic dogs of different breeds. Acta Veterinaria Hungarica 52, 245-252.
36. Sen, R. K., Tripathy, S. K., Kumar, R., Kumar, A., Dhatt, S., Dhillon, M. S., Nagi, O. N., Gulati, M., 2010. Proximal femoral medullary canal diameters in Indians: correlation between anatomic, radiographic, and computed tomographic measurements. The Journal of Orthopaedic Surgery (Hong Kong) 18, 189-194.
37. Sugano, N., Noble, P.C., Kamaric, E., Salama, J.K., Ochi, T., Tullos, H.S., 1998. The morphology of the femur in developmental dysplasia of the hip. Journal of Bone & Joint Surgery, British Volume 80, 711-719.
38. Sumner, D.R. Jr., Devlin, T.C., Winkelman, D., Turner, T.M., 1990. The geometry of adult canine proximal femur. Journal of Orthopaedics 8, 671-677.
39. Tawada, K., Iguchi, H., Tanaka, N., Watanabe, N., Murakami, S., Hasegawa, S., Otsuka, T., 2015. Is the canal flare index a reliable means of estimation of canal shape? Measurement of proximal femoral geometry by use of 3d models of the femur. Journal of Orthopaedic Science 20, 498-506.
40. Tomlinson, J., Fox, D., Cook, J.L., Keller, G.G., 2007. Measurement of femoral angles in four dog breeds. Veterinary Surgery 36, 593-598.
41. Umer, M., Sepah, Y.J., Khan, A., Wazir, A., Ahmed, M., Jawad, M.U., 2010. Morphology of the proximal femur in a Pakistani population. Journal of Orthopaedics Surgery 18, 279-281.
42. Yang, Z., Jian, W., Zhi-han, L., Jun, X., Liang, Z., Ge, Y., Zhan-jun, S., 2014. The geometry of the bone structure associated with total hip arthroplasty. PLoS ONE 9, e91058.
43. Yeung, Y., Chiu, K.Y., Yau, W.P., Tang, W.M., Cheung, W.Y., Ng, T.P., 2006. Assessment of the proximal femoral morphology using plain radiograph-can it predict the bone quality? The Journal of Arthroplasty 21, 508-513.
44. Voss, K., Wiestner, T., Galeandro, L., Hässig, M., Montavon, P.M., 2011. Effect of dog breed and body conformation on vertical ground reaction forces, impulses, and stance times. Veterinary Comparative Orthopedics and Traumatology 24, 106-112.
45. Wigger, A., Tellhelm, B., Kramer, M., Rudorf, H., 2008. Influence of femoral head and neck conformation on hip dysplasia in the German shepherd dog. Veterinary Radiology and Ultrasound 49, 243-248.