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Morphometric analysis of anatomical reference points in hip surgery: A study on cadaveric and radiographic images

Year 2025, Volume: 11 Issue: 5, 832 - 844, 04.09.2025
https://doi.org/10.18621/eurj.1700331

Abstract

Objectives: This study aims to evaluate the accuracy of morphometric measurements obtained from cadavers and anteroposterior (AP) pelvic radiographs.

Methods: A total of 15 cadavers from the anatomical collection of Cukurova University and 217 AP pelvic radiographs from individuals aged 65-80 years with no orthopedic conditions were analyzed. Morphometric measurements were taken from cadavers using Kirschner wires placed at anatomical reference points: the spina iliaca anterior superior (SIAS), the highest point of the crista iliaca (CI), and the trochanter major (TM). Distances were measured with a non-elastic tape, and angular measurements were conducted using ImageJ software. These were compared with radiographic data analyzed via the PACS system. Statistical analysis was performed using SPSS 20 with One-Way ANOVA to assess group differences.

Results: The mean age was 70.98±4.70 years for radiograph individuals and 80.36±5.13 years for cadavers. Significant differences were found between cadaveric, dissected cadaver, and radiological measurements. The SIAS-TM distance was longest in cadavers (113.82±7.46 mm) and shortest in radiographs (92.73±14.36 mm). The CI-TM distance was greatest in radiographs (147.81±12.02 mm), while the SIAS-CI distance was longest in cadavers (78.95±6.48 mm). Differences in SIAS-TM (P<0.001), CI-TM (P=0.007), and SIAS-CI (P=0.029) distances were statistically significant. Angular measurements also varied, with radiographs showing higher SIAS angles and cadavers showing greater TM and CI angles, especially on the right side.

Conclusions: The study reveals notable discrepancies between cadaveric and radiological morphometric measurements. These cadaver-based findings may serve as valuable resources for surgical training and anatomical education, especially in hip arthroplasty planning.

Ethical Statement

Ethical approval was approved by the Non-Invasive Clinical Research Ethics Committee of Cukurova University Faculty of Medicine on November 8, 2024 (Decision No: 149/7).

References

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  • 2. Bostan B, Sen C, Güneş T, Erdem M, Aytekin K, Erkorkmaz U. [Total hip arthroplasty using the anterolateral minimally invasive approach]. Acta Orthop Traumatol Turc. 2009;43(6):464-471. doi: 10.3944/AOTT.2009.464. [Article in Turkish]
  • 3. Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R. Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study. Int Orthop. 2017;41(7):1347-1353. doi: 10.1007/s00264-016-3365-2.
  • 4. Zha GC, Zhu XR, Wang L, Li HW. Tranexamic acid reduces blood loss in primary total hip arthroplasty performed using the direct anterior approach: a one-center retrospective observational study. J Orthop Traumatol. 2022;23(1):12. doi: 10.1186/s10195-022-00638-7.
  • 5. Zhai H, Huang J, Li L, et al. Deep learning-based workflow for hip joint morphometric parameter measurement from CT images. Phys Med Biol. 2023;68(22). doi: 10.1088/1361-6560/ad04aa.
  • 6. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br. 1998;80(4):711-719. doi: 10.1302/0301-620x.80b4.8319.
  • 7. Verma M, Joshi S, Tuli A, Raheja S, Jain P, Srivastava P. Morphometry of Proximal Femur in Indian Population. J Clin Diagn Res. 2017;11(2):AC01-AC04. doi: 10.7860/JCDR/2017/23955.9210.
  • 8. Solomon LB, Howie DW, Henneberg M. The variability of the volume of os coxae and linear pelvic morphometry. Considerations for total hip arthroplasty. J Arthroplasty. 2014;29(4):769-776. doi: 10.1016/j.arth.2013.08.015.
  • 9. Zeckey C, Bogusch M, Borkovec M, et al. Radiographic cortical thickness parameters as predictors of rotational alignment in proximal femur fractures: A cadaveric study. J Orthop Res. 2019;37(1):69-76. doi:10.1002/jor.24166.
  • 10. Zhou X, Ji H, Guo J, Yang Y, Cai P, Zhang X. Modified osteotomy of posterolateral overhanging part of the trochanter via posterior approach for hip arthroplasty: an anatomical study. BMC Musculoskelet Disord. 2020;21(1):119. doi: 10.1186/s12891-020-3088-9.
  • 11. Yee A, Padovano WM, Rowe AG, et al. The Effect of Surgical Video on Resident Performance of Carpal Tunnel Release: A Cadaveric Simulation-Based, Prospective, Randomized, Blinded Pilot Study. Plast Reconstr Surg. 2020;145(6):1455-1463. doi: 10.1097/PRS.0000000000006817.
  • 12. Zucal I, Feder AL, Kyaw T, et al. An Innovative Simulation Model for Microvascular Training. Plast Reconstr Surg. 2022;150(1):189e-193e. doi: 10.1097/PRS.0000000000009209.
  • 13. Zhang L, Huang T, Li C, et al. Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D-MRI Study. Orthop Surg. 2024;16(1):216-226. doi: 10.1111/os.13918.
  • 14. Austin MS, Hozack WJ, Sharkey PF, Rothman RH. Stability and leg length equality in total hip arthroplasty. J Arthroplasty. 2003;18(3 Suppl 1):88-90. doi: 10.1054/arth.2003.50073.
  • 15. Vanrusselt J, Vansevenant M, Vanderschueren G, Vanhoenacker F. Postoperative radiograph of the hip arthroplasty: what the radiologist should know. Insights Imaging. 2015;6(6):591-600. doi: 10.1007/s13244-015-0438-5.
  • 16. Cantrell WA, Samuel LT, Sultan AA, Acuña AJ, Kamath AF. Operative Times Have Remained Stable for Total Hip Arthroplasty for >15 Years: Systematic Review of 630,675 Procedures. JB JS Open Access. 2019;4(4):e0047. doi: 10.2106/JBJS.OA.19.00047.
  • 17. Heinz T, Vasilev H, Anderson PM, et al. The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases. J Clin Med. 2023;12(12):3941. doi: 10.3390/jcm12123941.
  • 18. Yiasemidou M, Gkaragkani E, Glassman D, Biyani CS. Cadaveric simulation: a review of reviews. Ir J Med Sci. 2018;187(3):827-833. doi: 10.1007/s11845-017-1704-y.
  • 19. James HK, Chapman AW, Pattison GTR, Griffin DR, Fisher JD. Systematic review of the current status of cadaveric simulation for surgical training. Br J Surg. 2019;106(13):1726-1734. doi: 10.1002/bjs.11325.
  • 20. Hughes JL, Katsogridakis E, Junaid-Siddiqi A, et al. The development of cadaveric simulation for core surgical trainees. Bull R Coll Surg Eng. 2019;101(1):38-43. doi: 10.1308/rcsbull.2019.38.
  • 21. Selçuk İ, Tatar İ, Huri E. The effect of cadaveric hands-on training model on surgical skills and confidence for transobturator tape surgery. J Turk Ger Gynecol Assoc. 2019;20(4):243-246. doi: 10.4274/jtgga.galenos.2018.2018.0043.

Year 2025, Volume: 11 Issue: 5, 832 - 844, 04.09.2025
https://doi.org/10.18621/eurj.1700331

Abstract

References

  • 1. Huo MH, Parvizi J, Bal BS, Mont MA. What's new in total hip arthroplasty. J Bone Joint Surg Am. 2009;91(10):2522-2534. doi: 10.2106/JBJS.I.00801.
  • 2. Bostan B, Sen C, Güneş T, Erdem M, Aytekin K, Erkorkmaz U. [Total hip arthroplasty using the anterolateral minimally invasive approach]. Acta Orthop Traumatol Turc. 2009;43(6):464-471. doi: 10.3944/AOTT.2009.464. [Article in Turkish]
  • 3. Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R. Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study. Int Orthop. 2017;41(7):1347-1353. doi: 10.1007/s00264-016-3365-2.
  • 4. Zha GC, Zhu XR, Wang L, Li HW. Tranexamic acid reduces blood loss in primary total hip arthroplasty performed using the direct anterior approach: a one-center retrospective observational study. J Orthop Traumatol. 2022;23(1):12. doi: 10.1186/s10195-022-00638-7.
  • 5. Zhai H, Huang J, Li L, et al. Deep learning-based workflow for hip joint morphometric parameter measurement from CT images. Phys Med Biol. 2023;68(22). doi: 10.1088/1361-6560/ad04aa.
  • 6. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br. 1998;80(4):711-719. doi: 10.1302/0301-620x.80b4.8319.
  • 7. Verma M, Joshi S, Tuli A, Raheja S, Jain P, Srivastava P. Morphometry of Proximal Femur in Indian Population. J Clin Diagn Res. 2017;11(2):AC01-AC04. doi: 10.7860/JCDR/2017/23955.9210.
  • 8. Solomon LB, Howie DW, Henneberg M. The variability of the volume of os coxae and linear pelvic morphometry. Considerations for total hip arthroplasty. J Arthroplasty. 2014;29(4):769-776. doi: 10.1016/j.arth.2013.08.015.
  • 9. Zeckey C, Bogusch M, Borkovec M, et al. Radiographic cortical thickness parameters as predictors of rotational alignment in proximal femur fractures: A cadaveric study. J Orthop Res. 2019;37(1):69-76. doi:10.1002/jor.24166.
  • 10. Zhou X, Ji H, Guo J, Yang Y, Cai P, Zhang X. Modified osteotomy of posterolateral overhanging part of the trochanter via posterior approach for hip arthroplasty: an anatomical study. BMC Musculoskelet Disord. 2020;21(1):119. doi: 10.1186/s12891-020-3088-9.
  • 11. Yee A, Padovano WM, Rowe AG, et al. The Effect of Surgical Video on Resident Performance of Carpal Tunnel Release: A Cadaveric Simulation-Based, Prospective, Randomized, Blinded Pilot Study. Plast Reconstr Surg. 2020;145(6):1455-1463. doi: 10.1097/PRS.0000000000006817.
  • 12. Zucal I, Feder AL, Kyaw T, et al. An Innovative Simulation Model for Microvascular Training. Plast Reconstr Surg. 2022;150(1):189e-193e. doi: 10.1097/PRS.0000000000009209.
  • 13. Zhang L, Huang T, Li C, et al. Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D-MRI Study. Orthop Surg. 2024;16(1):216-226. doi: 10.1111/os.13918.
  • 14. Austin MS, Hozack WJ, Sharkey PF, Rothman RH. Stability and leg length equality in total hip arthroplasty. J Arthroplasty. 2003;18(3 Suppl 1):88-90. doi: 10.1054/arth.2003.50073.
  • 15. Vanrusselt J, Vansevenant M, Vanderschueren G, Vanhoenacker F. Postoperative radiograph of the hip arthroplasty: what the radiologist should know. Insights Imaging. 2015;6(6):591-600. doi: 10.1007/s13244-015-0438-5.
  • 16. Cantrell WA, Samuel LT, Sultan AA, Acuña AJ, Kamath AF. Operative Times Have Remained Stable for Total Hip Arthroplasty for >15 Years: Systematic Review of 630,675 Procedures. JB JS Open Access. 2019;4(4):e0047. doi: 10.2106/JBJS.OA.19.00047.
  • 17. Heinz T, Vasilev H, Anderson PM, et al. The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases. J Clin Med. 2023;12(12):3941. doi: 10.3390/jcm12123941.
  • 18. Yiasemidou M, Gkaragkani E, Glassman D, Biyani CS. Cadaveric simulation: a review of reviews. Ir J Med Sci. 2018;187(3):827-833. doi: 10.1007/s11845-017-1704-y.
  • 19. James HK, Chapman AW, Pattison GTR, Griffin DR, Fisher JD. Systematic review of the current status of cadaveric simulation for surgical training. Br J Surg. 2019;106(13):1726-1734. doi: 10.1002/bjs.11325.
  • 20. Hughes JL, Katsogridakis E, Junaid-Siddiqi A, et al. The development of cadaveric simulation for core surgical trainees. Bull R Coll Surg Eng. 2019;101(1):38-43. doi: 10.1308/rcsbull.2019.38.
  • 21. Selçuk İ, Tatar İ, Huri E. The effect of cadaveric hands-on training model on surgical skills and confidence for transobturator tape surgery. J Turk Ger Gynecol Assoc. 2019;20(4):243-246. doi: 10.4274/jtgga.galenos.2018.2018.0043.
There are 21 citations in total.

Details

Primary Language English
Subjects Anatomy
Journal Section Original Articles
Authors

Ayşe Gül Kabakcı 0000-0001-7144-8759

Ömer Sunkar Biçer 0000-0002-1085-3141

Memduha Gülhal Bozkır 0000-0003-4164-4227

Early Pub Date July 15, 2025
Publication Date September 4, 2025
Submission Date May 15, 2025
Acceptance Date June 27, 2025
Published in Issue Year 2025 Volume: 11 Issue: 5

Cite

AMA Kabakcı AG, Biçer ÖS, Bozkır MG. Morphometric analysis of anatomical reference points in hip surgery: A study on cadaveric and radiographic images. Eur Res J. September 2025;11(5):832-844. doi:10.18621/eurj.1700331

e-ISSN: 2149-3189 


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