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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Three-dimensional analysis of age and sex differences in femoral head asphericity in asymptomatic hips in the United States
Mahad M Hassan, Aliya G Feroe, Brenton W Douglass, Andrew E Jimenez, Benjamin Kuhns, Charles F Mitchell, Robert L Parisien, Daniel A Maranho, Eduardo N Novais, Young-Jo Kim, Ata M Kiapour
Mahad M Hassan, Brenton W Douglass, Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN 55454, United States
Mahad M Hassan, Department of Orthopedic Surgery, TRIA Orthopaedic Center, Bloomington, MN 55122, United States
Aliya G Feroe, Charles F Mitchell, Daniel A Maranho, Eduardo N Novais, Young-Jo Kim, Ata M Kiapour, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA 02115, United States
Aliya G Feroe, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55901, United States
Andrew E Jimenez, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, United States
Benjamin Kuhns, Department of Orthopedic Surgery, American Hip Institute Research Foundation, Des Plaines, IL 60018, United States
Robert L Parisien, Daniel A Maranho, Department of Orthopedic Surgery, Mount Sinai, New York, NY 10029, United States
Daniel A Maranho, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14048-900, São Paulo, Brazil
Author contributions: Hassan MM, Parisien RL, Novais EN, Kim YJ, and Kiapour AM contributed to the study concept and design; Hassan MM, Feroe AG, Douglass BW, Jimenez AE, Kuhns B, Mitchell CF, Parisien RL, Maranho DA, and Kiapour AM participated in the data collection and analysis; Hassan MM, Feroe AG, Douglass BW, Mitchell CF, and Kiapour AM drafted the manuscript.
Institutional review board statement: This study and the protocols utilized were approved by the Institutional Review Board of our institution.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data supporting the findings of this study are available within the paper and its Supplementary Information. No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Brenton W Douglass, MD, Doctor, Department of Orthopedic Surgery, University of Minnesota, 2512 S 7th Street #R200, Minneapolis, MN 55454, United States. brentondouglass261@gmail.com
Received: February 26, 2024
Revised: June 5, 2024
Accepted: June 24, 2024
Published online: August 18, 2024
Processing time: 168 Days and 20.3 Hours
BACKGROUND
The sphericity of the femoral head is a metric used to evaluate hip pathologies and is associated with the development of osteoarthritis and femoral-acetabular impingement.
AIM
To analyze the three-dimensional asphericity of the femoral head of asymptomatic pediatric hips. We hypothesized that femoral head asphericity will vary significantly between male and female pediatric hips and increase with age in both sexes.
METHODS
Computed tomography scans were obtained on 158 children and adolescents from a single institution in the United States (8-18 years; 50% male) without hip pain. Proximal femoral measurements including the femoral head diameter, femoral head volume, residual volume, asphericity index, and local diameter difference were used to evaluate femoral head sphericity.
RESULTS
In both sexes, the residual volume increased by age (P < 0.05). Despite significantly smaller femoral head size in older ages (> 13 years) in females, there were no sex-differences in residual volume and aspherity index. There were no age-related changes in mean diameter difference in both sexes (P = 0.07) with no significant sex-differences across different age groups (P = 0.06). In contrast, there were significant increases in local aspherity (maximum diameter difference) across whole surface of the femoral head and all quadrants except the inferior regions in males (P = 0.03). There were no sex-differences in maximum diameter difference at any regions and age group (P > 0.05). Increased alpha angle was only correlated to increased mean diameter difference across overall surface of the femoral head (P = 0.024).
CONCLUSION
There is a substantial localized asphericity in asymptomatic hips which increases with age in. While 2D measured alpha angle can capture overall asphericity of the femoral head, it may not be sensitive enough to represent regional asphericity patterns.
Core Tip: Femoral head asphericity changes with age demonstrated by significant femoral head asphericity in asymptomatic hips via increased residual volume with age for both sexes. However, no significant overall asphericity differences existed between males and females. While the overall femoral head asphericity was small, there were substantial local divergencies from perfect sphericity in both males and females, with maximum diameter difference correlating with age overall and across all quadrants except for inferior quadrants in males.
