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Utility of anterior wall of greater trochanter in predicting femoral anteversion angle: a three-dimensional computed tomography-based simulation study

Abstract

Background

The femoral anteversion angle is an important factor in performing surgery in the proximal part of the femur. Predicting the femoral anteversion angle based on the morphology of the proximal femur is clinically useful. The purpose of this study was to investigate whether an anatomical landmark can be used to predict the femoral anteversion angle intraoperatively.

Materials and methods

We analysed CT data obtained from 100 hips in 69 patients with osteonecrosis of the femoral head with no more than 2 mm collapse and no evidence of osteoarthritic changes. The measured variables were the femoral anteversion angle, the femoral neck-shaft angle, and the AW angle (defined as the angle between the femoral shaft axis and the tangential line of the anterior wall of the greater trochanter). The correlations between variables were also investigated. Multiple regression analysis by the forced input method was performed for the degree of femoral anteversion angle, using sex and the AW angle as explanatory variables.

Results

On CT, the mean femoral anteversion angle was 14.8° ± 10.8°, the mean AW angle was 17.5° ± 8.0°, and the mean femoral neck-shaft angle was 127.3° ± 5.4°. There was a positive correlation between the femoral anteversion angle and the AW angle. The approximation equations based on the multiple regression analysis were as follows: male femoral anteversion angle = AW angle × 0.7 − 0.7 and female femoral anteversion angle = AW angle × 0.7 + 4.3.

Conclusions

Femoral anteversion angle can be predicted based on the AW angle of the greater trochanter.

Introduction

The femoral neck-shaft angle and femoral anteversion angle are important factors in performing surgery in the proximal part of the femur. These angles need to be considered when using lag screws and pins to treat femoral neck fracture and slipped capital femoral epiphysis, and when performing core decompression for osteonecrosis [1,2,3]. In addition, femoral anteversion is an important factor in obtaining an appropriate postoperative intact area in transtrochanteric rotational osteotomy for osteonecrosis, Perthes disease, and severe cases of slipped capital femoral epiphysis [4, 5].

Femoral anteversion angle has been measured based on several methods, including fluoroscopy, radiography, ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) [6,7,8,9,10,11]. Among them, CT of the whole femur (from the femoral head to the distal femoral condyles) has been reported to be the most accurate method for the measurement of femoral anteversion angle [10,11,12]. However, CT of the whole femur is not always possible for all cases because of patient age, pregnancy, radiation exposure, and hospital economy and ability [13,14,15]. In such cases, femoral anteversion angle has generally been measured using plain radiographs, which is also known to be influenced by the leg position when taking radiographs [16]. It is often difficult to obtain a precise and appropriate leg position in patients with hip pain and restricted range of motion. Therefore, the intraoperative use of an intensifier has been widely adopted to reconfirm the femoral anteversion angle at the time of surgery, but the duration of use should be as short as possible.

In total knee arthroplasty, several anatomical landmarks have been proposed as the predictor to adjust the rotational alignment of the femoral and tibial components, including the anteroposterior axis of the femur (Whiteside’s line) [17] and the anteroposterior axis of the tibia (Akagi’s line) [18]. The utility of these landmarks has been supported by several studies [19,20,21]. Similarly, in the hip joint, predicting femoral anteversion angle based on the morphology of the proximal femur is clinically useful [22,23,24,25]. The posterior lesser trochanter line has been reported as an intraoperative reference guide to predict the anteversion angle [24, 25], but it cannot be applied when using the anterior approach and its validity is still controversial [26].

To identify a useful anatomical landmark to predict the femoral anteversion angle intraoperatively, we focussed on the anterior wall angle (AW angle) of the greater trochanter (GT), which was defined as the angle between the femoral shaft axis and the tangential line of the anterior wall of the GT. We hypothesized that the AW angle is an anatomical landmark for predicting femoral anteversion angle.

Methods

Patients

This study was approved by our institutional review board (approval number: U20-12-001). We retrospectively reviewed CT data from 148 hips of 74 consecutive patients diagnosed with osteonecrosis of the femoral head (ONFH) in our hospital from April 2015 to February 2020. The diagnosis of ONFH was based on previously reported criteria [27]. CT examination of both hips was performed for all patients, even if no osteonecrosis was present on the contralateral side. To avoid any secondary changes in the morphology of the femoral head and GT, 48 of the 148 hips were excluded because there was more than 2 mm collapse (12 hips), evidence of osteoarthritic changes (24 hips), or a history of trauma or previous hip surgery (12 hips).

The final study cohort included 100 hips of 69 patients (Table 1). The patients comprised 34 males (53 hips) and 35 females (47 hips). Their mean age at the time of CT was 53.9 years. Their mean height was 162.2 cm. There were 33 normal hips, 3 hips classified as stage 1 ONFH, 21 hips classified as stage 2 ONFH, and 43 hips classified as stage 3A ONFH (less than 2 mm collapse) [28].

Table 1 Patients’ characteristics

CT imaging

All CT imaging was carried out using the Aquilion TSX-101A/HA (Toshiba Medical Systems, Tochigi, Japan) with the patient in the supine position and symmetrically placed in the scanner as shown by the scout views. The images were obtained at 2-mm intervals from the anterosuperior iliac spine to the knee, including the entirety of the distal femoral condyles. After downloading the CT data in Digital Imaging and Communications in Medicine format (National Electrical Manufacturers Association, Rosslyn, VA, USA) onto a personal computer, multiplanar reconstructed images were obtained using CT-based simulation software (ZedOsteotomy; LEXI, Tokyo, Japan).

Definition of level of anterior wall of the GT

We simulated the cutting of the GT passing through a point 5 mm distal to the lateral ridge of the GT, giving a maximum thickness of 10 mm (Fig. 1). The anterior wall of the cut surface of the GT was then nearly flat in all cases. The line tangential to the anterior wall was defined as the anterior wall line (Fig. 2).

Fig. 1
figure 1

The level of the anterior wall of the greater trochanter (dotted line) on anteroposterior view using the International Society of Biomechanics coordinate system. The simulated cut of the greater trochanter passes through the point 5 mm distal to the lateral ridge of the greater trochanter (a), giving a maximum thickness (t) of 10 mm. The cutting line was set based on the osteotomy line of the GT commonly used in hip joint-preserving osteotomies such as transtrochanteric rotational osteotomy and transposition osteotomy of the acetabulum [29, 30]

Fig. 2
figure 2

The plane of osteotomy site of the greater trochanter. The line tangential to the anterior wall was defined as the anterior wall line

Definition of variables

The centre of the femoral head was determined based on the sphere that best-fit the surface of the femoral head. The femoral neck axis was defined three-dimensionally as a line passing through the centre of the femoral head and the midpoint of the narrowest part of the femoral neck. The femoral shaft axis was determined as a line connecting the centre of the medullary canal in a transverse section at the base of the lesser trochanter and in a transverse section 5 cm further distally. Femoral anteversion angle was defined as the angle between the femoral neck axis and a line connecting the posterior aspect of the medial and lateral femoral condyles (posterior condylar line) on the axial view [31]. The femoral neck-shaft angle was defined as the angle between the femoral shaft axis and the femoral neck axis on the anteroposterior view on the tabletop coordinate system [31]. The AW angle was defined as the angle between the femoral shaft axis and the anterior wall line on the sagittal view using the International Society of Biomechanics coordinate system [32] (Fig. 3).

Fig. 3
figure 3

The anterior wall angle on sagittal view using the International Society of Biomechanics coordinate system. The anterior wall angle (AW angle) is defined as the angle between the femoral shaft axis (solid line) and the anterior wall line (dotted line)

Statistical analysis

CT images were measured independently by two orthopaedic surgeons (MS, SK). In addition, the same observer reviewed the radiographs twice on different days, and the average values were calculated. The intraobserver and interobserver reliabilities were assessed using interclass correlation coefficients. The relationships between the femoral anteversion angle, AW angle, and femoral neck-shaft angle were assessed using Pearson’s correlation coefficient. The chi-square test was used to compare categorical data, such as sex. In addition, multiple regression analysis by the forced input method was performed to assess the effect on the degree of femoral anteversion angle; the explanatory variables were sex and variables that showed a strong correlation with femoral anteversion angle. Sex was included as an explanatory variable because several previous studies have shown that females have significantly greater femoral anteversion angle than males [33, 34]. Before performing the multiple regression analysis, the normality of the variables was confirmed by the Shapiro–Wilk test, and the shape of the distribution was confirmed by a histogram. SPSS version 20.0 (IBM Corp., Armonk, NY, USA) was used for the statistical analysis. A P value of < 0.05 was considered statistically significant.

Results

The mean ± standard deviation femoral anteversion angle was 14.8° ± 10.8° (range, − 12.1–38.4°), the mean AW angle was 17.5° ± 8.0° (range, − 0.5–42.5°), and the mean femoral neck-shaft angle was 127.3° ± 5.4° (range, 116.6–143.2°). All measurements (femoral anteversion angle, AW angle, and femoral neck-shaft angle) showed good intraobserver reliability (0.99, 0.96, and 0.99, respectively) and interobserver reliability (0.98, 0.94, and 0.97, respectively). Six patients (5 males, 1 female) had a femoral anteversion angle of < 0° (femoral retroversion). The femoral anteversion angle was positively correlated with the AW angle (P < 0.001, r = 0.67) (Fig. 4) but was not correlated with the femoral neck-shaft angle (P = 0.59, r = − 0.05). The mean femoral anteversion angle and AW angle were significantly greater in females than in males (Table 2). There was no significant difference between ONFH and normal hips in the femoral anteversion angle, AW angle, and femoral neck-shaft angle (Table 3).

Fig. 4
figure 4

Graph showing the relationship between the femoral anteversion and anterior wall angle

Table 2 Sex differences in the femoral anteversion angle, anterior wall angle, and femoral neck-shaft angle
Table 3 Comparison in the femoral anteversion angle, anterior wall angle, and femoral neck-shaft angle between osteonecrosis of femoral head (ONFH) and normal hips

No variables significantly deviated from the normal distribution or had a biased frequency. Therefore, dummy variable conversion and change of variables were not performed. Multiple regression analysis was performed to predict the femoral anteversion angle based on the AW angle and sex as explanatory variables. The result of the multiple regression analysis for femoral anteversion angle is shown in Table 4. A significant regression equation was found [F (2, 97) = 49.945, P < 0.000] with an R2 value of 0.507. The predicted femoral anteversion angle was equal to 4.330 + 0.744 (AW angle) − 4.998 (sex), when sex was coded as 0 = female and 1 = male. Therefore, the approximation equations for each sex were as follows:

$${\text{Male}}\;{\text{femoral}}\;{\text{anteversion}}\;{\text{angle}} = {\text{AW - angle}} \times 0.7 - 0.7$$
$${\text{Female}}\;{\text{femoral}}\;{\text{anteversion}}\;{\text{angle}} = {\text{AW - angle}} \times 0.7 + 4.3$$

The femoral anteversion angle increased by 0.7° with each degree increase in the AW angle, and the femoral anteversion angle was about 5° greater in females than males, even at the same AW angle. Both the AW angle and sex were significant predictors of femoral anteversion angle. The result of the analysis of variance was statistically significant. The Durbin–Watson ratio was 1.789, which indicated only a very mild amount of autocorrelation, and there were no outliers whose predicted values exceeded ± 3 standard deviations with respect to the measured values. The error between the result of regression equation and femoral anteversion angle was more than 10° in 17% (17 of 100 hips), which included 6 cases with femoral retroversion.

Table 4 Results of multiple regression analysis for femoral anteversion angle

Discussion

This simulation study demonstrated that the femoral anteversion angle can be predicted based on the AW angle of the GT. Our findings indicate that the anterior wall of the GT may be used to predict the degree of femoral anteversion angle intraoperatively, even if CT of the whole femur (from the femoral head to the distal femoral condyles) cannot be performed.

Intraoperative use of an intensifier is a widely accepted method with which to confirm the femoral anteversion angle; however, a reduction in intraoperative radiation exposure has benefits for both surgeons and patients [35, 36]. We believe that measuring the AW angle may reduce the risk of unnecessary intraoperative radiation overexposure.

The lesser trochanter line is reported as a useful landmark for the prediction of the femoral anteversion angle [24, 25], but it can only be applied when using the posterior approach. In contrast, the regression equation in this study may be applicable not only to the posterior approach but also to other approaches to which the GT is able to be exposed.

This study was performed based on femoral CT models with no deformity of the proximal part of the femur in cases of ONFH and no evidence of deformity or osteophyte formation on the anterior wall of the GT. Therefore, this regression equation may be useful for hip surgery in young patients without deformity, such as transtrochanteric rotational osteotomy which is a joint-preserving surgery for ONFH [29] and internal fixation for femoral neck fracture and slipped capital femoral epiphysis. The anterior wall line of the GT is directly visible, especially in transtrochanteric rotational osteotomy, because the GT is osteotomized, and can help determine the neck osteotomy line to adjust the postoperative femoral anteversion.

The regression equation was not applied for hips showing femoral retroversion because all hips with retroversion showed an AW angle of > 0°. It has been reported that the larger the femoral anteversion angle, the greater the effect of rotation at the femoral neck, and the smaller the femoral anteversion angle, the greater the effect at the femoral shaft [37]. Thus, the femoral retroversion may be regulated at the femoral shaft in the absence of a relationship with the morphology of the anterior wall of the GT. Therefore, the cases with retroversion on plain radiography should be excluded before surgery.

Our study had several limitations. First, the regression equations are not applicable to patients with open epiphyseal growth plates because the study cohort only included patients with closed epiphyseal growth plates. Second, the validation of intraoperative measurement and AW angle in CT is not yet performed. Third, the AW angle was measured at a point 10 mm below the top of the GT. Whether the AW angle is constant in every part of the anterior wall of the GT remains unknown. Fourth, the use of the AW angle to predict the femoral anteversion angle may not be applicable in patients with severe deformity of the proximal femur, including those with end-stage osteoarthritis, osteonecrosis, and Perthes disease. Finally, all data in this study were collected from Japanese people. Previous studies have shown that the femoral anteversion angle does not significantly differ between Japanese males and females of other races, whereas Japanese females have a greater femoral anteversion angle than females of other races [33, 34]. Further study may be necessary before this regression equation is widely adopted, especially for females who are not Japanese.

This study was performed based on CT imaging analysis; thus, for preoperative femoral anteversion prediction, CT examination at least in the proximal part of the femur is necessary. The ideal method with which to predict femoral anteversion would be based on plain radiographs. Further studies will be performed using plain radiography based on the results of this study.

Conclusion

This CT-based simulation study demonstrated that the femoral anteversion angle can be predicted by the AW angle of the GT. The AW angle may be useful for intraoperative confirmation of the femoral anteversion angle.

Availability of data and materials

The data sets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

CT:

Computed tomography

AW:

Anterior wall

MRI:

Magnetic resonance imaging

GT:

Greater trochanter

ONFH:

Osteonecrosis of the femoral head

References

  1. Behr JT, Dobozi WR, Badrinath K. The treatment of pathologic and impending pathologic fractures of the proximal femur in the elderly. Clin Orthop Relat Res. 1985;198:173–8.

    Article  Google Scholar 

  2. Aronson DD, Carlson WE. Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Jt Surg Am. 1992;74(6):810–9.

    CAS  Article  Google Scholar 

  3. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Jt Surg Br. 1985;67(1):3–9.

    CAS  Article  Google Scholar 

  4. Sonoda K, Motomura G, Ikemura S, Kubo Y, Yamamoto T, Nakashima Y. Effects of intertrochanteric osteotomy plane and preoperative femoral anteversion on the postoperative morphology of the proximal femur in transtrochanteric anterior rotational osteotomy: 3D CT-based simulation study. Orthop Traumatol Surg Res. 2017;103(7):1005–10.

    CAS  Article  Google Scholar 

  5. Xu M, Motomura G, Ikemura S, Yamaguchi R, Utsunomiya T, Baba S, Kawano K, Nakashima Y. Proximal femoral morphology after transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head: a three-dimensional simulation study. Orthop Traumatol Surg Res. 2020;106(8):1569–74.

    Article  Google Scholar 

  6. Rogers SP. A method for determining the angle of torsion of the neck of the femur. J Bone Jt Surg. 1931;13:821–4.

    Google Scholar 

  7. Ogata K, Goldsand EM. A simple biplanar method of measuring femoral anteversion and neck-shaft angle. J Bone Jt Surg Am. 1979;61(6A):846–51.

    CAS  Article  Google Scholar 

  8. Moulton A, Upadhyay SS. A direct method of measuring femoral anteversion using ultrasound. J Bone Jt Surg Br. 1982;64(4):469–72.

    CAS  Article  Google Scholar 

  9. Botser IB, Ozoude GC, Martin DE, Siddiqi AJ, Kuppuswami S, Domb BG. Femoral anteversion in the hip: comparison of measurement by computed tomography, magnetic resonance imaging, and physical examination. Arthroscopy. 2012;28(5):619–27.

    Article  Google Scholar 

  10. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Femoral anteversion. J Bone Jt Surg Am. 1987;69(8):1169–76.

    CAS  Article  Google Scholar 

  11. Sugano N, Noble PC, Kamaric E. A comparison of alternative methods of measuring femoral anteversion. J Comput Assist Tomogr. 1998;22(4):610–4.

    CAS  Article  Google Scholar 

  12. Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat. 2020;237(5):811–26.

    Article  Google Scholar 

  13. Ichimaru M, Ishimaru T, Belsky JL. Incidence of leukemia in atomic bomb survivors belonging to a fixed cohort in Hiroshima and Nagasaki, 1950–71. Radiation dose, years after exposure, age at exposure, and type of leukemia. J Radiat Res. 1978;19(3):262–82.

    CAS  Article  Google Scholar 

  14. Streffer C, Shore R, Konermann G, Meadows A, Uma Devi P, Preston Withers J, et al. Biological effects after prenatal irradiation (embryo and fetus). A report of the international commission on radiological protection. Ann ICRP. 2003;33(1–2):5–206.

    CAS  PubMed  Google Scholar 

  15. Brambilla M, Vassileva J, Kuchcinska A, Rehani MM. Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action. Eur Radiol. 2020;30(5):2493–501.

    Article  Google Scholar 

  16. Kay RM, Jaki KA, Skaggs DL. The effect of femoral rotation on the projected femoral neck-shaft angle. J Pediatr Orthop. 2000;20(6):736–9.

    CAS  Article  Google Scholar 

  17. Whiteside LA, Arima J. The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res. 1995;321:168–72.

    Google Scholar 

  18. Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res. 2004;420:213–9.

    Article  Google Scholar 

  19. Arima J, Whiteside LA, McCarthy DS, White SE. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Jt Surg Am. 1995;77(9):1331–4.

    CAS  Article  Google Scholar 

  20. Jang ES, Connors-Ehlert R, LiArno S, Geller JA, Cooper HJ, Shah RP. Accuracy of reference axes for femoral component rotation in total knee arthroplasty: computed tomography-based study of 2,128 femora. J Bone Jt Surg Am. 2019;101(23): e125.

    Article  Google Scholar 

  21. Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C. Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res. 2005;436:172–6.

    Article  Google Scholar 

  22. Veilleux NJ, Kalore NV, Wegelin JA, Vossen JA, Jiranek WA, Wayne JS. Automated femoral version estimation without the distal femur. J Orthop Res. 2018;36(12):3161–8.

    Article  Google Scholar 

  23. Hu J, Xu L, Jing M, Zhang H, Wang L, Chen X. An approach to automated measuring morphological parameters of proximal femora on three-dimensional models. Int J Comput Assist Radiol Surg. 2020;15(1):109–18.

    Article  Google Scholar 

  24. Shon WY, Yun HH, Yang JH, Song SY, Park SB, Lee JW. The use of the posterior lesser trochanter line to estimate femoral neck version: an analysis of computed tomography measurements. J Arthroplast. 2013;28(2):352–8.

    Article  Google Scholar 

  25. Yun HH, Yoon JR, Yang JH, Song SY, Park SB, Lee JW. A validation study for estimation of femoral anteversion using the posterior lesser trochanter line: an analysis of computed tomography measurement. J Arthroplast. 2013;28(10):1776–80.

    Article  Google Scholar 

  26. Worlicek M, Weber M, Craiovan B, Zeman F, Grifka J, Renkawitz T, Wörner M. Posterior lesser trochanter line should not be used as reference for assessing femoral version in CT scans: a retrospective reliability and agreement study. Acta Radiol. 2017;58(9):1101–7.

    Article  Google Scholar 

  27. Sugano N, Kubo T, Takaoka K, Ohzono K, Hotokebuchi T, Matsumoto T, et al. Diagnostic criteria for non-traumatic osteonecrosis of the femoral head. A multicentre study. J Bone Jt Surg Br. 1999;81(4):590–5.

    CAS  Article  Google Scholar 

  28. Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplast. 2020;35(4):933–40.

    Article  Google Scholar 

  29. Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res. 1978;130:191–201.

    Google Scholar 

  30. Sonohata M, Yonekura Y, Kitajima M, Kawano S, Mawatari M. Transpositional periacetabular osteotomy with allografting in patients with severe dysplasia: mid-term results. Hip Int. 2017;27(1):35–41.

    Article  Google Scholar 

  31. 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 Jt Surg Br. 1998;80(4):711–9.

    CAS  Article  Google Scholar 

  32. Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion–part I: ankle, hip, and spine. Int Soc Biomechan J Biomech. 2002;35(4):543–8.

    Google Scholar 

  33. Fabry G, MacEwen GD, Shands AR Jr. Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Jt Surg Am. 1973;55(8):1726–38.

    CAS  Article  Google Scholar 

  34. Nakahara I, Takao M, Sakai T, Nishii T, Yoshikawa H, Sugano N. Gender differences in 3D morphology and bony impingement of human hips. J Orthop Res. 2011;29(3):333–9.

    Article  Google Scholar 

  35. Lai CH, Finlay A, Cannada LK, Chen AF, Chou LB. Radiation exposure and case characteristics in national sample of female orthopaedic trauma and arthroplasty surgeons. Iowa Orthop J. 2020;40(1):5–11.

    PubMed  PubMed Central  Google Scholar 

  36. Singer G. Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg. 2005;13(1):69–76.

    Article  Google Scholar 

  37. Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP. The contribution of different femur segments to overall femoral torsion. Am J Sports Med. 2016;44(7):1796–800.

    Article  Google Scholar 

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Acknowledgements

We thank Kelly Zammit, BVSc, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

Authors

Contributions

MS conceived the study and wrote the manuscript as the first author. KK, TS, HS, and IY provided the methodology of the study. KK and TS contributed to collecting the cases. SK contributed to measured CT imaging. TY supervised the study as the corresponding author. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takuaki Yamamoto.

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This study was performed with the approval (approval number: U20-12-001) of the Clinical Research Ethics Committee of Fukuoka University Faculty of Medicine. All subjects provided their consent to participate in this study.

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Not applicable.

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The authors declare that they have no competing interests.

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Suzuki, M., Kinoshita, K., Sakamoto, T. et al. Utility of anterior wall of greater trochanter in predicting femoral anteversion angle: a three-dimensional computed tomography-based simulation study. J Orthop Surg Res 17, 412 (2022). https://doi.org/10.1186/s13018-022-03313-z

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Keywords

  • Femoral anteversion angle
  • Anterior wall angle
  • Hip surgery
  • Anatomical landmark