The usefulness of spatial assessment of proximal femoral morphology in preoperative planning of cementless hip arthroplasty

Katarzyna Chamier-Ciemińska, Łukasz Kołodziej, Zbigniew Celewicz, Wojciech Poncyljusz

Abstract


Introduction: Accurate preoperative planning for cementless total hip arthroplasty (THA) requires precise assessment of proximal femoral morphology to ensure implant stability and long-term survival. 
This study aimed to evaluate the variability of proximal femoral morphology using computed tomography (CT)-based morphometry and to determine its clinical relevance in selecting the appropriate type of femoral prosthesis. 
Materials and methods: A retrospective analysis was performed on 99 patients (58 men, 41 women; mean age 61 ±6.6 years) who underwent lower-limb CT angiography between 2017–2019. Patients with a history of trauma, congenital or degenerative deformities were excluded. Radiological parameters assessed included: femoral length (relative and absolute), neck-shaft angle, canal flare index (CFI), Dorr classification, and femoral torsion angles (angle of varus deformity of the femur, angle of posterior convexity of the proximal femur and angle of anterior convexity of the middle part of the femur). Statistical analysis was conducted using Statistica 13.0 with significance set at p ≤ 0.05. 
Results: No statistically significant differences were found between right and left femur across all parameters. The mean relative femoral length was 44.6 ±3.0 cm, neck-shaft angle 127.3 ±5.0°, and mean CFI 4.53 ±0.59. Dorr type B morphology predominated (68%), followed by types A (19%) and C (13%). Males had significantly longer femur (p < 0.001), while CFI correlated positively with age (r = 0.38; p < 0.05). 
Conclusions: Proximal femoral morphology demonstrates high interindividual variability but no relevant side-to-side asymmetry. Computed tomography-based 3D assessment enhances the accuracy of preoperative planning and may help in selecting the optimal prosthesis for cementless hip arthroplasty.

Keywords


total hip arthroplasty; femoral morphology; canal flare index; Dorr classification; computed tomography; preoperative planning

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DOI: https://doi.org/10.21164/pomjlifesci.1198

Copyright (c) 2025 Katarzyna Chamier-Ciemińska, Łukasz KołodziejB, Zbigniew Celewicz, Wojciech Poncyljusz

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