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Online ISSN 1827-1707
Gennari E. 1, Bruzzone M. 1, Bellato E. 1, Rossi R. 1, Tellini A. 2, Castoldi F. 2, Blonna D. 2
1 Department of Orthopedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Turin, Italy;
2 Department of Orthopedics and Traumatology CTO – Maria Adelaide Hospital,, University of Turin Medical School, Turin, Italy
Aim. Leg length discrepancy has been described after hemiarthroplasty of the hip. Its origin is not known with certainly, however inaccurate identification of anatomical landmarks may play a role. The aim of this study was to measure the intra- and interobserver reliability of intraoperative landmarks used in hip hemiarthroplasty. The reliability of the gluteus maximum insertion into the femur was also tested. This landmark has been tested for its potential utility in case of hemiarthroplasty for the treatment of unstable intertrochanteric fractures when other landmarks are lacking.
Methods. Thirty-four hips were studied. Dissection was done via the posterolateral approach. Two observers, a senior resident and an orthopedic surgeon, determined the following measures: femoral head diameter, neck-shaft angle and distance from the deep insertion of the gluteus maximum muscle into the femur to: 1) the trochanteric fossa; 2) the tip of the greater trochanter; 3) the farthest aspect of the femoral head (GM-DFH); 4) the external center of the femoral head as well as the distance from the lesser trochanteric sulcus to e) the trochanteric fossa; 5) the tip of the greater trochanter, g) the farthest aspect of the femoral head (LT-DFH); 6) the external center of the femoral head (LT-EC). Intra- and interobserver reliability was analyzed using Bland and Altman analysis.
Results. The GM-DFH was the distance with the best intra- and interobserver reliability (error: 0±3 mm). The distance LT-DFH had moderate reliability: intraobserver reliability 0±5 mm, interobserver reliability 1±6 mm. The distance LT-EC showed the worst reliability: intraobserver reliability: 3±8 mm, interobserver reliability 4±11 mm. The GM-DFH was consistently twice the diameter of the femoral head (errors: 0±7 mm).
Conclusions. The gluteus maximum tendon insertion into the femur is a reliable landmark. The lesser trochanter should be used with caution. The use of the external center of the femoral head and the tip of the trochanter and the trochanteric fossa should be avoided during hip surgery.
language: English, Italian