MOJ Header

Current Issue - March 2023, Volume 17, Issue No. 1

Official Journal of Malaysian Orthopaedic Association and ASEAN Orthopaedic Association

Radiographic Characteristics of the Femoral Nutrient Artery Canals in Total Hip Arthroplasty using Cementless Femoral Stem


Introduction: Accurate diagnosis of undisplaced periprosthetic femoral fracture (PFF) after hip arthroplasty is crucial, as overlooked PFF may affect its treatment and prognosis. The undisplaced PFF is often difficult to distinguish from radiolucent lines of nutrient artery canal (NAC) of the femur present on post-operative radiographs. We aimed to identify the radiographic features of NAC to distinguish them from PFFs.

Materials and methods: In this retrospective radiological study, a total of 242 cases in 215 patients with hip arthroplasty were analysed using pre-operative and post-operative anteroposterior (AP) and translateral (TL) radiographs. Interobserver agreement of the measurements was assessed by two independent experienced orthopaedic surgeons. The kappa value ranged from 0.83 to 0.87, indicating strong agreement according to the Landis and Koch criteria.

Results: The NACs were found pre-operatively in 94 (39.8%) cases on AP views and in 122 cases (50.4%) on TL views. The radiolucent lines were observed post-operatively in 42 (17.4%) on AP views and 122 (50.4%) on the TL views. three cases (1.2%) had a fracture around the stem that were detected on radiographs. One case with PFF presented simultaneously with NAC on the immediate post-operative radiographs. All patients were treated by conservative measures, and the radiolucent lines did not appear on follow-up radiographs.

Conclusion: It is not easy to differentiate undisplaced PFFs that can occur after hip arthroplasty operation from NACs. However, accurate diagnosis is possible through careful observation and comparison of pre-operative and post-operative radiologic images.

Abstract   |   Reference

MOJ footer

About Us

The Malaysian Orthopaedic Journal is a peer-reviewed journal that is published three times a year in both print and electronic online version. The purpose of this journal is to publish original research studies, evaluation of current practices and case reports in various subspecialties of orthopaedics and traumatology, as well as associated fields like basic science, biomedical engineering, rehabilitation medicine and nursing.

Keep in Touch

creative-commons License