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ORIGINAL ARTICLE
Year : 2021 | Volume
: 24
| Issue : 3 | Page : 369-379
Proximal femoral geometry analysis of igbos of South East Nigeria and its clinical application in total hip replacement and hip surgeries: A dry bone study
AU Katchy, NJ Nto, AU Agu, IT Ikele, SC Chime, AU Ugwu
Department of Anatomy, University of Nigeria, Enugu Campus, Nigeria
Correspondence Address:
Mr. N J Nto
Department of Anatomy, University of Nigeria, Enugu Campus
Nigeria
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/njcp.njcp_389_20
Abstract
Background: Proximal femoral geometry(PFG) plays a role in the biomechanics of the hip. During total hip replacement detailed efforts are made to restore this biomechanics in other to ensure patients satisfaction and implant survival. There are variations in these parameters. Ethnicity is one of the most influential factors accounting for these variations. Aim: To determine the values of the parameters of the proximal femoral geometry among the ethnic Igbos of the South Eastern Nigeria, determine any correlation between these parameters, and compare these values with known populations as well as discuss the clinical application in total hip replacement and other hip surgeries. Materials and Method: Seven hundred and sixteen (716) femoral bones taken from the osteology unit of department of anatomy of University of Nigeria Enugu Campus (UNEC) were screened and proximal femoral parameters measured using Vernier calipers. Results: There were 356 right and 360 left femoral bones with the following values: Femoral Neck Anteversion Angle (FNAVA): M=19.04°, SD=2.075°, Proximal Femoral Length(PFL): M=73.24mm,SD=7.622, Femoral Head Vertical Diameter(FHVD):M= 44.64mm, SD=3.134, Femoral Head Transverse Diameter(FHTD),M=44.55mm, SD=3.379mm, Femoral Head Diameter(FHD),M=44.60mm, SD=3.119mm, Femoral Neck Anterior Length(FNAL), M=31.86mm, SD=5.383mm, Femoral Posterior Neck Length(FPNL):M=22.23mm, SD=3.520mm, Femoral Neck Diameter (FND), M=32.71mm,SD= 3.315mm, Proximal Femoral Width Head to Side (PFWHS), M=89mm.80,SD= 10.331mm, Proximal Femoral Width Side to Side (PFWSS), M=31.47mm, SD=2.812mm, Femoral Neck Shaft Angle(FNSA), M=132.15°, 7.305°. Conclusion: The parameters of the proximal femoral geometry of the ethnic Igbos of the South East of Nigeria, differed from other populations and exhibited laterality.
Keywords: Ethnic igbos of south east nigeria, hip surgeries, total hip replacement proximal femoral geometry
Introduction 
Proximal femoral geometry (PFG) plays a role in the biomechanics of the hip. During total hip replacement detailed efforts are made to restore this biomechanics in other to ensure patients satisfaction and implant survival. It is also mandatory that that the design and the dimensions of the femoral component should match the anatomy of the native femur.[1]
Apart from the role of PFG in total hip replacement (THR) it has also been implicated as possible pathogenic indicator of some hip disorders like osteoporotic hip fractures in the elderly irrespective of the bone mineral density (BMD),[2] aetiogenesis of hip osteoarthritis,[3],[4] development dysplasia of the hip (DDH),[5],[6] and gluteal tendinopathy.[7]
These parameters of the proximal femoral geometry are as follows: Femoral neck anteversion (FNA), proximal femoral length (PFL), femoral head vertical diameter (FHVD), femoral head transverse diameter (FHTD), femoral neck anterior length (FNAL), femoral posterior neck length (FNPL), femoral neck diameter (FND), proximal femoral width head to side (PFWHS), proximal femoral width side to side (PFWSS).
Most of the studies of PFG show a lot of variation in the values amongst populations and these variations have been attributed to many factors, such as ethnicity, age, sex, body side, measurement methods, even climate, clothing, and lifestyle.[8]
Ethnicity is one of the most influential factors accounting for these variations.
Incidentally, most of the PFG studies have been performed in America,[9],[10],[11] Europe[12],[13] and other Asian countries like Japan,[14] Korean,[15] India,[16] and Thailand[17] Chinese.[18],[19],[20]
Although a recent study[21] had been done on the PFG parameters of the ethnic Igbos of the South East Nigeria, it was majorly radio-graphically based. Unlike measurements from radiographs, this dry bone study had an advantage of allowing several measurements to be taken on each bone thereby eliminating problems arising from dimensional issues. This study raised three questions for determination, Firstly, what are the parameters of the proximal femoral geometry of the ethnic Igbos of the South East of Nigeria, Secondly, are there any relationship between the determined values, Thirdly, is there any difference between the values and that of other selected populations? Fourthly, do these parameters exhibit laterality? The study further hypothesized that there were no relationships existing between these values, no difference between the values and that of other selected populations and that these parameters do not exhibit any laterality. This study was designed to provide answers to these questions.
Therefore, the aim of the study was to: Determine the values of the parameters of the proximal femoral geometry among the ethnic Igbos of the South Eastern Nigeria, determine any correlation between these parameters, and compare these values with known populations as well as discuss the clinical implication in total hip replacement and other hip surgeries.
Materials and Method Seven hundred and sixteen (716) femoral bones taken from the osteology unit of department of anatomy of University of Nigeria Enugu Campus (UNEC) were screened and old bones with pathology, bones with features of wear and tear from storage or preparation and bones whose epiphyses had not fused were excluded from the study (Date of Approval–October 2 2019). The bones certified to be normal adult bones were selected and using the Vernier calipers the following parameters were obtained:
1. Femoral Neck Shaft Angle (FNSA):
A dry femur was placed on the board. The midpoints of the shaft at the proximal and distal ends of the shaft were taken, and a line was drawn joining the mid points on the shaft [Figure 1]a.The midpoint of the femoral head and neck were marked and a line was drawn joining the mid points on the femoral head and neck .The angle formed by the axis of femoral shaft and a line drawn along the axis of femoral neck passing through the centre of the head of femur was measured [Figure 1]b.
Figure 1: (a) Femoral Neck Angle Measurement: A dry femur was placed on the board. (b)The midpoints of the shaft at the proximal and distal ends of the shaft were taken, and a line was drawn joining the mid points on the shaft. (c)The angle formed by the axis of femoral shaft and a line drawn along the axis of femoral neck passing through the center of the head of femur was measured2.Femoral Anteversion Angle (FAA):
Parallel horizontal lines were drawn on the board. The transcondylar axis of the femur was placed tangent to the parallel lines [Figure 2]a.The midpoint of the femoral head and neck were marked and a line was drawn joining the mid points on the femoral head and neck to the transcondylar axis [Figure 2]b.Femoral Anteversion Angle was measured as the angle formed between the axis of the femoral neck and the transcondylar axis of the knee [Figure 2]c.
Figure 2: (a) Femoral Anteversion Angle (FAA): Parallel horizontal lines were drawn on the board. The transcondylar axis of the femur was placed tangent to the parallel lines. (b) Femoral Anteversion Angle (FAA): The midpoint of the femoral head and neck were marked and a line was drawn joining the mid points on the femoral head and neck to the transcondylar axis. (c) Femoral Anteversion Angle (FAA): Femoral Anteversion Angle was measured as the angle formed between the axis of the femoral neck and the transcondylar axis of the knee3. Proximal Femoral Length (PFL): This was measured as the distance between the most proximal point of the greater trochanter to the most distal point of the lesser trochanter [Figure 3].
Figure 3: Proximal Femoral Length (PFL): Measured as the distance between the most proximal point of the greater trochanter to the most distal point of the lesser trochanter4a. Femoral Head Vertical Diameter (FHVD): This was measured as the straight distance between the highest and deepest points of the head of femur [Figure 4]a.
Figure 4: (a) Femoral Head Vertical Diameter (FHVD): This was measured as the straight distance between the highest and deepest points of the head of femur. (b) Femoral Head Transverse Diameter (FHTD): Was measured as the straight distance between the most laterally projected points on the head of femur4b. Femoral Head Transverse Diameter (FHTD): Was measured as the straight distance between the most laterally projected points on the head of femur [Figure 4]b.
5. Femoral Neck Diameter (FND): This was measured as the straight distance between the highest and deepest points of the neck of femur [Figure 5].
Figure 5: Femoral Neck Diameter (FND): This was measured as the straight distance between the highest and deepest points of the neck of femur6a. Femoral Anterior Neck Length (FANL): This was measured on the anterior surface as the distance between the head and the intertrochanteric line [Figure 6]a.
Figure 6: (a) Femoral Anterior Neck Length (FANL): This was measured on the anterior surface as the distance between the head and the intertrochanteric line. (b) Femoral Posterior Neck Length (FPNL): Was measured on the posterior surface as the distance between the head and the intertrochanteric crest using a Vernier caliper6b. Femoral Posterior Neck Length (FPNL) Was measured on the posterior surface as the distance between the head and the intertrochanteric crest using a Vernier caliper [Figure 6]b.
7a. Proximal Femoral Width Head to Side (PFWHS): This was measured as the distance between the most medial points of the head to the most lateral point of the greater trochanter [Figure 7]a.
Figure 7: (a) Proximal Femoral Width Head to Side (PFWHS): This was measured as the distance between the most medial points of the head to the most lateral point of the greater trochanter. (b) Proximal Femoral Width Side to Side (PFWSS): This was measured as the distance between the most medial to the most lateral points of the shaft of femur below the lesser trochanter7b. Proximal Femoral Width Side to Side (PFWSS): This was measured as the distance between the most medial to the most lateral points of the shaft of femur below the lesser trochanter [Figure 7]b.
Test-retest reliability
To assess the test –retest reliability some of the femoral bones were measured on two occasions within 5 days and the reliability of the repeated measures was evaluated using scatter plots and correlation coefficient.
Statistical analysis
The IBM SPSS package (IBM Corp., IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY, USA), developed by International Business Machines Corporation (IBM) was used to analyze the observed data. Descriptive statistics were calculated for all variables of interest. Continuous measures were summarized as means and standard deviations. The p- values for comparing means of continuous variables were determined after selecting a level of significance (α = 0.05). A one sample t -test was used for comparison with parameters of both sides in determining laterality and also used in determining the differences between the study parameters and that of Western, Indian, Hong Kong, Caucasian, Malay, Pakistani, Korean, Thai, American, Chinese and Kenyan populations. The Pearson correlation coefficient (r) was used to determine correlation between the proximal femur geometry parameters.
Results Proximal femoral geometry parameters –Descriptive statistics
There were 356 right and 360 left femoral bones with the following values: Femoral Neck Anteversion Angle (FNAVA): M = 19.04°, SD = 2.075°, Proximal Femoral Length (PFL): M = 73.24 mm, SD = 7.622, Femoral Head Vertical Diameter (FHVD): M = 44.64 mm, SD = 3.134, Femoral Head Transverse Diameter (FHTD), M = 44.55 mm, SD = 3.379 mm, Femoral Head Diameter (FHD), M = 44.60 mm, SD = 3.119 mm, Femoral Neck Anterior Length (FNAL), M = 31.86 mm, SD = 5.383 mm, Femoral Posterior Neck Length (FPNL): M = 22.23 mm, SD = 3.520 mm, Femoral Neck Diameter (FND), M = 32.71 mm, SD = 3.315 mm, Proximal Femoral Width Head to Side (PFWHS), M = 89 mm. 80, SD = 10.331 mm, Proximal Femoral Width Side to Side (PFWSS), M = 31.47 mm, SD = 2.812 mm, Femoral Neck Shaft Angle (FNSA), M = 132.15°, 7.305°. [Table 1].
Table 1: Proximal Femoral Geometry Parameters of the Dry bones of Igbos of South East Nigeria-Descriptive StatisticsCorrelations of parameters of the proximal femoral geometry of the dry bones of Igbos of South East Nigeria
Femoral neck shaft angle (FNSA) correlations
FNSA and FNAVA were significantly strongly positively correlated, r (715) = 0.846, P < 001. FNSA was significantly positively weakly correlated with, PFL (715) = 0.165, P < 001, FHVD (715) = .152, P < 001, FND (715) = .182, P < 001, FNAL (715) = .118, P < 001. It was significantly negatively correlated with PFWHS (715) = .087, P = 020. It had no significant correlation with FHTD = (715) = .004, P = .911, FNPL = (715) = .047, P = .213 and PFWSS = (715) = .056, P = .135.
Femoral neck anteversion angle (FNAVA) correlations
FNAVA was significantly positively weakly correlated with PFL, r (715) = 0.235, P < 001, FHVD r (715) = 0.103, P = 006, FNAL r (715) = .116, P = .002, FNPL r (715) = .103, P = .006, PFWSS r (715) = -.142, P < 001.
Proximal femoral length (PFL) correlations
The PFL was significantly positively moderately correlated with FHVD, r (715) = 0.611, P < 001. It was significantly weakly positively correlated with FHTD r (715) = 0.365, P < 001, FND r (715) = .283, P < 001, FNAL r (715) = .374, P < 001, FNPL, r (715) = .110, P < 001, PFWHS, r (715) = .290, P < 001, PFWSS, r (715) = .131, P < 001.
Femoral head vertical diameter (FHVD)
The FHVD was significantly positively strongly correlated with FHTD r (715) = 0.833, P < 001, and significantly positively moderately correlated with FND r (715) = 0.673, P < 001 and significantly weakly correlated with FNAL r (715) = .296, P < 001, FNPL r (715) = .150, P < 001, PFWHS r (715) = .399, P < 001 and PFWSS r (715) = .253, P < 001.
Femoral head transverse diameter (FHTD)
The FHTD was significantly positively moderately correlated with FND r (715) = 0.650, P < 001, significantly weakly correlated with FNAL r (715) = 0.375, P < 001, significantly weakly correlated with FNPL r (715) = .124, P = 001, PFWHS significantly weakly correlated with FNAL r (715) = .417, P < 001 and PFWSS r (715) = .316, P < 001.
Femoral neck diameter (FND)
The FND had with FNAL a weak positive correlation which was significant, r (715) = 0.144, P < 001, PFWHS r (715) = 0.299, P < 001, PFWHSS r (715) = .207, P < 001, but no significant correlation with FNPL r (715) = .072, P = 055.
Femoral posterior neck length (FPNL)
The FPNL had with FNAL a weak positive correlation which was significant r (715) = 0.144, P < 001, PFWHS r (715) = 0.209, P < 001 but not significant correlation with PFWSS r (715) = .051, P = 176.
Proximal femoral width head to side (PFWHS)
The PFWHS had with FNAL a weak positive correlation which was significant r (715) = 0.109, P = 004 and PFWSS r (715) = 0.161, P < 001. [Table 2].
Table 2: Correlations of parameters of the proximal femoral geometry of the Dry bones of Igbos of South East NigeriaComparison of proximal femoral geometry parameters of both sides of the dry bones of Igbos of South East Nigeria
The FNAVA of the right femur were significantly higher (M = 19.04, SD = 2.075) than that of the left (M = 18.95, SD = 2.38), t (715) = 9.218, P < 0.001.
The PFL of the right femur were significantly higher (M = 75.97, SD = 8.138) than that of the left (M = 70.54, SD = 5.96), t (715) = 10.183, P < 0.001
The FHVD of the right femur were significantly higher (M = 44.88, SD = 2.754) than that of the left (M = 44.40, SD = 3.457), t (715) = 2.095, P = 0.037.
The FND of the right femur were significantly lower (M = 32.22, SD = 3.297) than that of the left (M = 33.19, SD = 3.265), t (715) = -3.966, P < 001.
The FNPL of the right femur were significantly lower (M = 21.68, SD = 2.174) than that of the left (M = 22.76, SD=), t (715) = -4.170, P < 001.
The PFWHS of the right femur were significantly higher (M = 91.06, SD = 5.429.) than that of the left (M = 88.55, SD = 13.426), t (715) = 3.292, P = 0.001.
The PFWSS of the right femur were significantly lower (M = 31.26, SD = 2.867.) than that of the left (M = 31.67, SD = 2.745), t (715) =, P = 0.052.
The FNSA (p = 0.326), FHTD (p = 0.602) and FNAL (p = .855) were not statistically significant different. Apart from the FNSA, FHTD, FNAL values the test statistic for the rest provided evidence to reject the null hypothesis that the means are equal [Table 3].
Table 3: Comparison of both sides parameters of proximal femoral geometry of the Dry bones of Igbos of South East NigeriaOne-sample test comparing the Femoral neck anteversion angle (FNAVA) of the dry bones of Igbos of South East Nigeria with that of other populations
The study had hypothesized that the mean values of femoral neck anteversion angle (FNAVA) parameters of this study were equal to the means of that of Western,[22] Indian,[27] Hong kong,[20] and Caucasian[20] populations. In other to test this hypothesis the mean values of the observed parameters were compared with the mean values of these populations usingthe one sample student's t-test and the findings were as follows:
The FNAVA of the dry bones of the Igbos of the South East Nigeria (M = 19.04, SD =) was higher than that of the selected Western (t (715) = 144.881, P < 001, d = 5.41), Indian (t (715) = 119.221, P < 001, d = 4.46), Hong kong (t (715) = 62.870, P < 001, d = 2.35) and Caucasian (t (715) = 153.908, P < 001, d = 5.75) populations with huge effect sizes. The test statistic provided evidence to reject the null hypothesis that the means of femoral neck anteversion Angle (FNAVA) of this study are equal to that of the selected comparative population [Table 4].
Table 4: One-Sample t-Test Comparing the Femoral Neck Anteversion Angle (FNAVA) of the Dry bones of Igbos of South East Nigeria with that of other populationsOne-sample test comparison of the Femoral head diameter (FHD) of the dry bones of Igbos of South East Nigeria with that of other populations
The FHD of the dry bones of the Igbos of the South East Nigeria (M = 44.60, SD = 3.12) was higher than that of the selected Malay[28] (t (715) = 32.472, P < 001, d = 1.31), Thai[18] (t (715) = 5.278, P < 001, d = 0.20), Indian[31] (t (715) = 19.519, P < 001, d = 0.73) and Kenyan[34] (t (715) = 17.117, P < 001, d = 0.64) populations with mild and moderate effect sizes respectively. It was lower Pakistani[30] (t (715) = -47.222, P < 001, d = -1.76), Korean[30] (t (715) = -7.761, P < 001, d = 0.029), American[32] (t (715) = -64.293, P < 001, d = -2.40) and Chineese[33] (t (715) = -6.903, P < 001, d = -0.26) populations with strong and weak effect sizes respectively. The test statistic provided evidence to reject the null hypothesis that the means of femoral head diameter (FHD) of this study are equal to that of the selected comparative population [Table 5].
Table 5: One-Sample Test Comparison of the Femoral Head Diameter (FHD) of the Dry bones of Igbos of South East Nigeria with that of other populationsOne-sample test comparing the mean Femoral neck diameter (FND) with that of selected population
The FND of the dry bones of the Igbos of the South East Nigeria (M = 32.71, SD = 3.315) was lower than that of the selected Indian[31] (t (715) = 2.495, P = 0.013, d = 0.09), and higher than that of Chinese[33] (t (715) = 6.466, P < 001, d = 0.24), populations with weak effect sizes.
The test statistic provided evidence to reject the null hypothesis that the means of femoral neck diameter (FND) of this study is equal to that of the selected comparative population [Table 6].
Table 6: One-Sample t-Test comparing the Mean Femoral Neck diameter (FND) with that of selected populationOne-sample test comparing the mean Femoral neck shaft angle (FNSA) with that of selected population
The study had hypothesized that the mean values of femoral neck shaft angle (FNSA) of this study were equal to the means of that Kenyan,[34] Indian,[35] Nepalese,[36] South Indian,[37] Americans,[38] populations.
The FNSA of the dry bones of the Igbos of the South East Nigeria (M = 132.15, SD = 7.305) was higher than that of the selected Nepalese[36] (t (715) = 33.896, P < 001, d = 1.27), Indian[35] (t (715) = 31.698, P < 001, d = 1.19), Kenyan[34] (t (715) = 10.782, P < 001, d = 0.40), Americans[38] (t (715) = 27.585, P < 001, d = 1.03), and lower than that of South Indian[37] (t (715) = 7.386, P < 001, d = -0.65), populations with strong effect sizes for Nepalese, Indian and American populations and a weak effect size for South Indian and American populations. The test statistic provided evidence to reject the null hypothesis that the means of femoral neck shaft angle (FNSA) of this study is equal to that of the selected population for comparison [Table 7].
Table 7: One-Sample t-Test comparing the Mean Femoral Neck Shaft Angle (FNSA) with that of selected population Discussion The proximal femoral geometry plays a major role in biomechanics of the hip joint. The parameters of the PFG have a wide ethnic variation hence the need to conduct this study among the Igbo ethnic population of the South East Nigeria. Knowledge of these parameters amongst the studied ethnic group is essential as it opens a new horizon in better understanding of etiology of diseases like primary osteoathrosis of the hip joint amongst the studied population. Murray[39] had postulated that an incongruous joint is more prone to develop degenerative changes than a joint having normal anatomy. In forensic medicine, experts are assisted by the knowledge of average of these parameters in determining disputed sex. Total hip replacement surgery has become routine surgery in Nigeria[40] and the knowledge of these parameters will assist both the surgeons and implant manufacturers when dealing with patients of ethnic Igbo population. To the best of our knowledge not much is available in the literature on the Igbo population. Most studies available on the Igbo population are mostly radiological and radiological studies have their draw backs hence the estimation using dry bone remains the most accurate method.[41] This study established the values for studied population which were correlated and compared with other selected populations.
The FNAVA of the right femur were significantly higher than that of the left. This is in consonance with the study of Saikia et al.[42] who found a similar higher value on the right in an Indian population. It is variance with the findings of Maheshwari et al.[43] who found the opposite in an Iraqi population. The PFL, FHVD, and the PFWHS of the right femur were significantly higher than that of the left. The FND, FNPL and the PFWSS of the right femur were significantly lower than that of the left while The FNSA and FNAL were not statistically significant different.
These differences between the sides in different studies of the same populations are also a matter of debate and may be attributed to different methods of measurements.[44] These differences in values of both sides should be taking into consideration when choosing size of implants of during hip surgeries. The determined values of PFWSS is of uttermost important in our environment taking into consideration that surgeons in our environment do not have the privilege of using a C-Arm to pin hip fractures hence the resort to blind pinning. This is froth with danger of driving of pins beyond the femoral head into the pelvis as there is no fluoroscopy to guide the surgeon. Therefore, these determined values acts as a guide to determine pin or screw length intra-operatively during such procedures.
The mean FHD of the dry bones of the Igbos of the South East Nigeria was higher than that of the selected Malay,[28] Thai,[18] Indian[31] and Kenyan[34] and lower than that of Pakistani,[29] Korean,[30] American[32] and Chineese[33] populations. This is of clinical importance as our people continue to travel to these places for total hip replacement.[44] The knowledge of the femoral head diameter assists the surgeon to determine the size of the acetabular cup. Normally, adding 2 mm to the size of the native head gives the surgeon the idea of the required acetabular cup size and what size of reamer to start with. This knowledge is also applicable during the hemiarthroplasties and also supports the inventory of these implants in a developed country like ours with a dwindling economy.
Saikia[42] had suggested, in an attempt to explain the difference in these values with that of their Western population, evolutionally changes due to life style and social traditions of the Indian population which is more adept to floor level activities with increased external rotation of the hip the hip joints as a contributing factor.[22],[45]
These determined parameters had several magnitudes of correlations amongst themselves.
The FNSA strongly positively correlated with FNAVA. This is in consonant with the findings of Ehsangolchin[46] who found a similar relationship between these parameters amongst the Iranian population. This is at variance with the findings of Labronici et al.[47] who did not find any correlation in these findings in their study to demonstrate a relationship between these two parameters with development of osteoarthritis.
During reconstructive surgery such as total hip replacement, femoral neck anteversion is important and many researches have been undertaken in order to develop the optimal orientation of the hip prosthesis. Tayton[48] postulated that femoral neck anteversion developed as a result of forces acting through the hip during daily activities, and in a study advocated the anteversion of the prosthesis of 10 to 15 degrees during total hip replacement if optimal hip stability together with optimal range of motion is to be achieved while Charnley[49] suggested 0 degree to enhance the stability of the arthroplasty.
Khamanarong et al.[50] in a study recommended the setting of the femoral neck anteversion to their normal anteversion (15-17 degrees) in a reconstructive surgery of the hip, especially the femoral stem replacement in hemiarthroplasty surgery, while also recommending and investigation of the contralateral side anteversion for the preoperative planning in a situation where the affected side cannot be evaluated for its version.
The limitations of this study was that the femoral bones couldn't be grouped into female and male categories as they were not documented in the records of the museum hence using the gender morphological features alone couldn't have shown that high degree of accuracy. The strength of the study is strongly embedded in the fact that direct measurements were being made on the bones rather than radiological measurements thereby eliminating firstly, dimensional views issues associated with radiological methods and secondly, the fact that direct measurements mimics correctly the measurements in real surgical situations.
Future study is being recommended to compare the sizes of the implant used on the patients of Igbo extraction during THR, hemiathroplasty and pinning of hip fractures with that of the findings of this study.
Conclusion The parameters of the proximal femoral geometry of the ethnic Igbos of the South East of Nigeria, have been established. These values differed from other populations and exhibited laterality. These are important information for manufacturers of prosthesis and other implants and devices for proximal femoral geometry which are based on Western and Indian populations. There were relationships between the determined values which will be useful for implant sizes assessments for the arthroplasty surgeon when dealing with patients of ethnic Igbo extraction.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
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