Abstract
Purpose
Discrepancy between the morphology of the acetabular margin and the design of hemispheric acetabular cups used in total hip arthroplasty may produce postoperative hip pain due to an iliopsoas im**ement at the iliopsoas notch. This study aimed to determine the anatomical features of the iliopsoas notch in the Central European sample, and to test whether the morphology of the proximal femur affects the size of the iliopsoas notch.
Methods
The sample was composed of 40 matched pairs of dry hip bones and corresponding femora. The depth and length of the iliopsoas notch were measured and correlated with the available demographic data. The anthropometric parameters of the proximal femur were calculated using image-analysis software, and their association with the measurements of the iliopsoas notch was tested.
Results
The iliopsoas notch was present in all specimens and featured four morphological configurations: curved (61.3%), angular (16.2%), irregular (16.2%), and straight (6.3%). Its size was found to be larger in males (P = 0.014 for depth, P < 0.001 for length). No significant difference existed between the sides. The height and age of the specimens did not correlate with the size of the iliopsoas notch. Furthermore, neither the femoral neck version, the lesser trochanteric version, nor the angle between the neck of the femur and the lesser trochanter influenced the dimensions of the iliopsoas notch.
Conclusion
The iliopsoas notch is a consistent landmark of the acetabulum, although its anatomical appearance is widely variable. The iliopsoas notch arrangement cannot be predicted perioperatively based on the morphology of the proximal femur. The various shapes and sex-related differences detected in this study could be used for designing new hip implants or could be utilized during cup positioning in total hip arthroplasty.
Similar content being viewed by others
Availability of data and materials
All data that support the findings of the current study are accessible upon reasonable request from the corresponding author.
References
Devi TB, Philip C (2014) Acetabulum-morphological and morphometrical study. Res J Pharm Biol Chem Sci 5:793–799
Domb BG, Shindle MK, McArthur B, Voos JE, Magennis EM, Kelly BT (2011) Iliopsoas im**ement: a newly identified cause of labral pathology in the hip. HSSJ 7:145–150
Govsa F, Ozer MA, Ozgur Z (2005) Morphologic features of the acetabulum. Arch Orthop Trauma Surg 125:453–461
Hert J, Bartak V, Fulin P, Pokorny D, Sosna A (2021) Does the femoral CCD angle measurement in a standard AP projection correlate with the true anatomical shape of the femur? Acta Chir Orthop Traumatol Cech 88:169–175
Kopydlowski NJ, Tannenbaum EP, Smith MV, Sekiya JK (2014) Characterization of human anterosuperior acetabular depression in correlation with labral tears. Orthop J Sports Med 2:2325967114551328
Kuroda Y, Rai A, Saito M, Khanduja V (2020) Anatomical variation of the psoas valley: a sco** review. BMC Musculoskelet Disord 21:219
Maruyama M, Feinberg JR, Capello WN, D’Antonio JA (2001) Morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res 393:52–65
O’Connor MI (2011) Use of an anatomical acetabular component for treatment of iliopsoas im**ement. J Arthoplasty 26(1570):e13–e15
Pachner P (1937) Pohlavní rozdíly na lidské pánvi [Sex differences in the human pelvis]. Česká akademie věd a umění, Praha
Park CW, Yoo I, Cho K, Jeong SJ, Lim SJ, Park YS (2023) Incidence and risk factors of iliopsoas tendinopathy after total hip arthroplasty: a radiographic analysis of 1602 hips. J Arthroplasty. https://doi.org/10.1016/j.arth.2023.01.037
Sachdeva K, Singla RK, Kalsey G (2011) The role of the anterior border of the hip bone in sexual dimorphism: a morphometric study in the North Indian population. Med Sci Law 51:208–214
Schröder RG, Reddy M, Hatem MA, Gomez-Hoyos J, Toyte L, Khoury A, Martin HD (2015) A MRI study of the lesser trochanteric version and its relationship to proximal femoral osseous anatomy. J Hip Preserv Surg 2:410–416
Ueno T, Kabata T, Ka**o Y, Inoue D, Ohmori T, Tsuchiya H (2018) Risk factors and cup protrusion thresholds for symptomatic iliopsoas im**ement after total hip arthroplasty: a retrospective case-control study. J Arthroplasty 33:3288–3296
Vandenbussche E, Saffarini M, Deloge N, Moctezuma JL, Nogler M (2007) Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthop 78:327–332
Vandenbussche E, Saffarini M, Taillieu F, Mutschler C (2008) The asymmetric profile of the acetabulum. Clin Orthop Relat Res 466:417–423
Acknowledgements
The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.
Funding
This study was supported by the Charles University Grant Agency (GAUK, No. 174523).
Author information
Authors and Affiliations
Contributions
MB: protocol development, data collection and analysis, manuscript writing. VK: interpretation of data, manuscript editing. ON: data collection, manuscript editing. DK: interpretation of data, manuscript editing. VB: protocol development, data interpretation, supervision, manuscript editing.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
The study was approved by the Ethics Committee for Multi-Centric Clinical Trials of the University Hospital Motol and Second Faculty of Medicine, Charles University in Prague (No. EK-1107/22).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Benes, M., Kunc, V., Nanka, O. et al. Anatomy of the iliopsoas notch and its relationship with morphology of the proximal femur. Surg Radiol Anat 46, 51–57 (2024). https://doi.org/10.1007/s00276-023-03263-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-023-03263-z