|Year : 2020 | Volume
| Issue : 4 | Page : 201-206
Morphological side differences of the hemipelvis
Gloria Maria Hohenberger1, Angelika Maria Schwarz2, Andreas Heinrich Weiglein3, Sabine Kuchling4, Georg Hauer1, Uldis Berzins1, Magdalena Holter5, Christoph Grechenig6, Renate Krassnig1, Axel Gänsslen7
1 Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria
2 Department of Orthopaedics and Trauma, AUVA Trauma Hospital Styria │, Graz, Göstinger Straße 24, Graz, Austria
3 Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, Graz, Austria
4 Department of Trauma Surgery, General Hospital Wolfsberg, Paul-Hackhofer-Straße 9, Wolfsberg, Austria
5 Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, Graz, Austria
6 Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
7 Department of Trauma, Clinical Centre Wolfsburg, Sauerbruchstraße 7, Wolfsburg, Germany
|Date of Submission||23-Jul-2019|
|Date of Acceptance||12-Oct-2020|
|Date of Web Publication||29-Dec-2020|
Dr. Gloria Maria Hohenberger
Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz
Source of Support: None, Conflict of Interest: None
Introduction: Differences of anatomical characteristics regarding side and gender have been the topic of interest in various recent studies. Studies have reported either significant or insignificant differences of the bony pelvis. The aim of this study was to evaluate possible gender and side differences of the pelvis in a cadaveric model. Material and Methods: Fifty human cadaver pelves, preserved by the use of Thiel's method, underwent measurement during this study. Diverse parameters were measured on both hemipelves by three surgeons. Analysis of the morphology of the acetabular cavity was performed by measuring its longitudinal, horizontal, and maximal diameters. Results: The distance between the anterior superior iliac spine and the posterior superior iliac spine (females: mean of 15.9 cm; males: mean of 16.9 cm) and the horizontal diameter of the acetabular cavity (females: mean of 4.5 cm; males: mean of 4.9 cm) were statistically significantly shorter in females than in males. The subpubic angle was significantly (P < 0.001) larger in females (mean 61.4°; standard deviation [SD] 11.02°; range 37°–82°) when compared to males (mean 45.5°; SD 7.48°; range 35°–60°). The vertical diameter of the obturator foramen was significantly (P = 0.002) smaller for the right (mean 3.1; SD 0.56; range 1.9–4.6) in comparison to the left side (mean 3.4; SD 0.57; range 2.5–5.2). Discussion and Conclusion: Overall, a clear gender difference was observed for typical gender-specific parameters, whereas the anatomy of the hemipelves showed no relevant side differences.
Keywords: Gender differences, hemipelvis, morphologic differences, pelvis, side differences
|How to cite this article:|
Hohenberger GM, Schwarz AM, Weiglein AH, Kuchling S, Hauer G, Berzins U, Holter M, Grechenig C, Krassnig R, Gänsslen A. Morphological side differences of the hemipelvis. J Anat Soc India 2020;69:201-6
|How to cite this URL:|
Hohenberger GM, Schwarz AM, Weiglein AH, Kuchling S, Hauer G, Berzins U, Holter M, Grechenig C, Krassnig R, Gänsslen A. Morphological side differences of the hemipelvis. J Anat Soc India [serial online] 2020 [cited 2021 Jan 22];69:201-6. Available from: https://www.jasi.org.in/text.asp?2020/69/4/201/305381
| Introduction|| |
Differences of anatomical characteristics regarding side and gender have been the topic of interest in various recent studies.
Macedo and Magee, as well as Moromizato et al. found statistically significant differences regarding the passive range of motion between dominant and nondominant sides in several joints. Bonneau et al. examined 91 adult femora and evaluated an increased anteversion of the femoral neck in women compared to men. In Rouleau et al.'s radiologic study concerning the proximal ulna dorsal angulation, this was significantly decreased on left female extremities compared to male elbow joints. Chanplakorn et al. conducted a computed tomographic (CT) analysis of 740 pedicles concerning the cervical vertebral segments three to seven. The authors did not find significant differences during side comparison; however, male cervical pedicles showed larger dimensions of some studied parameters compared to females in their sample. Yu et al. found an increased pedicle height and width in the thoracic vertebral segments 1–6 in 503 specimens, whereas Chawla et al. stated no significant side differences regarding the third lumbar vertebra.
Some studies have also reported either significant or insignificant differences of the bony pelvis.,, The aim of this study was to evaluate possible gender and side differences of the pelvis in a cadaveric model.
| Materials and Methods|| |
Dissection and measurement
A total of 50 pelves from adult human cadavers donated to science, embalmed with Thielxs method, were evaluated. All investigated cadavers were donated to the Department of Macroscopic and Clinical Anatomy of the Medical University of Graz under the approval of the Anatomical Donation Program of the University of Graz and according to the Austrian law for donations. Twenty-eight were from male and 22 from female body donors. None of the specimens had signs of previous fractures or malformations. After removal of the surrounding soft tissues and bilateral enucleation of the hip joints, measurements in centimeters were conducted on both hemipelves using a digital caliper. Three surgeons individually measured several parameters [Figure 1] and [Figure 2], and the mean of their results was assessed.
|Figure 1: Measurement pattern. The pelvis is depicted from the ventral (a) and dorsal sides (b)|
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Detailed analysis of the morphology of the acetabular cavity was performed by measuring its long, horizontal, and maximal diameters [Figure 2].
In addition, the thickness of the acetabular fossa, was measured (in millimeters), and the anterior acetabular ridge shape was morphologically classified as either straight, curved, or irregular [Figure 3]. The acetabular depth was evaluated by the placement of a ruler across its diameter and measurement of the distance between the deepest part of the acetabular cavity and the ruler.
|Figure 3: Variations of the anterior acetabular ridge's shape (a) straight, (b) curved, (c) irregular|
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All measurements were exported into Microsoft Excel sheets (Microsoft Excel 2010; Microsoft, Redmond, WA, USA). Statistical analysis was performed using SPSS statistical software (version 22.0; IBM Corp, Armonk, NY, USA). For descriptive statistic mean ± standard deviation (SD), median, minimum, and maximum were calculated. For side comparison, dependent t-tests were conducted and for gender comparison, a repeated ANOVA measurement was conducted, including gender as within-subject effect. By the use of Bonferroni correction, a value of P < 0.002 for side and gender differences was regarded as statistically significant.
| Results|| |
The distance between the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS) showed a mean of 16.9 cm in males (SD 1.10; range 14.3–19.4) and 15.9 cm in females (SD 0.99; range 13.50–17.40, respectively. Repeated measurement ANOVA revealed a statistically significant difference between sexes (P = 0.001). The horizontal diameter of the acetabular cavity was significantly (P = 0.002) shorter in females (mean 4.5; SD 0.38; range 3.1–5.3) than in males (mean 4.9; SD 0.42; range 4.1–5.9). In addition, the subpubic angle was significantly larger in females (mean 61.4°; SD 11.02°; range 37°–82°) compared to males (mean 45.5°; SD 7.48°; range 35°–60°), (P < 0.001), [Figure 4].
|Figure 4: Difference of subpubic angle in a female (a) and male (b) pelvis|
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Regarding side differences, the vertical diameter of the obturator foramen was significantly (P = 0.002) smaller for the right (mean 3.1; SD 0.56; range 1.9–4.6) in comparison to the left side (mean 3.4; SD 0.57; range 2.5–5.2).
Statistically insignificant differences regarding gender and sides are presented in [Table 1] and [Table 2].
The anterior acetabular ridge's shape was straight in 57 hemipelves, curved in 36 and irregular in seven specimens. In 14 pelves, their hemipelves showed different patterns, whereas eleven of these had a combination of a curved and straight ridge and further three pelves had an irregular and a curved form.
| Discussion|| |
Possible side and gender differences have been under discussion in various articles.
Boulay et al. performed measurements by the use of an electromagnetic device which provided three-dimensional spatial coordinate measurements in twelve anatomical specimens. During this analysis, 349 different targets, including angles and distances, were checked in detail for side differences. On the right side, the main axis of the obturator foramen was significantly larger compared to the left side. This was comparable to the presented sample with a significantly smaller vertical diameter (P = 0.002) on the right (mean 3.1 cm) compared to the left side (mean 3.4 cm).
The distance between the ASIS and the PSIS showed no side differences which was also observed by Boulay et al. However, a statistically significant difference (P = 0.001) between the sexes was observed in the present study between ASIS and PSIS (males: 16.9 cm; females: 15.9 cm).
Among other characteristics, Ma et al. evaluated the acetabular depth in 100 patients by routine CT scans. They found a significant difference between male and female specimens in both coronal (2.1 vs. 1.8 cm) and axial (2.5/2.6 vs. 2.3 cm) planes but no differences regarding side.
Zeng et al. in a CT analysis reported that the acetabular depth was significantly smaller in women (left: 1.74 cm; right: 1.73 cm) than in men (left: 1.94 cm; right: 1.93 cm). However, further statistical tests did not reveal significant differences when the acetabular depth was adjusted for individual body height.
Chauhan et al. found a significant gender difference between both acetabular depths (males: left: 28.18 mm, right: 27.49 mm; females: left: 25.70 mm, right: 24.68 mm). In contrast, our results only showed a tendency of a larger acetabular depth compared to previous studies. No gender difference (female: 3.11 cm; male: 3.39 cm) or side difference (left: 3.27 cm; right: 3.27 cm) was observed.
However, the horizontal diameter of the acetabular cavity was significantly shorter in females (mean 4.5 cm) than in males (mean 4.9 cm). Chauhan et al. observed a slight significant difference between sexes on the right side (males: right: 4.71 cm, left: 4.75 cm; females: right: 4.44 cm, left: 4.60 cm). These results were comparable to the presented values.
In a noncomparable analysis of the morphology of the anterior acetabular ridge's shape in 154 hip joints by Taştekın Aksu et al., the shape was found to be curved in 46.1%, straight in 23.3%, angular in 16.8%, and irregular in 13.6%. Thoudam and Chandra. and Vyas et al. found the curved form to be most common with 60%. In our sample, the straight form was most present in even 57%, although the occurrence of this form has been reported in a low range of 4%–4.5% up to 31.6%. However, these highly varying results may be due to interobserver variability.
Not surprisingly, we also observed a significantly larger subpubic angle in females (mean 61.4°; SD 11.02°; range 37°–82°) in comparison to males (mean 45.5°; SD 7.48°; range 35°–60°). Igbigbi and Nanono-Igbigbi observed higher values for their Ugandan collective with a mean of 116.1° (range: 75–155) for females and 93.9° (range: 50–140) in males in a radiologic study. Small et al. reported an average angle of 84.1° (range: 52.5–100.2) in females and of 63.9° in males (45.3–93.2) black South Africans. Since our sample consisted of Caucasian specimens, varying values may be the result of racial differences.
| Conclusion|| |
Overall, a clear gender difference was observed for typical gender-specific parameters, whereas the anatomy of the hemipelves showed no relevant side differences. In contrast, Boulay et al. found some differences, which were clinically unimportant due to their large sample size. The results in the present study indicate that gender and side differences may be neglected during preoperative planning of the acetabular component for total hip arthroplasty or during the use of prebended plates during acetabular osteosynthesis.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]