Clinical Application of Hip Joint Anatomical CT Digital Measurement and Correlation Analysis

doi:10.21203/rs.3.rs-4677998/v1

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Clinical Application of Hip Joint Anatomical CT Digital Measurement and Correlation Analysis

https://doi.org/10.21203/rs.3.rs-4677998/v1

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Purpose

This study employed CT multi-planar reconstruction and cinematic rendering techniques to measure anatomical parameters of the hip joint. It aimed to compare the differences in hip joint anatomical parameters among adults of different age groups and analyze their correlations with baseline data such as height, weight, and BMI.

Methods

A total of 156 cases, comprising 312 hips, were included and divided into six groups based on 10-year age intervals. The following parameters of both hip joints were measured: acetabular anteversion angle, center-edge angle, acetabular coverage rate, acetabular depth, neck shaft angle, femoral offset distance, center-edge angle, anterior and posterior acetabular sector angles, and acetabular anteversion angle. Data were analysed and processed using SPSS statistical software.

Results

When comparing the different age groups, the values of Acetabular coverage, Acetabular depth and other hip parameters were lower in the young adult group than in the older group, but the Sharp angle was greater than in the older group. There was no statistically significant correlation between the innovative and traditional measures of Acetabular coverage and Acetabular depth (r = 0.76, 0.95, P < 0.01). Sharp angle also showed correlation with body mass index and other hip parameter indices.

Conclusion

There are significant differences in hip joint anatomical parameters among different genders and age groups, and significant correlations exist between various anatomical parameters. There is a close relationship between some anatomical parameters and the mechanism of hip arthroplasty, hip dislocation and femoroacetabular impingement, which plays a crucial role in clinical management.

Hip joint

Clinical anatomical application

Digital measurement

Correlation

The hip joint, the largest weight-bearing joint in the human body, is a ball-and-socket joint with significant flexion, extension, and rotational capabilities. It plays a crucial role in bodily movement and is, consequently, one of the most commonly affected joints^[1]. The anatomical structure of the hip joint is complex, and with age and changes in lifestyle, it undergoes degenerative alterations. For the detection of subtle hip joint lesions, multi-slice spiral CT three-dimensional reconstruction technology has been recognised by clinicians and plays an irreplaceable role in personalised and precise treatment with X-ray radiographs^[2]. Total Hip Arthroplasty (THA) is a common and ultimate means of treating hip joint diseases in clinical practice ^[3]. In the past, orthopedic surgeons relied on two-dimensional or three-dimensional hip joint imaging data for THA preoperative planning, repeatedly constructing the lesion site and the contralateral hip joint's anatomical structure in their minds to effectively carry out the surgery. The fuzzy concept of fine anatomical parameter indices has increased the error rate of surgeries and postoperative complications. Maratt et al. ^[4] conducted a follow-up study of 120 post-THA patients in 2012 and found that 30% of patients had unequal lower limb lengths, poor hip joint function, and some experienced limping symptoms.

Cinematic rendering (CR) technology, originating from post-production special effects in filmmaking, involves a computer mapping the grayscale values of each voxel in the original image to three-dimensional space using transfer functions. Different transfer functions are then applied to render objects, ultimately optimizing image quality and providing a clear and objective representation of complex anatomical structures. CR shares similarities with CT three-dimensional reconstruction in that both create three-dimensional images by collecting rays of light after irradiation. However, CR can simulate a global lighting model, achieving complex lighting effects, and is thus referred to as multidimensional rendering ^[5], Applying CR technology to CT scan images results in more realistic and three-dimensional reconstructed images^[6].

This study employed Cinematic rendering (CR) and Multi-Planar Reconstruction (MPR) techniques to obtain clear visualization of the intricate anatomical microstructure of the hip joint. Through digital measurements and analysis, the study aimed to delineate the structural characteristics of the hip joint and investigate correlations among various anatomical parameters. It compared the anatomical features of the hip joint across different age groups, genders, and BMI categories, uncovering patterns of progression. These findings contribute to the establishment of precise anatomical parameters, thereby offering a foundational basis for the treatment, theoretical analysis, and joint replacement procedures in hip joint diseases.

1.1 General Information: A total of 156 cases of hip joint spiral CT data from patients treated at the Site from June 2022 to June 2023 were selected as the research subjects.

Ethical Affirmations

This is a retrospective study that has been agreed upon by the patients and their families and informed consent was signed. In addition, the study protocol was approved by the Academic Ethics Committee of Baotou Central Hospital and conducted in accordance with the latest version of the Declaration of Helsinki.

1.2 Inclusion and Exclusion Criteria:

Inclusion Criteria:

① Individuals aged 18 and above without a history of hip joint trauma, infection, or tumors.

② Complete imaging data and baseline information.

③ No abnormalities detected in the hip joint by CT diagnosis.

Exclusion Criteria:

① Individuals with significant artifacts diagnosed by radiologists or poor image quality.

② Those with metabolic bone diseases, infectious bone diseases, pathological fractures, or concurrent bone tumors.

③ Patients who have undergone revision surgery for artificial hip joint replacement.

1.3 Imaging and Measurement Equipment: The CT machine used in this study was the Siemens SOMATOM Force CT, a dual-source scanner from Germany. The scanning range covered from 2 cm above the acetabulum to the pubic symphysis, with a scan condition of 120 kV tube voltage, 350–400 mA tube current, pitch of 1.0, 1 mm layer thickness, and 1 mm spacing. The hip joint CT scan data obtained were imported into the Syngo.via VB10B (Siemens, German) post-processing software for three- dimensional measurements.
1.4 Measurement Protocol: All anatomical parameter measurements in this study were conducted using a multi-person repeated measurement protocol. Prior to measurements, standard training was conducted to ensure uniform measurement methods. The measurement group was divided into two subgroups: A and B. Each group was assessed by a senior attending radiologist (with experience in this setting ≥ 3 years) and a deputy chief radiologist. Each radiologist measured all anatomical parameter indices, and after the initial measurements, a repeat measurement was carried out two weeks later in a randomized order. The results from groups A and B were summarized, and the averages of the two groups' measurements were calculated. In cases where significant differences were observed between the groups, a confirmatory measurement was conducted through mutual agreement to obtain the final result.
1.5 Observation Indices and Measurement Methods:

The measurement methods in this study were based on CT's CR and MPR technologies, utilizing the diverse and multifunctional auxiliary tools in Syngo.via for maximum presentation of the true essence and integrity of the hip joint's bone structure. This ensured the accuracy and advanced nature of anatomical parameter measurements.

Cinematic Rendering Technique ^[7]: CR is a novel three-dimensional reconstruction technology that utilizes isotropic voxel data obtained from CT scans to perform volume rendering (VR). It employs a more complex global lighting mathematical model, making the reconstructed images more realistic and three-dimensional, capable of displaying more adjacent details.

Coronal Measurements:

1) Acetabular abduction angle (Sharp Angle): The angle between a horizontal line drawn through the lowest edge of the ilium in both acetabula (Hilgenreiner's line, H-line) and the line connecting the inner and outer edges of the acetabulum (Fig. 1-A).

2) Femoral Head Distance (FHD): The distance between the centers of the circles drawn around both femoral heads, measured at the midpoint of the circles (Fig. 1-A).

3) Acetabular Coverage - Traditional Method (AC-T): The acetabular coverage rate is calculated as the ratio of ac to ab, where ac is the vertical diameter drawn through the center of the femoral head and ab is the horizontal diameter passing through the center of the femoral head (Fig. 2-C).

4) Acetabular Coverage - Innovative Method (AC-I): The acetabular coverage rate is determined by the angle between the line connecting the center of the femoral head to the inner and outer edges of the acetabulum and 180 degrees (Fig. 2-D).

5) Acetabular Depth - Coronal (AD-C): The maximum vertical distance from the inner wall of the acetabulum to the line connecting the inner and outer edges of the acetabulum (Fig. 2-F).

6) Cape Verde (CV): The angle between the centerline of the femoral shaft and the centerline of the femoral neck (Fig. 2-E).

7) Femoral Offset (FO): The vertical distance from the center of the femoral head to the centerline of the femoral shaft (Fig. 2-E).

8) Centre Edge Angle ( CEA): The angle between the line connecting the center of the femoral head to the outer edge of the acetabulum and the perpendicular line drawn through the center of the femoral head (Fig. 1-A).

Axial Measurements:

1) Acetabular Depth - Axial Position (AD-A): The maximum vertical distance from the inner wall of the acetabulum to the line connecting the inner and outer edges of the acetabulum in axial position images (Fig. 1-B).

2) Acetabular Anterior Section Angle (AASA): The angle between the inner edge of the acetabulum and the line connecting the centers of the femoral heads versus the line connecting the centers of both femoral heads in axial position images (Fig. 1-B).

3) Posterior Acetabular Section Angle (PASA): The angle between the outer edge of the acetabulum and the line connecting the centers of the femoral heads versus the line connecting the centers of both femoral heads in axial position images (Fig. 1-B).

4) Anterior Acetabular Tilt (AAT): The angle between the vertical line connecting the centers of both femoral heads and the line connecting the inner and outer edges of the acetabulum in axial position images (Fig. 1-B).

1.6 BMI Grouping Criteria:

The Body Mass Index (BMI) ^[8], abbreviated as BMI, is a measure commonly used internationally to assess body weight and health. BMI is calculated as weight (kg) divided by height (m) squared. The following BMI categories are utilized: Normal (18.5-23.99), Overweight (24–28), Obese (28–32), and Extremely Obese (above 32).

1.7 Age Grouping:

Group 1: 18–30 years, Group 2: 31–40 years, Group 3: 41–50 years, Group 4: 51–60 years, Group 5: 61–70 years, Group 6: ≥71 years. Categories include Youth (15–40 years), Middle Age (41–60 years), and Elderly (≥ 61 years).

1.8 Statistical Methods:

Data analysis was conducted using SPSS 20.0 (IBM SPSS Statistics V.22.0). Differences in the parameters among various groups were assessed using analysis of variance (ANOVA). When variances were homogenous and data followed a normal distribution, a one-way ANOVA was employed, followed by post hoc pairwise comparisons using the LSD-t test. In cases of heterogeneous variances or non-normal data distribution, the Kruskal-Wallis H test was applied, and pairwise comparisons were conducted using the Nemenyi test. For parameters between males and females that followed a normal distribution, the t-test was used; for those not following a normal distribution, the Wilcoxon rank-sum test was applied. Correlation analysis between parameters was performed using Pearson/Spearman correlation analysis. A significance level of P < 0.05 was considered statistically significant.

A total of 156 cases with 312 hip joints were included in the study. The age ranged from 18 to 83 years (mean age 49.74 ± 18.49 years). There were 88 males (56.4%) and 68 females (43.6%). Age groups were distributed as follows: Group 1: 31 cases (19.9%), Group 2: 25 cases (16%), Group 3: 21 cases (13.5%), Group 4: 27 cases (17.3%), Group 5: 25 cases (16%), and Group 6: 27 cases (17.3%). The mean and standard deviation of hip joint anatomical parameter indices are presented in Table 1.

Table 1

Overall Mean Levels of Hip Joint Anatomical Parameters
Variant	N	Minimum value	Maximum value	Average
Sharp Angle (°)	312	25	59	38.98 ± 4.46
AC-T	312	0.62	1.02	0.86 ± 0.07
AC-I	312	0.7	0.99	0.85 ± 0.06
AD-C (cm)	312	1.7	3.58	2.49 ± 0.38
CV (°)	312	111	155	133.28 ± 7.13
FO (cm)	312	1.11	5.71	2.60 ± 0.74
CEA (°)	312	15	63	35.83 ± 7.41
AD-A (cm)	312	1.75	3.72	2.53 ± 0.37
AASA (°)	312	41	96	61.63 ± 8.75
PASA (°)	312	82	156	100.50 ± 9.47
AAT (°)	312	6	47	21.23 ± 5.77
FHD (cm)	156	12.57	19.32	17.35 ± 0.86
BMI	156	15.63	36.23	24.28 ± 3.79
AGE	156	18	83	49.74 ± 18.49
Note: Sharp Angle(Acetabular abduction angle), FHD (Femoral head distance), AC-T (Acetabular coverage-traditional method), AC-I (Acetabular coverage-innovative method), CV (Cape Verde), FO (Femoral Offset), CEA (Centre edge angle), AD-A (Acetabular depth-axial position), AD-C (Acetabular depth-coronal), AASA (Acetabular anterior section angle), PASA (Posterior acetabular section angle), AAT (anterior acetabular tilt)

2.1 Comparison of Hip Joint Anatomical Parameters between Left and Right Sides

Statistical differences were observed in CV and FED between the left and right sides (P < 0.05). However, no statistical differences were found in the remaining anatomical parameters between the left and right sides (Table 2).

Table 2

Results of Hip Joint Anatomical Parameters Comparison between Left and Right Sides
Variant	Left side	Right side
Sharp Angle (°)	39.01 ± 4.69	38.96 ± 4.24
AC-T	0.86 ± 0.69	0.86 ± 0.62
AC-I	0.85 ± 0.59	0.85 ± 0.62
AD-C (cm)	2.47 ± 0.39	2.51 ± 0.38
CV (°)	133.78 ± 6.79 *	132.78 ± 7.44
FED (cm)	2.66 ± 0.74 **	2.55 ± 0.74
CEA (°)	36.15 ± 7.68	35.51 ± 7.15
AD-A (cm)	2.53 ± 0.37	2.54 ± 0.37
AASA (°)	61.67 ± 8.84	61.58 ± 8.68
PASA (°)	100.91 ± 9.96	100.09 ± 8.96
AAT (°)	21.20 ± 5.92	21.27 ± 5.63
Note: * P < 0.05,** P < 0.01.
Note: Sharp Angle(Acetabular abduction angle), AC-T (Acetabular coverage-traditional method), AC-I (Acetabular coverage-innovative method), CV (Cape Verde), FO (Femoral Offset), CEA (Centre edge angle), AD-A (Acetabular depth-axial position), AD-C (Acetabular depth-coronal), AASA (Acetabular anterior section angle), PASA (Posterior acetabular section angle), AAT (anterior acetabular tilt)

2.2 Comparison of Hip Joint Anatomical Parameters between Genders

Statistical differences were observed in Sharp angle, AD-C, AD-A, FO, FHD, CEA, AASA, and AAT between genders (P < 0.05). In Sharp angle, FO, FHD, and AAT, females had higher values than males, while males had higher values in AD-C, AD-A, CEA, and AASA (Table 3).

Table 3

Results of Hip Joint Anatomical Parameters Comparison between Genders
Variant	Male(176)	Fmale(136)
AC-T	0.86 ± 0.07	0.85 ± 0.06
AC-I	0.85 ± 0.06	0.85 ± 0.06
Sharp Angle (°)	38.34 ± 4.61	39.82 ± 4.13**
AD-C (cm)	2.65 ± 0.30	2.28 ± 0.38**
AD-A (cm)	2.68 ± 0.31	2.34 ± 0.36**
CV (°)	134.36 ± 7.31	131.88 ± 6.66
FO (cm)	2.51 ± 0.69	2.73 ± 0.78*
FHD (cm)	17.23 ± 0.86	17.51 ± 0.84*
CEA (°)	36.49 ± 7.49	34.98 ± 7.26*
AASA (°)	63.51 ± 9.14	59.19 ± 7.57**
PASA (°)	100.21 ± 8.73	100.88 ± 10.36
AAT (°)	19.81 ± 5.15	23.07 ± 6.02**
Note: P < 0.05,*P < 0.01
Note: Sharp Angle(Acetabular abduction angle), FHD (Femoral head distance), AC-T (Acetabular coverage-traditional method), AC-I (Acetabular coverage-innovative method), CV (Cape Verde), FO (Femoral Offset), CEA (Centre edge angle), AD-A (Acetabular depth-axial position), AD-C (Acetabular depth-coronal), AASA (Acetabular anterior section angle), PASA (Posterior acetabular section angle), AAT (anterior acetabular tilt)

2.3 Comparison of Hip Joint Anatomical Parameters among Different Age Groups and BMI Groups There were significant differences (P < 0.01) in AC, AD, Sharp angle, AASA, PASA, CEA, and AAT among age groups 1, 2, 4, 5, and 6. Group 3 showed differences (P < 0.05) in AC, AASA, PASA, and CEA compared to groups 4, 5, and 6. In AD, AC, AASA, PASA, AAT, and CEA, values

in age groups 1 and 2 were lower than those in groups 5 and 6, while Sharp angle values in age groups 1 and 2 were higher than those in group 6 (Fig. 3, 4).

FHD showed no statistical differences among different age groups and BMI groups. However, there was a statistically significant difference in FHD between genders (P = 0.03), with females having higher values.

AD-C and AD-A showed statistical differences in mild and moderate obesity groups (P = 0.00, P = 0.02). AD-C also showed statistical differences in moderate and severe obesity groups (P = 0.000). No other anatomical parameters showed statistical differences among different BMI groups.

2.4 Correlation Analysis of Hip Joint Anatomical Parameters

No statistical differences were found when comparing AC-T to AC-I (P = 0. 16) and AD-C to AD-A (P = 0.32). However, there was a significant correlation between AC-T and AC-I, as well as AD-C and AD-A (r = 0.76, r = 0.95, P < 0.01) (Fig. 5).

AC, AD, CEA, AASA, and PASA showed positive correlations with each other (P < 0.01). Sharp angle showed negative correlations with BMI, AC, AD, CEA, AASA, and PASA (P < 0.05), with AC also negatively correlated with BMI (P < 0.05). AAT showed negative correlations with AD and AASA and positive correlations with PASA (P < 0.05). FO showed a negative correlation with CV (r=-0.51, P < 0.01), while AD showed a positive correlation with CV (r = 0. 11, P < 0.05) (Table 4).

Table 4

Correlation Analysis of Hip Joint Anatomical Parameters
		BMI	Sharp	AC-T	AC-I	AD-C	CEA	AASA	PASA	AAT
BMI	r	1	-0.12*	0.12*	0.11	0.05	0.07	0.04	-0.03	-0.03
	P	-	0.04	0.03	0.07	0.39	0.22	0.49	0.57	0.65
Sharp	r	-0.12*	1	-0.51**	-0.37**	-0.26**	-0.63**	-0.19**	-0.22**	-0.03
	P	0.04	-	0	0	0	0	0	0	0.58
AC-T	r	0.12*	-0.51**	1	0.76**	0.35**	0.76**	0.45**	0.42**	-0.03
	P	0.03	0	-	0	0	0	0	0	0.57
AC-I	r	0.11	-0.37**	0.76**	1	0.37**	0.70**	0.42**	0.45**	-0.04
	P	0.07	0	0	-	0	0	0	0	0.46
AD-C	r	0.05	-0.26**	0.35**	0.37**	1	0.44**	0.55**	0.39**	-0.18**
	P	0.39	0	0	0	-	0	0	0	0
CEA	r	0.07	-0.63**	0.76**	0.70**	0.44**	1	0.45**	0.41**	-0.04
	P	0.22	0	0	0	0	-	0	0	0.47
AASA	r	0.04	-0.19**	0.45**	0.42**	0.55**	0.45**	1	0.20**	-0.53**
	P	0.49	0	0	0	0	0	-	0	0
PASA	r	-0.03	-0.22**	0.42**	0.45**	0.39**	0.41**	0.20**	1	0.39**
	P	0.57	0	0	0	0	0	0	-	0
AAT	r	-0.03	-0.03	-0.03	-0.04	-0.18**	-0.04	-0.53**	0.39**	1
	P	0.65	0.58	0.57	0.46	0	0.47	0	0	-
Note: Correlation significant at P < 0.05, *Correlation significant at P < 0.01.

Note: Sharp Angle (Acetabular abduction angle), AC-T (Acetabular coverage-traditional method)，AC-I (Acetabular coverage-innovative method), CEA (Centre edge angle)，AD-C (Acetabular depth-coronal)，AASA (Acetabular anterior section angle)，PASA (Posterior acetabular section angle)，AAT (anterior acetabular tilt)

This study employed CR and MPR techniques to conduct a comprehensive assessment of bilateral hip joint anatomical parameters. In addition to comparing genders and left-right sides, the study introduced age group and BMI group analyses. The results indicated differences in hip joint anatomical parameters among different age groups, presenting a distinctive trend (values in the youth group were lower in AD, AC, AASA, PASA, AAT, and CEA compared to the elderly group, but Sharp angle was higher in the youth group). However, in the BMI group analysis, only AD showed statistical differences. Furthermore, this study innovatively introduced a measurement method for acetabular coverage, which is simple and highly reproducible. Correlation analysis revealed significant correlations among hip joint anatomical parameters.

3.1 Analysis of Variability in Hip Joint Anatomical Parameters

In this study, digital measurements of hip joint parameters were conducted on 156 patients (312 sides) across different age groups. The study revealed differences between males and females in parameters such as Sharp angle, AAT, acetabular depth (AD), FO, and FHD. Notably, female values for Sharp angle, AAT, FO, and FHD were greater than those of males. These findings align with the established sexual dimorphism in pelvic anatomy, where females typically have wider but shorter pelves, while males have narrower but longer pelves.

Conventional hip arthroplasty relies on the surgeon's experience to grind the acetabulum until uniform bleeding occurs, followed by the insertion of a prosthetic implant ^[9]. The appropriate acetabular abduction angle and anteversion angle are crucial for successful outcomes. Without precise anatomical parameters, improper implant positioning may lead to complications such as postoperative pain, reduced hip abduction function, and limb length discrepancy ^[10]. The Lewinnek Safe Zone ^[11], proposed in 1978, recommends an abduction angle of 40°±10° and an anteversion angle of 15°±10° for acetabular implants. However, reports of impingement and dislocation cases within this safe zone have increased with the proliferation of hip joint replacement surgeries ^[12–14]. Various studies ^[15–19] have measured Sharp angles ranging from 41.5°±4. 1° to 53.54°±6.74°, and AAT from 16. 16°±4.93° to 18.6°±4. 1° in different populations. In this study, Sharp angle was measured as 38.98°±4.46°, and AAT was 21.23°±5.77° (19.81°±5. 15° in males and 23.07°±6.02° in females), with statistically significant differences between genders (P < 0.01). Although the measurements in this study differed from those of other scholars, the gender-based comparison yielded consistent results, with females having greater values. These variations may be attributed to differences in geographical selection, gender distribution, age groups, and imaging techniques. Therefore, surgeons are advised to consider these factors during surgery to enhance precision and success.

Some studies ^[20–22] have suggested that bilateral CV and FO in normal individuals exhibit statistical differences but not gender-based differences. This study found that CV was 133.28°±7. 13°, with the left side being larger than the right (P < 0.01), and no statistical difference between genders, in agreement with previous research. Additionally, it is noteworthy that CV measurements can vary depending on the population studied. Femoroacetabular impingement (FAI) ^[23] is a degenerative joint disease of the hip caused by frequent impingement at the junction of the femoral head and neck with the acetabulum. It is often associated with anatomical abnormalities in the acetabulum or proximal femur. This study measured acetabular depth in two dimensions, finding no statistical difference. between the coronal and axial measurements, and a significant correlation between the two (P < 0.01). Moreover, males exhibited greater acetabular depth than females, which requires further investigation regarding the susceptibility of males to FAI. The study also identified differences in acetabular depth among different BMI groups, suggesting that obesity may have an impact on acetabular depth.

Traditional acetabular coverage rate measurement involves calculating the ratio of the projection of the acetabular rim to the transverse diameter of the femoral head, with a normal value exceeding 0.75. In this study, the acetabular coverage rate was measured as 0.85 ± 0.06. However, this traditional measurement method, involving two distance measurements, is prone to errors and has low repeatability. This study innovatively defined the coverage rate as the angle between the line connecting the center of the femoral head to the inner and outer edges of the acetabulum and 180°. This method resulted in measurements with no statistical difference compared to traditional methods and a significant correlation (r = 0.95, P < 0.01), offering the advantages of simplicity, good repeatability, and lower error rates.

Aging can lead to hip joint wear and may result in degenerative hip joint diseases and infectious diseases ^[24]. This study analyzed and compared anatomical parameters of the hip joint across different age groups, revealing significant differences between the youth group (18–40 years) and the middle- aged to elderly group ( ≧ 51 years). The youth group exhibited greater acetabular abduction angles, indicative of better hip abduction function compared to the elderly group. Meanwhile, the middle- aged group (41–60 years) displayed significantly greater acetabular coverage and depth than the youth group, suggesting improved hip joint stability and resistance to pressure but potentially an increased risk of FAI. These findings concur with similar studies ^[25], emphasizing the importance of parameter adjustments based on age when treating hip joint diseases.

3.2 Correlation Analysis of Hip Joint Anatomical Parameters

This study identified positive correlations among AC, AD, CEA, AASA, and PASA, while Sharp angle exhibited negative correlations with all other anatomical parameters. These findings indicate that changes in hip joint anatomical parameters due to disease are interconnected, rather than isolated changes in individual parameters. Additionally, this study found correlations between AC, Sharp angle, and BMI (P < 0.05), suggesting that obese individuals may experience reduced hip joint mobility. These observations align with previous studies ^{[16, 17, 26–29]} indicating correlations between various hip joint parameters and functional aspects of the hip joint. They also underscore the potential for hip joint diseases to affect other parts of the body due to spinal-pelvic imbalances.

However, it is important to acknowledge some limitations in this study. Firstly, being retrospective in nature, the study may contain inherent selection biases. Secondly, the use of CT for three-dimensional measurements is static and may not capture dynamic movements, which are often relevant to joint impingement or collisions. Lastly, the study's sample size, age distribution, geographical representation, and other factors may limit its generalizability to the broader population.

The present study revealed significant differences in the anatomical parameter indices of the hip joint between different genders and age groups, and significant correlations between different anatomical parameter indices. There is a close relationship between anatomical parameters (Sharp Angle, Acetabular Coverage, Acetabular Depth, Cape Verde, Anterior and Acetabular Tilt) and the mechanism of hip arthroplasty, hip dislocation and femoroacetabular impingement. These indicators are core parameters for the treatment of these diseases and play a crucial role in clinical management.

Acknowledgements: Thank you to the Imaging Centre and doctors at Baotou Central Hospital for their great support!

Funding statement: Joint project with Inner Mongolia Medical University (YKD2022LH039), Baotou Municipal Health Commission Science and Technology Programme (wsjkwkj035), and Inner Mongolia Autonomous Region Science and Technology Innovation Guidance Project (CXYD2022BT08), and Science and Technology Program of the Joint Fund of Scientific Research for the Public Hospitals of Inner Mongolia Academy of Medical Sciences (2023GLLH0225).

Authors' contributions: Chao Wu finished the manuscript writing. Ning Su was Co-first author, responsible for the experimental design and discussion of the partial modification, with the same contribution. Wenjing Ou is responsible for data aggregation and submission. Xiaolin Liu, Guoqiang Chen, Wei Li and Haibin Liu are in charge of anatomical measurements. Xiuxiong Bai is responsible for the collection and aggregation.

Data availability：

The datasets generated during and/or analyzed during the current study are available by request.

Competing interests：

The authors declare that they have no competing interests.

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No competing interests reported.

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Clinical Application of Hip Joint Anatomical CT Digital Measurement and Correlation Analysis

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