In this section
@article{Karia:2026,
author = {Karia, M and Behforootan, S and Stoy, L and Al-Obaidi, I and Logishetty, K and Cobb, J and Abel, R},
journal = {Advances in Orthopedics},
title = {The relationship between radiographic metrics and mechanical properties of the proximal femur},
year = {2026}
}
TY - JOUR
AB - Background: Bone mechanical properties, including strength and stiffness, influence intraoperative fracture risk and implant stability in hip arthroplasty. Surgeons frequently utilize radiographic metrics to evaluate bone quality and inform surgical strategies. This study investigates the correlation between radiographic bone metrics and mechanical properties of the femoral neck.Methods: Femoral neck cortical bone samples from 23 patients undergoing elective hip arthroplasty were subjected to mechanical compression testing to measure elastic modulus and ultimate strength. Density was also measured. Radiographic metrics, including cortical thickness index, canal flare index, canal-bone ratio, and canal-calcar ratio, were determined from preoperative radiographs. The correlations between these metrics and bone mechanical properties were analysed using linear regression, with intra- and inter-observer reliability assessed.Results: Analysis included 19 of the 23 participants. Whilst cortical thickness index measurements demonstrated a weak positive correlation with bone density (R2 = 0.291; p = 0.013) and ultimate strength (R2 = 0.279; p = 0.015), canal-bone ratio showed a weak negative correlation with both factors (R2 = 0.291; p = 0.013 and R2 = 0.279; p = 0.015, respectively). Both cortical thickness index and canal-bone ratio demonstrated excellent inter and intra-observer reliability. Neither canal flare index nor canal-calcar ratio correlated with any mechanical properties, and none of the radiographic metrics correlated with elastic modulus.Conclusions: Cortical thickness index and canal-bone ratio correlate weakly with bone strength and density, but not with elastic modulus. Given their limited utility, radiographs should be used with caution in surgical decision-making regarding impaction force and implant fixation strategy.
AU - Karia,M
AU - Behforootan,S
AU - Stoy,L
AU - Al-Obaidi,I
AU - Logishetty,K
AU - Cobb,J
AU - Abel,R
PY - 2026///
SN - 2090-3464
TI - The relationship between radiographic metrics and mechanical properties of the proximal femur
T2 - Advances in Orthopedics
ER -