The relationship between radiographic metrics and mechanical properties of the proximal femur
Author(s)
Type
Journal Article
Abstract
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.
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.
Date Issued
2026-01-01
Date Acceptance
2025-11-19
Citation
Advances in Orthopedics, 2026, 2026 (1)
ISSN
2090-3464
Publisher
Wiley
Journal / Book Title
Advances in Orthopedics
Volume
2026
Issue
1
Copyright Statement
© 2026 Monil Karia et al. Advances in Orthopedics published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1155/aort/9613597
Subjects
bone
cortical thickness
hip replacement
mechanical properties
radiographs
Publication Status
Published
Article Number
9613597
Date Publish Online
2026-03-11