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Study of the sex, age and geography based variability in the distal femur

Abstract : The shape of human bones varies based on age, sex and ethnicity. This variability in human anatomy can be used to determine a person's age, sex and ethnicity. Historically, the tools used for such analyses are osteometric methods (length, angle, length ratio) that can be plagued by analysis or interpretation biases. Three-dimensional geometric morphometric analysis (3D GM) can limit the impact of these biases. It is used to describe and compare the general shape of one or more objects by eliminating any size-related effects. To the best of our knowledge, this method has never been used to analyse the sexual dimorphism, ethnicity-related and age-related differences in the distal femur. The femur is one of the longest human bones and is often well preserved in human remains. The goal of this study was to demonstrate differences in the shape of the distal femur according to age, sex and ethnicity using GM. We carried out 3D GM on 482 CT scans of the distal femur of adults living in the South of France and in the Chongqing region of China. Subjects with bone or joint pathologies were excluded. Ten landmarks were defined on 3D reconstructions of the distal femur. A standard osteometric analysis was performed in addition to the GM analysis to evaluate the plausibility of our results. The data were analysed by two observers at two different times. This allowed us to calculate the inter- and intra-observer variability for each landmark. The chosen landmarks were used to characterise the shape of the distal femur. The first step consisted of a generalized Procrustes analysis (GPA). The landmarks' coordinates in space were analysed using a principal component analysis (PCA). A discriminant analysis was performed to determine the percentage of cases in which the sex, age or ethnicity was correctly estimated. The GPA found a statistically significant difference in the distal femur shape between different sexes, ethnicity groups and age groups. The PCA found that age, sex and ethnicity accounted for 54.4%, 58.6% and 61.9% of the observed variability in distal femur shape, respectively. Using this method, 80% of cases were assigned the correct age, 77.3% the correct sex and 82% the correct ethnic group. The results of the osteometric analysis were comparable to published values. The percentage error for the intra- and interobserver comparisons for all the landmarks was always less than 2%. In this study, MG analysis of the distal femur revealed age-related, sex-related and ethnicity-related variability in the distal femur. The high reproducibility and plausibility of our results validate our methodology. These shape differences have direct implications for anthropobiology and also orthopaedics. Although this method is not sufficiently accurate to be used alone, it has the advantage of being usable in the context of virtual or in vivo autopsy cases. Moreover, this study has updated the morphometric data for a modern population in the south of France and the Chongqing region of China. This reliable and accurate methodology can be used to perform diachronic and interethnic comparisons. Validation of this medical imaging modality opens new avenues in physical anthropology research. In the orthopaedics field, this variability means that the shape of implants used for knee arthroplasty should be re-assessed regularly and brings into question the need for gender-specific or ethnicity-specific implants.
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Étienne Cavaignac. Study of the sex, age and geography based variability in the distal femur. Biological anthropology. Université Paul Sabatier - Toulouse III, 2017. English. ⟨NNT : 2017TOU30202⟩. ⟨tel-01926850⟩

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