Femoral bowing in the Arab population: A cross-sectional study and literature review

Background: The femur normally has a degree of bowing that could influence the performance and outcome of some surgical procedures like intra-medullary nailing and hip replacement. This article aimed at evaluating the anterior femoral bowing angle in the Arab population, determining if age and sex are potential influencing factors, and reviewing the literature for identifying possible risk factors. Methods: Measuring the anterior bowing of 116 Arab femora was done using lateral radiographs. The relationship between age and femoral bowing was done using the Pearson correlation coefficient, while an independent t-test was used to compare the bowing angles in males and females. A literature review was done to identify similar studies using PubMed and the references included in the identified papers. Results: From the 116 femora, of which 37 (32%) belonged to male individuals and 79 (68%) to females, the mean femoral bowing angle was 8.13° with a standard deviation of 1.87°. Weak positive correlation was found between age and the bowing angle (r = 0.09, 95%CI [-0.09 to 0.27], p-value = 0.312). However, the angle of femoral bowing was greater in males than females by a mean of 0.76° (95%CI [0.04 to 1.49], p-value = 0.04) when compared using the independent t-test. Conclusion: It appears that anterior femoral bowing is more pronounced in the Arab population, compared to other ethnicities. We encourage more research to define the possible outcomes in patients with severe femoral deformity and to assess the use of computer-assisted surgery in these cases.