{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T17:15:54Z","timestamp":1772471754188,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Intertrochanteric hip fractures (ITFs) are common in older adults and frequently coexist with knee osteoarthritis (KOA). Although both conditions share key biomechanical risk factors, the specific relationship between KOA severity and ITF stability has not been well defined. Recent evidence suggests that degenerative knee changes may alter lower-limb load distribution and increase susceptibility to unstable fracture patterns. This study evaluated whether KOA severity, graded using the Kellgren\u2013Lawrence (KL) system, is associated with ITF stability according to the 2018 AO\/OTA classification. Materials and Methods: A retrospective observational study was conducted on 138 patients with IHFs treated between 2018 and 2023. KOA severity was assessed using KL grades I\u2013IV on non-weight-bearing anteroposterior knee radiographs. Lateral wall thickness (LWT) was measured using the Hsu method, with &lt;20.5 mm indicating fracture instability. Statistical analyses included correlation, linear regression, logistic regression, and receiver operating characteristic (ROC) curve analysis to examine the association between KL grade and fracture stability. Results: Among 138 patients, 98 (71.0%) had unstable ITFs. Advanced KOA was significantly more common in the unstable group (KL III 45.9%, KL IV 48.0%; p &lt; 0.001). KL grade showed a significant inverse correlation with LWT (Pearson\u2019s r = \u22120.394, p &lt; 0.001). Each one-grade increase in KL severity was associated with a 3.8 mm reduction in LWT (p &lt; 0.001). In multivariable logistic regression, KL grade remained an independent predictor of fracture instability (adjusted OR = 4.9, 95% CI: 2.8\u20138.8, p &lt; 0.001), whereas age and comorbidities were not significant. ROC analysis demonstrated good discriminatory power (AUC = 0.79). A KL \u2265 III threshold achieved 95% sensitivity and 56% specificity for predicting instability. Conclusions: Higher KOA severity is strongly associated with unstable ITF patterns. KL grade independently predicts instability and may serve as a simple, accessible radiographic indicator of biomechanical vulnerability and fracture risk in older adults. Incorporating KOA severity into the preoperative evaluation may enhance risk stratification, guide selection of fixation strategy, and support individualized rehabilitation planning.<\/jats:p>","DOI":"10.3390\/medicina62030469","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:06:59Z","timestamp":1772467619000},"page":"469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knee Osteoarthritis (KOA) Severity Influences Proximal Femoral Biomechanics and Predicts Pertrochanteric Fracture Instability: A Retrospective Radiographic Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Seyed Ali","family":"Hashemi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz 71348, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bahram","family":"Abedini","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz 71348, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2018-5255","authenticated-orcid":false,"given":"Hossein","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Student Research Committee, Shiraz University of Medical Sciences, Shiraz 71348, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3283-769X","authenticated-orcid":false,"given":"Shayan","family":"Yousufzai","sequence":"additional","affiliation":[{"name":"Student Research Committee, Shiraz University of Medical Sciences, Shiraz 71348, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1398-9626","authenticated-orcid":false,"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8343-0337","authenticated-orcid":false,"given":"Georgi P.","family":"Georgiev","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, 1527 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0122-2436","authenticated-orcid":false,"given":"George","family":"Tiantafyllou","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Diomidous","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8559-8969","authenticated-orcid":false,"given":"George","family":"Tsakotos","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6221-7537","authenticated-orcid":false,"given":"Ioannis","family":"Paschopoulos","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6385-7110","authenticated-orcid":false,"given":"Fotios","family":"Kantas","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4831-8005","authenticated-orcid":false,"given":"Maria","family":"Piagkou","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2020.0215","article-title":"Hip fractures","volume":"81","author":"Li","year":"2020","journal-title":"Br. J. Hosp. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"185","DOI":"10.26574\/maedica.2020.15.2.185","article-title":"Gender and Age Differences in Hip Fracture Types among Elderly: A Retrospective Cohort Study","volume":"15","author":"Alpantaki","year":"2020","journal-title":"Maedica"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification compendium\u20142018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Moldovan, F., and Moldovan, L. (2025). The Impact of Total Hip Arthroplasty on the Incidence of Hip Fractures in Romania. J. Clin. Med., 14.","DOI":"10.3390\/jcm14134636"},{"key":"ref_5","first-page":"152","article-title":"The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee","volume":"107","author":"Michael","year":"2010","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1038\/s41584-021-00673-4","article-title":"Early-stage symptomatic osteoarthritis of the knee\u2014time for action","volume":"17","author":"Mahmoudian","year":"2021","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/s13075-023-03179-4","article-title":"Association of knee and hip osteoarthritis with the risk of falls and fractures: A systematic review and meta-analysis","volume":"25","author":"Zhang","year":"2023","journal-title":"Arthritis Res. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1016\/j.arth.2025.01.016","article-title":"High Prevalence of Symptomatic Knee Osteoarthritis Among Patients Who Have Fragility Hip Fractures","volume":"40","author":"Mekariya","year":"2025","journal-title":"J. Arthroplasty"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1002\/acr.25001","article-title":"Relationship Between Knee Biomechanics and Pain in People with Knee Osteoarthritis: A Systematic Review and Meta-Analysis","volume":"75","author":"Hutchison","year":"2023","journal-title":"Arthritis Care Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.bjpt.2017.03.012","article-title":"Hip, knee, and ankle kinematics during activities of daily living: A cross-sectional study","volume":"21","author":"Hyodo","year":"2017","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s00223-021-00846-z","article-title":"Fall Patterns Predict Mortality After Hip Fracture in Older Adults, Independent of Age, Sex, and Comorbidities","volume":"109","author":"Burm","year":"2021","journal-title":"Calcif. Tissue Int."},{"key":"ref_12","first-page":"18","article-title":"Age, Comorbidities and Fear of Fall: Mortality predictors associated with fall-related fractures","volume":"15","author":"Velegraki","year":"2020","journal-title":"Maedica"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/ajag.12300","article-title":"In-hospital falls in older patients: A prospective study at the University Hospital of Heraklion, Crete, Greece","volume":"35","author":"Koutserimpas","year":"2016","journal-title":"Australas. J. Ageing"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1302\/0301-620X.95B8.31495","article-title":"Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures","volume":"95","author":"Hsu","year":"2013","journal-title":"Bone Jt. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"220","DOI":"10.18229\/kocatepetip.1533019","article-title":"Does the severity of knee osteoarthritis affect the type of proximal femur fracture in the elderly population: A retrospective cohort study","volume":"26","author":"Polat","year":"2025","journal-title":"Kocatepe T\u0131p Derg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"863","DOI":"10.28982\/josam.7514","article-title":"Does a relationship between type of hip fracture and osteoarthritis exist?: Osteoarthritis and hip fracture","volume":"6","author":"Davut","year":"2022","journal-title":"J. Surg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Lv, J., Li, X., Qiu, W., Ji, J., Cao, L., Li, L., Zhang, Y., and Su, Z. (2023). Effect of knee osteoarthritis on the postoperative outcome of proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly: A retrospective analysis. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-07012-6"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1016\/j.injury.2017.08.037","article-title":"Hip osteoarthritis as a predictor of the fracture pattern in proximal femur fractures","volume":"48","author":"Panteli","year":"2017","journal-title":"Injury"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1007\/s00198-019-05015-5","article-title":"Correlation between hip osteoarthritis and proximal femoral fracture site: Could it be protective for intracapsular neck fractures? A retrospective study on 320 cases","volume":"30","author":"Maluta","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"109808","DOI":"10.1016\/j.ijscr.2024.109808","article-title":"Brucellosis-induced bilateral avascular necrosis of the hip joints in a middle-aged Iranian woman with refractory intolerance to medications: A case report","volume":"120","author":"Yousufzai","year":"2024","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1177\/1120700019859275","article-title":"Does hip morphology correlate with proximal femoral fracture type?","volume":"30","author":"Rotem","year":"2020","journal-title":"Hip Int."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Traverso, A., Bayram, A., Rossettini, G., Chiappinotto, S., Galazzi, A., and Palese, A. (2024). Investigating the biomechanics of falls in older adults in long-term care using a video camera: A scoping review. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-05395-2"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1093\/hmg\/ddae169","article-title":"The genetic architecture of hip shape and its role in the development of hip osteoarthritis and fracture","volume":"34","author":"Faber","year":"2025","journal-title":"Hum. Mol. Genet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1007\/s11999-016-4732-4","article-title":"Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis","volume":"474","author":"Kohn","year":"2016","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1466478","DOI":"10.1155\/2022\/1466478","article-title":"Knee Osteoarthritis: Kinesiophobia and Isometric Strength of Quadriceps in Women","volume":"2022","author":"Machado","year":"2022","journal-title":"Pain. Res. Manag."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"548","DOI":"10.3899\/jrheum.220538","article-title":"The Association Between Quadriceps Strength and Synovitis in Knee Osteoarthritis: An Exploratory Study From the Osteoarthritis Initiative","volume":"50","author":"Gong","year":"2023","journal-title":"J. Rheumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1249\/MSS.0000000000003549","article-title":"Sex Differences in Ambulatory Biomechanics: A Meta-Analysis Providing a Mechanistic Insight into Knee Osteoarthritis","volume":"57","author":"Yamagata","year":"2025","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_28","first-page":"24","article-title":"Reliability of lateral wall-thickness measurement in trochanteric fractures and parameters associated with lateral wall integrity","volume":"18","author":"Ratanakornphan","year":"2024","journal-title":"Asian Biomed. Res. Rev. News"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/469\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:47:34Z","timestamp":1772470054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030469"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030469","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,1]]}}}