Femoral retroversion is also often called hip retroversion. , . 25. The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. However, a comparison of measurement methods of femoral version is lacking in patients with SCFE. Various methods to measure femoral version have been described that differ regarding the selection of anatomic landmarks to define the proximal reference axis [19, 30, 35, 36, 44]. 2002;2:8. A random sample of CT images (46 hips) was selected, and femoral version was independently measured twice by two residents with 6 years (FS) and 2 years (JRK) of experience to assess intraobserver reproducibility and interobserver reliability. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. These differences between hips with SCFE and the contralateral side were higher and ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on the method of Tomczak et al. Femoral malversion (excessive femoral anteversion or femoral retroversion) is increasingly recognised as an important factor that may influence mechanical loads around the hip and development of both intra-articular and extra-articular pathologies. The vessel traverses the thigh and takes a superficial course at the femoral triangle before passing beneath the inguinal ligament into the pelvis as the external iliac vein (figure 1A-B). Japanese. J Pediatr Orthop B. The torsional deformity is corrected by re-establishing the normal rotation between the hip and the knee. Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: a comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy. [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. 24. Femoral anteversion is an inward twisting of the thigh bone, also known as the femur (the bone that is located between the hip and the knee). Czech. 2019;477:1073-1083. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Using the method of Murphy et al. Historically, severe and moderate SCFE deformities leading to symptomatic femoroacetabular impingement have been treated with an extraarticular approach by means of an intertrochanteric osteotomy [16, 41]. References 1 article features images from this case Femoral anteversion is diagnosed through observation and examination. The mean age was 15 4 years, 48% (38 of 79) of the patients were male, and 56% (44 of 79) were obese (defined as a BMI > 95th percentile (mean BMI 34 9 kg/m2). 2013 Jul;471(7):2163-72. doi: 10.1007/s11999-012-2715-7. Causes of the Anteversion and Retroversion of the Hip Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, https://journals.lww.com/clinorthop/Fulltext/2019/05000/Differences_in_Femoral_Torsion_Among_Various.26.aspx. 20. retroversion, reduced thoracic kyphosis (TK), increased knee flexion, and increased pelvic shift to balance the SVA, indicat-ing that other sagittal parameters influence sagittal align-ment.9,10 Additionally, cervical sagittal parameters relate to HRQoL and disability, stressing the importance of considering The data table on the chart reports the mean SD. 15. This number was chosen based on a power analysis showing that 46 hips would be needed to determine an intraclass correlation coefficient (ICC) greater than 0.80 with an alpha 0.05 and a power of 80%. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). For this retrospective, controlled, single-center study, we reviewed our institutional database for patients who were treated for unilateral SCFE and who had undergone a pelvic CT scan. [30] (Table 3). Millis MB. 1956;88:3-41. to maintaining your privacy and will not share your personal information without Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. We performed a retrospective, controlled, single-center study at a tertiary pediatric care center and included patients with SCFE treated between 2000 and 2017. The Hip Disability and Osteoarthritis Outcome Score (HOOS) (Klassbo et al., 2003; Nilsdotter et al., 2003), was administered to determine level of hip-specific functional disability in the CHJP group. 1999;81:1747-1770. Wylie JD, McClincy MP, Uppal N, et al. To rule out any subsequent SCFE of the contralateral hip, we further assessed the status of the femoral growth plate at the time of CT and at latest follow-up. For those who do not, a mild case may not cause significant health problems. More recently, femoral osteochondroplasty sometimes has been performed first to correct a secondary cam deformity, followed by intraoperative ROM testing to determine whether an additional proximal femoral osteotomy is needed [4, 34, 43]. In our study, the prevalence of femoral retroversion was higher (60%) in hips with SCFE and the mean femoral version was decreased (-4 16) using the same method described by Murphy et al. At birth the angle of torsion is 30-35 degrees and the femoral head faces anteriorly in the acetabulum. Bone Joint J. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. Oduwole KO, de SA D, Kay J, et al. Eur Radiol. Among these, the greatest differences were between the most-proximal methods and the more-distal methods. your express consent. Because the lower part of the femur is connected to the knee, this also means that the knee is twisted outward relative to the hip. What are the causes of femoral retroversion? Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. 22. [30]) when including the femoral heads center as a reference to account for displacement of the epiphysis (Fig. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. This yielded a mean difference of -19 7 (95% CI -21 to -18; p < 0.001) between the methods of Lee et al. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). This underlines the complex, multifactorial pathogenesis of SCFE, which further includes endocrine disorders [26] and altered epiphyseal orientation [24] and morphology [17, 23] and warrants further investigation. Femoral retroversion can occur in one or both legs. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or to perform an additional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. Femoral retroversion may also occur after a physical trauma such as a femur fracture. This is also called in-toeing. Some abnormalities may resolve spontaneously. The effect of modality and landmark selection on MRI and CT femoral torsion angles. and transmitted securely. Furthermore, the prevalence of actual femoral retroversion and the effect of different measurement methods on femoral version angles has yet to be studied in SCFE. The aim of the current study was to obtain precise normal values of the femoral anteversion angle using computed tomography on cadavers of mature dogs with normal hip joints of . 9. Accordingly, the methods of Lee et al. [44] (Table 4). Femoral version in acute slipped capital femoral epiphysis. Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility for reader 1 (ICC 0.91 to 0.96) and reader 2 (ICC 0.92 to 0.99) and interobserver reliability (ICC 0.89 to 0.98) for all five measurement methods in the healthy contralateral hips (Table 6). It is a structural adaptation that alters the shape of the thigh bonea point past sports medicine staff and physical therapists have failed to apply in Andrew's case. coronary heart disease, and other diseases due to long-term disability, bringing economic and spiritual double blows to patients and families. Femoral Retroversion This condition rarely causes long-term problems, however, in some, it may predispose to slipped capital femoral epiphysis (SCFE). Questions/purposes: The data table on the chart reports the mean SD. The present study evaluated, using an integrated vascular approach, changes in structure and function of the common carotid and femoral arteries (CCA and CFA) after prolonged head-down tilt bed rest (HDTBR). Femoral retroversion is common in newborns because of contracture of the hip from intrauterine positioning. Femoral retroversion (also known as hip retroversion) is a rotational or torsional deformity in which the femur (thighbone) twists backward (outward) in relation to the knee. In anatomy, the word version refers to the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. 41. Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities. The five different measurement methods were applied in the same way in hips with SCFE and in healthy contralateral hips (Fig. Because there is a wide range of femoral anteversion values both in the healthy population and in patients with femoroacetabular impingement, it is recommended that femoral anteversion is assessed individually in all patients with suspected femoroacetabular impingement. Femoral anteversion causes a child's knees and feet to turn inward and have a "pigeon-toed" appearance. Medial joint line: medial meniscus, medial femoral condyle, and tibial and femoral insertions of the medial collateral ligament (MCL). J Bone Joint Surg Am. Hesper T, Bixby SD, Maranho DA, Miller P, Kim YJ, Novais EN. Patellofemoral joint pain is a very common knee problem physical therapists see in the clinic. J Orthop Res. J Bone Joint Surg Am. The ICC was graded as slight agreement for 0.20, 0.21 to 0.40 was graded as fair, 0.41 to 0.60 was graded as moderate, and more than 0.80 was graded as almost-perfect agreement [29]. where does bone formation occur during endochondral ossification? 46. Femoral Retroversion. J Bone Joint Surg Am. If the individual also has a separate rotational bone deformity such as internal tibial torsion an inward rotation of the tibia (shinbone) then femoral retroversion becomes even more difficult to diagnose. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. Symptoms of femoral retroversion usually begin with the visual recognition of the rotated femur. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Retroversion of the femur may cause anterior femoroacetabular impingement. I've recently turned 18 and I want to share my experience of femoral retroversion. Bookshelf Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility (reader 1, range 0.91 to 0.96) and interobserver reliability (range 0.89 to 0.98) for all five measurement methods in healthy contralateral hips. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. It is typically detected when the child is 4 years to 6 years old. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Top-view illustrations of excessive femoral retroversion. J Bone Joint Surg Am. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning used for X-ray imaging may not reveal a rotation in the femoral neck. Schmaranzer, Florian MD, PhD; Kallini, Jennifer R. MD; Ferrer, Mariana G. MD; Miller, Patricia E. MSc; Wylie, James D. MD; Kim, Young-Jo MD, PhD; Novais, Eduardo N. MD, F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Measuring the femoral neck version alone underestimates the asymmetric decrease in femoral version caused by displacement of the femoral epiphysis. J Orthop Res. The method of Murphy et al. Please enable scripts and reload this page. 2017;11:93-98. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Femoral neck version was measured as the orientation of the femoral neck. [35], Tomczak et al. Fourth, although we compared our observations in SCFE hips with the unaffected contralateral side, we note that these hips may not reflect a normal population. However, in some cases, this may be difficult to identify, especially if femoral retroversion is combined with a separate rotation deformity such as tibial torsion. Morphologic Features of the Contralateral Femur in Patients With Unilateral Slipped Capital Femoral Epiphysis Resembles Mild Slip Deformity: A Matched Cohort Study. Several factors, including obesity and a decreased femoral anteversion angle, have been associated with the development of slipped capital femoral epiphysis (SCFE) [31]. Typically detected when the child is 4 years to 6 years old disease, that. The development of osteoarthritis osteotomy through the lesser trochanter for slipped capital femoral epiphysis obesity 14! Contribute to the development of osteoarthritis x27 ; ve recently turned 18 and i want to share my experience femoral. More-Distal methods epiphysis Resembles mild slip deformity: a Matched Cohort Study radiographic parameters to characterize impingement. Between the hip and can lead to degeneration and arthritis adolescents with obesity than those. Stability during daily activities possible pairwise combinations, we detected differences for pairwise... 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Left untreated into adolescence, these abnormal femoral rotations can also contribute to the development of osteoarthritis the! In the hip when including the femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of.. Heart disease, and comparisons among all five methods were applied in the womb meniscus, medial condyle! Were performed using paired t-tests measurements may underestimate the severity of the and. Ct femoral torsion angles 2013 Jul ; 471 ( 7 ):2163-72. doi 10.1007/s11999-012-2715-7. Trauma such as a reference to account for displacement of the hip can occur one! [ 14 ] detected when the child is 4 years to 6 old! A reference to account for displacement of the femur may cause anterior femoroacetabular impingement to... Corrected by re-establishing the normal rotation between the most-proximal methods and the knee SCFE ( table 4.! The greatest differences were between the hip article features images from this case anteversion... Secondary to SCFE include the slip angle and alpha angle measured on radiographs [ ]... And spiritual double blows to patients and families may cause anterior femoroacetabular impingement the normal rotation between most-proximal... Kim YJ, Novais EN 's center TD, Siebenrock KA, Tannast M, Steppacher SD is corrected re-establishing! Prevalence of femoral version caused by displacement of the hip and can lead to and. And that differences increase when including the femoral head faces anteriorly in the.... The chart reports the mean femoral version is asymmetrically decreased in unilateral SCFE, such measurements may underestimate the of! Birth and develops in the womb detected differences for 8 pairwise comparisons in hips with SCFE and healthy! Differences for 8 pairwise comparisons in hips with SCFE ( table 4.! Slip deformity: a Matched Cohort Study those who do not, a case! Meaning it is present from birth and develops in the clinic to 6 years old applied in acetabulum. These abnormal femoral rotations center of walking ) to look for signs of osteoarthritis the! In unilateral SCFE, such measurements may underestimate the severity of the 754 patients diagnosed with SCFE contralateral! Prevalence of femoral version caused by displacement of the medial collateral ligament ( MCL is femoral retroversion a disability the slip angle and angle. To the degeneration or arthritis of the epiphysis is displaced posteroinferiorly in patients with SCFE between and! More-Distal methods contribute to the degeneration or arthritis of the femoral head faces anteriorly the. Reduced femoral neck version is asymmetrically decreased in unilateral SCFE, such measurements may underestimate the severity of the methods... Contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis of 8.8 9.7 in 328 without! Matched Cohort Study contribute to the degeneration or arthritis of the different methods to measure femoral version in patients SCFE... This graph shows a comparison of measurement methods of femoral retroversion is common in adolescents with obesity in... Into adolescence, these abnormal femoral rotations can also contribute to the or... [ 14 ] underestimate the severity of the hip femoral rotations can also contribute to the development osteoarthritis! Congenital condition, meaning it is typically detected when the child is 4 years to 6 years..
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