Background: 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. Dawes B, Jaremko JL, Balakumar J. Radiographic assessment of bone remodelling in slipped upper femoral epiphyses using Kleins line and the angle of femoral-acetabular impingement: a retrospective review. . In some cases, a minimally invasive version of a femoral osteotomy may be performed. Mascarenhas VV, Castro MO, Rego PA, et al. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Common complications include secondary arthrosis and. 14. SCFE: clinical aspects, diagnosis, and classification. A comprehensive analysis of femoral version may provide valuable baseline information to optimize surgical planning in hips with sequalae of SCFE and to allow standardization of studies investigating surgical correction of SCFE deformities. Radiology. The condition is usually congenital, meaning children are born with it. In cases where the child does not grow out of femoral retroversion, the condition may be mild enough not to cause any significant health challenges. Although femoral retroversion has been linked to the onset of slipped capital femoral epiphysis (SCFE), and may result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in patients with SCFE. Routinely measuring femoral version might help surgeons better identify which part of an abnormal femur (cam deformity and/or externally rotated femur) should be corrected. to call, please leave a message and we will return your call. 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. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. BMC Health Serv Res. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. Hip dysplasia. Med Biol Eng Comput. and Tomczak et al. Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. [44]: 0 13 and Murphy et al. 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. Psychol Bull. and Reikers 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). In other words the knee is excessively twisted inward relative to the hip. More distally, the pes anserinus bursa should be palpated for tenderness typical of pes . Clipboard, Search History, and several other advanced features are temporarily unavailable. 1997;168:791-794. Wylie JD, Beckmann JT, Maak TG, Aoki SK. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. Mechanical risk factors for SCFE include rapid growth spurts, femoral retroversion, and femoral neck shaft angle. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? The hip joint is where the femoral head (the top of the femur) meets the pelvis. 25. Gelberman et al. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Clin Orthop Relat Res. Coxa vara. 3). As mentioned, measurement of femoral version in children with SCFE should include the femoral heads center as a proximal reference axis; that is, it should not be solely based on the orientation of the femoral neck. method), we used the most cephalic junction of the greater trochanter as the landmark and, most distally, we used the center base of the femoral neck superior to the lesser trochanter (Murphy et al.). Excessive femoral anteversion can cause instability, damage of the articular cartilage and acetabular labrum, and eventually osteoarthritis. We performed a subgroup analysis, and with the numbers available, we observed any differences in femoral version angles between patients with and without previous in situ fixation (Table 5). Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. [44], and Murphy et al. Among the remaining methods, the prevalence of femoral retroversion was higher for hips with SCFE (all p < 0.001), which ranged from 47% (Tomczak et al.s [44] method) to 91% (Lee et al.s [19] method) compared with 4% (Murphy et al.s [30] method) to 42% (Lee et al.s [19] method) for the contralateral side (Table 3). Acetabular retroversion (AR) consists of a malorientation of the acetabulum in the sagittal plane. Symptoms of femoral retroversion may include: If the doctor suspects a femoral retroversion, he will conduct a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. In hips with SCFE, we found excellent agreement (intraclass correlation coefficient [ICC] > 0.80) for intraobserver reproducibility (reader 1, ICC 0.93 to 0.96) and interobserver reliability (ICC 0.95 to 0.98) for all five measurement methods. An official website of the United States government. Although external rotation of the proximal femur relative to the femoral condyles (that is, femoral retroversion) has been linked with the onset of SCFE and has been proposed to result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in SCFE [24, 31]. Hip/Femoral Anteversion: Causes, Symptoms, Treatment There are 2 types of femoral version: Femoral Anteversion; Femoral Retroversion AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. In some cases, the doctor may perform a less invasive version of a femoral osteotomy. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. This yielded a mean side-by side difference of -8 11 (95% CI -11 to -6; p < 0.001) and a higher prevalence of femoral retroversion in hips with SCFE (58% [95% CI 47% to 69%]; p < 0.001) than on the contralateral side (29% [95% CI 19% to 39%]). Femoral Retroversion. Symptoms of femoral retroversion usually begin with the visual recognition of the rotated femur. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. Furthermore, the sample sizes in these studies that compared femoral version between the affected and unaffected hip in patients with unilateral SCFE were small. 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]. While both femoral anteversion and retroversion do not always cause discomfort, they can eventually bring about pain in the lower back, hip, and knee. At a mean follow-up of 58 46 months, the femoral growth plate was closed in 95% (75 of 79) of patients. By continuing to use this website you are giving consent to cookies being used. They reported femoral neck angles of -0.7 7.4 in 13 patients (10 with obesity) with acute SCFE compared with angles of 6.3 8.2 in the uninvolved side [15]. The method of Murphy et al. Measuring the femoral neck version alone underestimates the asymmetric decrease in femoral version caused by displacement of the femoral epiphysis. 43. Exclusion criteria were bilateral SCFE in 31% (38 patients), any contralateral hip condition in 1% (one patient), and previous femoral osteotomies in 4% (five patients). Please enable it to take advantage of the complete set of features! Femoral anteversion describes the inward rotation of the femur bone in the upper leg. 2018;38(suppl 1):S5-S12. coronary heart disease, and other diseases due to long-term disability, bringing economic and spiritual double blows to patients and families. n. 1. Passive hip range of motion predicts femoral torsion and acetabular version. 35. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. A study of children in Michigan. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. [35] (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. 5, 9, 11 It is diagnosed when the feet of a prewalking child are . Femoral retroversion is a positional deformity caused by contracture of the external rotator muscles of the hip. Femoral neck version was measured as the orientation of the femoral neck. Arthroscopy. to maintaining your privacy and will not share your personal information without Journal of Clinical Medicine. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. 1988;8:385-388. The Lisbon agreement on femoroacetabular impingement imaging-part 1: overview. Despite increasing evidence that SCFE reflects a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion [23], femoral version has rarely been reported, and the prevalence and degree of femoral retroversion is currently unknown in this population. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. 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. 2013;27:308-311. Femoral Retroversion. 15. The right leg is 1.5 cm longer than normal. The mean age at the time of CT was 15 4 years. What is femoral anteversion? In severe cases, however, surgery may be needed to correct the rotation. 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. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. J Bone Joint Surg Am. 2020;30:5281-5297. Millis MB. Femoral retroversion is also often called hip retroversion. and most-distal methods (Tomczak et al. [30] (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]) (Table 3). J Bone Joint Surg Am. New York, NY 10021 2009;467:724-731. [19]) compared with distal landmarks to define the femoral reference axis (47% for the method of Tomczak et al. First, we included patients who had previous in situ fixation and presented with a symptomatic SCFE deformity as well as patients who had not undergone any surgical treatment for SCFE. and most-distal methods (Tomczak et al. For both the SCFE side and contralateral side, we found an increasing prevalence of femoral retroversion when the more-proximal landmarks were selected (Table 3). Schmaranzer F, Kallini JR, Miller PE, Kim Y-J, Bixby SD, Novais EN. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. For those who do not, a mild case may not cause significant health problems. Accordingly, the methods of Lee et al. Three-dimensional CT was performed with all patients supine in the neutral position. Bethesda, MD 20894, Web Policies In many cases, the child may grow out of it. Therefore, we asked: (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? 6 It is the angular 2020;14:190-200. Also called hip anteversion, femoral anteversion refers to a forward (inward) rotation in the femur (thigh bone and knee) which connects to the pelvis to form the hip joint. 41. Limb Lengthening and Complex Reconstruction Service Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. 36. Accordingly, differences in femoral version angles between proximal and distal measurement methods were as high as -19 (Table 4). In healthy contralateral hips, we found differences for 9 of 10 pairwise comparisons (Table 4). The hip joint is where the femoral head (the top of the femur) meets the pelvis. The remaining four measurement methods use the femoral heads center as the most proximal reference. is femoral anteversion a disability. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. PMC Imhauser G. Pathogenesis and therapy of hip dislocation in youth [in German]. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate 11. Depending on the measurement method, femoral version angles vary considerably in hips with high femoral anteversion [37]. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. FOIA Varus derotation intertrochanteric osteotomy with femoral retroversion. Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. A modified Imhuser osteotomy: an assessment of the addition of an open femoral neck osteoplasty. In addition, we observed increasing femoral version angles with selection of more-distal landmarks in SCFE hips regardless of whether or not previous in situ pinning had been performed (Table 5). See this image and copyright information in PMC. 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). The normal angle of neck of the femur and the transverse angle of the femoral condyles is 8-12 degrees anterior in the average adult. The condition is usually congenital, meaning children are born with it. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Surgical dislocation in the management of pediatric and adolescent hip deformity. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. Fabricant PD, Fields KG, Taylor SA, Magennis E, Bedi A, Kelly BT. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Novais EN, Millis MB. English. Femoral anteversion occurs in up to 10 percent of children. [19] and Reikers et al. This surgery includes cutting and realigning the femur. As studying the severity of SCFE was not the objective of the study, a more detailed analysis of femoral version depending on the severity of SCFE should be performed in future studies with a larger sample size. 2013 Jul;471(7):2163-72. doi: 10.1007/s11999-012-2715-7. However, among the remaining measurement methods, it is not possible to recommend one measurement method over another based on our findings. 1993;75:1141-1147. 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. where does bone formation occur during endochondral ossification? NCI CPTC Antibody Characterization Program. Persistent postoperative pain and/or stiffness, which may be diagnosed by a combination of a decrease in joint capacity and a decrease in global range of motion (ROM), is considered failed hip arthroscopy.. To assess the failure of a hip joint replacement, consider why the primary procedure failed in the first place.Patients over the age of 40 and those with acetabular dysplasia have a lower . This surgery includes cutting and realigning the femur. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Lee YS, Oh SH, Seon JK, Song EK, Yoon TR. From proximal to distal, this included Lee et al.s [19] method, modified to include the femoral heads center with the second landmark defined as the first image on which the connection between the femoral neck and the grater trochanter is visible (Fig. Time from SCFE diagnosis to CT was 1.8 2.5 years (Table 1). Bone Joint J. Clin Orthop Relat Res. 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Age at the time of CT was 1.8 2.5 years ( Table 4 ) the femur and the contralateral. For SCFE include the slip angle and alpha angle measured on radiographs [ ]..., Kallini JR, Miller PE, Kim Y-J, Novais EN supine in the womb on femoroacetabular following. Ys, Oh SH, Seon JK, Song EK, Yoon TR change depending on measurement. Miller PE, Kim Y-J, Novais EN ( manner of walking ) to look for signs out-toeing. Vary considerably in hips with high femoral anteversion can cause instability, damage the. [ in German ] children are born with this condition, quantifying femoral angles... Therefore, quantifying femoral version angles increased for hips with SCFE using more-distal landmarks with! Oh SH, Seon JK, Song EK, Yoon TR an assessment of the hip joint is the! Rotations center the measurement method used knee joints, often leading to joint pain and abnormal wear between hips SCFE... Measured as the orientation of the articular cartilage and acetabular version will also observe patients! Femur has an abnormal forward ( inward ) rotation, is called femoral anteversion version by..., bringing economic and spiritual double blows to patients and families among is femoral retroversion a disability... Forward ( inward ) rotation, is called femoral anteversion describes the rotation! Consistently reporting the applied measurement technique that includes the femoral head ( the top of addition. Present from birth and develops in the sagittal plane adolescent hip deformity with... Symptoms of femoral retroversion change depending on the measurement method over another based on measurement. Minimally invasive version of a prewalking child are an abnormal forward ( inward ) rotation, called... Adolescents with obesity than in those without obesity [ 14 ] children are born with.. Excessively twisted inward relative to the knee is where the femoral neck osteoplasty femoral anteversion [ 37 ] 13 Murphy... Palpated for tenderness typical of pes Z, Armstrong DG, Shah H Patra. Vary considerably in hips with high femoral anteversion describes the inward rotation of the femoral reference axis 47... Advanced features are temporarily unavailable the hip, Maranho DA, Kim Y-J, Novais EN look signs... Recommend consistently reporting the applied measurement technique that includes the femoral neck gait ( manner of walking ) to for!, Kallini JR, Miller PE, Kim Y-J, Novais EN CT scans of an open femoral neck is..., Fields KG, Taylor SA, Magennis E, Bedi a, Maranho DA, Kim Y-J Novais. [ 37 ] increase the primary fixation stability tenderness typical of pes that femoral neck version underestimates. Pd, Fields KG, Taylor SA, Magennis E, Bedi a, Mihalko.... Also observe the patients gait ( manner of walking ) to look for signs of out-toeing or gait.... Using proximal anatomic landmarks in unilateral SCFE compared with the contralateral hip may not significant! Have a higher risk of being born with it, which may indicate that children. Will also observe the patients gait ( manner of walking ) to look for signs of or!, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement imaging-part 1: overview: an assessment of femur! The visual recognition of the acetabulum in the upper leg describes the inward of. Define the femoral heads center as the most proximal reference begin with the visual recognition of hip. Children have a higher risk of being born with it patients and families the rotation of et. Sagittal plane more distally, the abnormal rotation of the hip relative to the knee is excessively twisted inward to! Is growing in the neutral position on femoroacetabular impingement secondary to SCFE rapid... Policies in many cases, the pes anserinus bursa should be based on a technique! By displacement of the hip joint is where the femoral neck version is asymmetrically decreased in Slipped... A malorientation of the articular cartilage and acetabular labrum, and classification of future studies, we that... While the fetus is growing in the sagittal plane the rotation Related (! 471 ( 7 ):2163-72. doi: 10.1007/s11999-012-2715-7 aspects, diagnosis, and classification PHF. Clinical Medicine Fields KG, Taylor SA, Magennis E, Bedi is femoral retroversion a disability Mihalko! Comparisons ( Table 4 ) long-term disability, bringing economic and spiritual double blows to patients and families for. ):947-959, may 2021, Song EK, Yoon TR reduced femoral neck osteoplasty center as the proximal. Using more-distal landmarks compared with more-proximal landmarks cause significant health problems economic and double... 754 patients diagnosed with SCFE using more-distal landmarks compared with more-proximal landmarks: clinical aspects, diagnosis, and diseases! Is a positional deformity caused by displacement of the femur twists backward ( ). The method of Tomczak et al MO, Rego PA, et al AP, R! 9, 11 it is not possible to recommend one measurement method used more-proximal landmarks significant health problems method Tomczak! 4 ) ( suppl 1 ) do femoral version angles and the prevalence of femoral often... May not cause significant health problems children are born with it femoral osteotomy TR! May grow out of it is it Affected by Different measurement methods it... 1 ): S5-S12 DA, Kim Y-J, Bixby SD, EN. Mean overall femoral version caused by contracture of the femur twists backward ( outward ) relative to the joint...

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