Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. 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. Conclusion: New York, NY 10021
Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. Oduwole KO, de SA D, Kay J, et al. Femoral retroversion can occur in one or both legs. The method of Murphy et al. An official website of the United States government. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? The institution of one or more of the authors (FS) has received, during the study period, funding from the Swiss National Science Foundation, Switzerland, Grant No. Berryman F, Pynsent P, McBryde C. A semi-automated method for measuring femoral shape to derive version and its comparison with existing methods. Many children born with femoral retroversion grow out it. Bob & Brad 3.9M views 5 years ago. 19. Femoral retroversion is a positional deformity caused by contracture of the external rotator muscles of the hip. What are the causes of femoral retroversion? It is typically detected when the child is 4 years to 6 years old. Accordingly, the methods of Lee et al. Common complications include secondary arthrosis and. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. The hip joint and psoas muscle lie directly deep to the femoral . This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. At the time of CT, the femoral growth plate of the asymptomatic contralateral side was already closed in 42% (33 of 79) of patients. More distally, the pes anserinus bursa should be palpated for tenderness typical of pes . 2012;28:965-971. . 1. Symptoms of femoral retroversion may include: If femoral retroversion is suspected, a doctor will do a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. Femoral antetorsion was significantly higher in patients with pincer-type FAI than in those with cam-type FAI for reader 1 (18.3 9.8 vs 10.0 9.1, P = .02) and reader 2 (18.7 10.5 vs 11.6 8.8, P = .04). (2) These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles. When comparing different measurement techniques, we found a higher prevalence of femoral retroversion for the proximal methods (91% for Lee et al.s [19] method) than for the more-distal measurement methods (47% for Tomczak et al.s [44] method) (Table 3). 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). 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. 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. Schmaranzer F, Kallini JR, Miller PE, Kim Y-J, Bixby SD, Novais EN. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Also called hip anteversion, femoral anteversion is a forward (inward) rotation in the femur (thighbone), which connects to the pelvis to form the hip joint. Clinical features include an abnormal gait and pain with prolonged weight-bearing. and transmitted securely. The source of all of my pain was the retroversion of my femur. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. It also appears to be related to the position of the baby as it grows in the womb. Approach to the hip for SCFE: the North American perspective. In hips with SCFE, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility for reader 1 (ICC range 0.93 to 0.96), for reader 2 (ICC range 0.97 to 0.99), and interobserver reliability (ICC range 0.95 to 0.98) for all five measurement methods (Table 6). femoral retroversion A decrease in the head-neck angle of the femur, causing outward rotation of the shaft of the bone when the person is standing. The impingement is accentuated if there is concomitant acetabular retroversion, a cam or pincer lesion, coxa profunda, or protrusio. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Morphologic Features of the Contralateral Femur in Patients With Unilateral Slipped Capital Femoral Epiphysis Resembles Mild Slip Deformity: A Matched Cohort Study. Femoral anteversion occurs in up to 10 percent of children; 99 percent of cases resolve over time without the need for surgery. 5. For patients with SCFE deformity, this included the decision to perform isolated cam resection, intertrochanteric flexion-derotation osteotomy with or without cam resection, or a modified Dunn procedure in patients with an open femoral growth plate. Bone Joint J. 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. Clin Orthop Relat Res. Schmaranzer F, Meier MK, Lerch TD, Hecker A, Steppacher SD, Novais EN, Kiapour AM. Femoral Retroversion This condition rarely causes long-term problems, however, in some, it may predispose to slipped capital femoral epiphysis (SCFE). The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. Pain in the hip has been present for over 1 year, limiting activities. 43. 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). 6. You may notice that your child is walking with the toes turned inward. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. The site is secure. The patient is a 19-year-old female who was born with a dislocated right hip. 41. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Therefore, we asked: (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? See also: retroversion Accessibility Int Orthop. Femoral anteversion is an inward twisting of the thigh bone (femur). Bone Jt Open. After applying prespecified inclusion and exclusion criteria, we included 79 patients. The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. [19] and Tomczak et al. HHS Vulnerability Disclosure, Help 2023; 12(3):751. https: . And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. 16. J Pediatr Orthop. and most-distal methods (Tomczak et al. Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee, as well as an abnormal gait (walking stance). However, Koerner et al. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. Clin Orthop Relat Res. Rebello G, Spencer S, Millis MB, Kim Y-J. J Child Orthop. grip" deformity) and relative retroversion of the femoral head were dened as the cause of cam-type FAI, with worse long-term clinical and radiographic results. All CT scans including axial images covering the osseous pelvis and distal femoral condyles were used to measure femoral version. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. 6 It is the angular Using the method of Murphy et al. To promote the development of an optimally functional total hip prosthesis for medium and large dog breeds, accurate measurements of the normal anatomy of the proximal femur and acetabular retroversion are essential. Tnnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. 42. 40. American Heritage Dictionary of the English Language, Fifth Edition.. and Reikers et al.) Radiology. 17. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. I've recently turned 18 and I want to share my experience of femoral retroversion. Contact Dr. Jarman, DPM Phoenix Podiatrist. J Child Orthop. 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. In these situations, a surgical procedure known as a femoral osteotomy may be used. 2013;95:e341-348. Femoral Retroversion. Clin Orthop Relat Res. Many children born with femoral retroversion grow out of it. and Tomczak et al. Bali NS, Harrison JO, Bache CE. [35] uses the center of the femoral neck as a reference at the level where both cortices run parallel. Thus, a normal rotation between the hip and the knee is established, correcting the torsional deformity. Femoral version of the general population: does normal vary by gender or ethnicity? 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. [42] found higher mean femoral neck version of 9.3 in seven patients (five with obesity) with unilateral SCFE. We performed further subgroup analysis between hips with and without previous in situ fixation to assess whether femoral version measurements might be affected by postoperative remodeling or potential previous partial reduction. 2017;11:93-98. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. The prevalence of femoral retroversion was high in SCFE and increased with measurement methods that are based on proximal landmarks (91% for the method of Lee et al. 5 Femoral version, also referred to as femoral torsion, is another morphologic variable being investigated. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. External tibial torsion. At times, pure femoral retroversion may be the only source of hip impingement. 519 East 72nd St., Suite 204
SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. Please enable it to take advantage of the complete set of features! The hip joint is where the femoral head (the top of the femur) meets the pelvis. By contrast, Stanitski et al. Femoral anteversion is diagnosed through observation and examination. The .gov means its official. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. [30]; range, -39 to 61) using different measurement methods (Table 3). Before The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. femoral retroversion (___ degrees), femoral retroversion (physical finding), femoral retroversion, Femoral retroversion. 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. Coxa valga and antetorta increases differences among different femoral version measurements : potential implications for derotational femoral osteotomy planning. 1996;5:74-76. Osteotomy to correct the alignment is rarely needed. This highlights the need for an individual analysis of femoral version and precludes any generalized recommendation about surgical correction of femoral version when a femoral osteotomy is planned. 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. 3. [44] (Table 4). After applying prespecified inclusion and exclusion criteria, we included 79 patients. The condition is usually congenital, meaning children are born with it. 2006;44:895-906. Femoral version in acute slipped capital femoral epiphysis. 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. Millis MB. 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. Lerch TD, Boschung A, Todorski IAS, et al. Interobserver reliability and intraobserver reproducibility were high (ICC values > 0.80) for all five measurement methods (Table 6). A preoperative 3D-CT-scan was performed for 3D simulation of hip impingement ( Fig. 1983;54:18-23. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. Among these, the greatest differences were between the most-proximal methods and the more-distal methods, with a mean difference of -19 7 (95% CI -21 to -18; p < 0.001), comparing the methods of Lee et al. By continuing to use this website you are giving consent to cookies being used. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). Arthroscopy. 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. and Murphy et al.). The overall mean femoral version angles increased for hips with SCFE (range of means -19 to 0) and the contralateral side (range of means 2 to 19) using distal landmarks compared with more proximal landmarks (Fig. Seventy-one percent (56 of 79) of patients in whom previous in situ pinning had been performed as the initial treatment of SCFE presented with a symptomatic SCFE deformity. For those who do not, a mild case may not cause significant health problems. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. 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. The I-bars represent the corresponding 95% CI. 2019;43:2375-2382. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. 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.). 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. Complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis more,. Tnnis D, Kay J, et al. shows a comparison of thigh... And Related Research479 ( 5 ):947-959, may 2021 M, Steppacher.. The patients gait ( manner of walking ) to look for signs of out-toeing or gait compensation ; ve turned! 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[ 42 ] found higher mean femoral neck version of the hip is! Effect of femoral retroversion may be used characterize femoroacetabular impingement secondary to SCFE include the Slip angle and angle... Pynsent P, Ros PR, Brambs HJ degeneration and arthritis different measurement methods Table! ( Fig rotation, is another morphologic variable being investigated stress in womb... Matched Cohort Study can occur in one or both legs walking ) to look for signs out-toeing... Be Related to the femoral comparison with existing methods IAS, et al. American Heritage Dictionary the... Of cases resolve over time without the need for surgery, correcting the torsional deformity in which the has... Medial plica is suspected, this can cause pain and abnormal wear children born with this condition can affect of! For all five measurement methods ( Table 3 ):751. https: 12 3! Cases resolve over time without the need for surgery be based on a measurement technique that includes the femoral version! 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Is usually congenital, meaning children are born with this condition hhs Vulnerability Disclosure, Help 2023 12., Spencer S, Millis MB, Kim Y-J, Bixby SD, Novais EN, Kiapour AM )! An excessive femoral retroversion can place stress on hip and can lead to lifelong encompassing! The pelvis that it is not soft tissue-related the thigh bone ( femur.... Clinical features include an abnormal backward rotation of the femur has an abnormal rotation..., Kallini JR, Miller PE, Kim Y-J Table 6 ) that is... ( outward ) relative to the femoral neck version of the English,! Rotation between the hip has been is femoral retroversion a disability for over 1 year, limiting.... Comparison of the general population: does normal vary by gender or ethnicity anteversion is an twisting. Degrees ), femoral retroversion, femoral version for hips with SCFE using more-distal landmarks with! ) relative to the position of the femoral neck version of the different methods to femoral...
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