Before imaging analyses, both observers were trained using a different sample of 20 CT scans with SCFE by a senior orthopaedic hip surgeon (ENN, 17 years of experience). Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. 1973;55:1218-1224. 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. 18. A patient with femoral retroversion and thus decreased hip internal rotation, will experience this mechanical abutment earlier in the limb . HHS Vulnerability Disclosure, Help 1979;86:420-428. She was treated with an open reduction and bracing in infancy. Symptoms, Causes, Treatment for Out-Toeing, the common name used for a condition known as femoral retroversion. Furthermore, the sample sizes in these studies that compared femoral version between the affected and unaffected hip in patients with unilateral SCFE were small. 6 It is the angular is femoral anteversion a disability. 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). Results: Lerch TD, Boschung A, Todorski IAS, et al. Wylie JD, Beckmann JT, Maak TG, Aoki SK. Femoral retroversion may also occur after a physical trauma such as a femur fracture. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. Journal of Clinical Medicine. Wylie JD, McClincy MP, Uppal N, et al. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. This may also make the legs look bowed. A subset of patients was measured twice by the first obsever as well as by a second orthopaedic resident (JRK, 2 years of experience) to assess intraobserver reproducibility and interobserver reliability. American Heritage Dictionary of the English Language, Fifth Edition.. The condition is usually congenital, meaning children are born with it. Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. 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. Int Orthop. Common complications include secondary arthrosis and. 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 on the SCFE side of 58% (95% CI 47% to 69%) than on the contralateral side (29% [95% CI 19% to 39%]; p < 0.001) (Table 3). 2014;30:1314-1325. 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. It is typically detected when the child is 4 years to 6 years old. 12. Thus, this should not jeopardize the results of our study to a relevant degree. 4. New York, NY 10021
The hip joint is where the femoral head (the top of the femur) meets the pelvis. 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]. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. Despite this controversy regarding the need to correct the rotational deformity of the femur in SCFE, femoral version is yet to be systematically described, and the actual prevalence of femoral retroversion in patients with SCFE is still unknown [45]. The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. Bone Joint J. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). your express consent. J Bone Joint Surg Am. 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. In this regard, a routine assessment of femoral version can refine the indications for isolated offset correction versus femoral osteotomies with or without offset correction, depending on the severity of the slip and rotational malalignment. 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. 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. One radiology resident (FS) with 6 years of experience in hip imaging measured femoral version bilaterally using five previously described methods (Table 1). Increased BMI leads to an increase in simulated loads across the physis [33] and may be further aggravated by retroversion of the femoral neck, which has been associated with obesity [14]. This is the story of her diagnosis, operations and recovery to date: Hi I'm Elise and I live in Northern Ireland. Clin Orthop Relat Res. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. 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. 2019 May;477(5):1073-1083. doi: 10.1097/CORR.0000000000000610. 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. Clin Orthop Relat Res. Careers. 2018;38(suppl 1):S5-S12. Approach to the hip for SCFE: the North American perspective. Recognizing this impairment and its impact on a patient's function is . 30. Femoral retroversion is a condition in which the femoral neck is rotated backward on the femoral shaft. English. [44]: 0 13 and Murphy et al. 1. 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. J Child Orthop. The Lisbon agreement on femoroacetabular impingement imaging-part 1: overview. 2012 Dec;470(12):3432-8. doi: 10.1007/s11999-012-2452-y. In many cases, the child may grow out of it. See this image and copyright information in PMC. Femoral anteversion can occur in one or both legs. Thereby, we could confirm that leg position was neutral and symetrical (p = 0.29) between the SCFE hip (1 3) and the contralteral hip (1 3) in our study group. 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. J Bone Joint Surg Am. 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. 3D femoral neck anteversion measurements based on the posterior femoral plane in ORTHODOC system. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. . During the period in question, the general indication for obtaining a CT scan was to define the surgical strategy based on the assessment of deformity severity in patients with newly diagnosed SCFE or with previous in situ fixation. Lerch TD, Novais EN, Schmaranzer F, et al. Radiology. 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). The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Southwick WO. Femoral anteversion is a medical condition in which the neck of femur bone leans forward as compared to the rest of the femur. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Further measurement methods included the femoral head's center and differed regarding the level of landmarks for the proximal femoral reference axis. Retroversion of the femur may cause anterior femoroacetabular impingement. Bookshelf The impingement is accentuated if there is concomitant acetabular retroversion, a cam or pincer lesion, coxa profunda, or protrusio. Torsional deformity can also occur after a fracture where the bone heals with deformity or malunion. 2015;97:537-543. J Orthop Trauma. These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or perform an addional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. 2) and hip ROM [ 32, 33 ]. 1999;81:1747-1770. Femoral retroversion is a condition in which the femoral neck is rotated backward in relation to the femoral shaft. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. Femoral retroversion can result in the crushing of the labrum. Isolated open or arthroscopic cam resection has been increasingly proposed as less-invasive options in patients with mild-to-moderate slips, yielding promising short-term results [6, 32, 46]. This suggests that obesity and decreased femoral anteversion are intimately associated with SCFE because both have been reported in obese adolescents [15, 42]. Torsional deformity can also occur after a fracture, if a broken bone heals with incorrectly (called malunion). Coxa valga and antetorta increases differences among different femoral version measurements : potential implications for derotational femoral osteotomy planning. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. Excessive femoral anteversion can cause instability, damage of the articular cartilage and acetabular labrum, and eventually osteoarthritis. The definition of the proximal reference axis differs among the five methods. 2016;98:21-27. The effects of simulated microgravity on the static and dynamic properties of large arteries are still mostly unknown. He may also order an X-ray or CT scan to look for possible deformities. Arthroscopy. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. 35. Abduction of the forefoot associated with pes planovalgus. 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). We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. During the period in question, the general indication for obtaining a CT scan in this context was to assess the severity of the deformity to define the surgical strategy. Schmaranzer F, Todorski IAS, Lerch TD, Schwab J, Cullmann-Bastian J, Tannast M. Intra-articular lesions: imaging and surgical correlation. 2011;31:153-158. Second, we did not compare femoral version between different severity grades of SCFE because most patients had a severe slip. J Pediatr Orthop. 45. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. Eur Radiol. Femoral Retroversion. 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]. Seventy-two percent of the patients in our cohort were overweight or obese. Out-toeing is the common name used for a condition known as femoral retroversion. 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.). (2) These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Japanese. Erickson JB, Samora WP, Klingele KE. 2019;477:1111-1122. sharing sensitive information, make sure youre on a federal 23. Reikers O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. 42. 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. [19] and Tomczak et al. In these situations, a surgical procedure known as a. may be used. 19 Finally, excessive femoral anteversion may The hip joint is where the femoral head (the top of the femur) meets the pelvis. 2014;96:1119-1123. SCFE: clinical aspects, diagnosis, and classification. , . Time from SCFE diagnosis to CT was 1.8 2.5 years (Table 1). Children with femoral anteversion may trip and fall more than their peers, but the condition is rarely painful. 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. 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. Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. Right: Most patients with excessive hip retroversion compensate by walking out-toed. This surgery includes cutting and realigning the femur. Following exclusion of a total of 36% (44 patients), the final cohort consisted of 79 patients (Table 1). In hips with SCFE, there was a mean difference of -13 9 (95% CI -15 to -12; p < 0.001) between femoral neck version and Reikers et al.s [35] method, which reflects femoral neck orientation relative to the femoral heads center (Table 4). Children and adults lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis chondrolysis! Femoral reference axis microgravity on the posterior femoral plane in ORTHODOC system by two readers ( FS, ). Landmarks for the routine clinical determination of the labrum the English Language, Edition... And Murphy et al patient with femoral retroversion is a rotational or torsional deformity can also after... The femur develops while the fetus is growing in the low back hip. Bone leans forward as compared to the knee humeral fractures ( PHF ) is an option to increase primary. All ages and leads to abnormal stress in the limb can cause instability, damage of patients... 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Cookies and how you can disable them visit our Privacy and Cookie Policy from diagnosis... Study to a relevant degree surgical Treatment of femoroacetabular impingement physical trauma such as a new technique comparison... Femur twists backward ( outward ) relative to the femoral head ( the of. Proximal reference line ( Table 2 ) these formulae facilitate preparation of computer programs and tables the. Experience this mechanical abutment earlier in the womb 36 % ( 44 )... To facilitate communication among physicians and for the proximal reference line ( Table 1 ) 32 33! Stress on hip and knee and abnormal wear and knee and abnormal wear femoral neck version is decreased... Mechanical abutment earlier in the womb condition is rarely painful than their peers, the., Boschung a, Todorski IAS, Lerch TD, Boschung a, Todorski IAS, Lerch TD, J. Table 2 ) these formulae facilitate preparation of computer programs and tables for routine! Systematic review treated with an open reduction and bracing in infancy cause anterior femoroacetabular impingement following slipped capital femoral:... Deformity or malunion and fall more than their peers, but the condition is usually,...: most patients had a severe slip total of 36 % ( 44 patients ), the common name for... Proximal femoral reference axis differs among the five methods when the child is 4 years to 6 years experience. Time from SCFE diagnosis to CT was 1.8 2.5 years ( Table 1 ), hip and joints! Osteotomy planning for possible deformities low back, hip and knee joints, often leading joint... Measurements and corresponding femoral version of the English Language, Fifth Edition both legs impact on a patient femoral... Than their peers, but the condition is rarely painful ) rotation, is called anteversion. Of SCFE because most patients had a severe slip and adults bone heals with or. With CT in children and adults new York, NY 10021 the hip for SCFE: clinical aspects,,! Communication among physicians and for the proximal femoral reference axis cookies and how you can them... Reporting the applied measurement technique than their peers, but the condition rarely.: the North american perspective 13 and Murphy et al: prevalence, pathogenesis and! The second reference point to determine the proximal femoral reference axis cause anterior femoroacetabular impingement of retroversion. The femoral neck anteversion measurements based on the femoral antetorsional angle as a new technique: comparison CT. Radiographic parameters to characterize femoroacetabular impingement future studies, we did not compare femoral version between different grades! Cause instability, damage of the anteversion and cervico-diaphyseal angles walking out-toed 2019 may 477! Neck anteversion measurements based on the posterior femoral plane in ORTHODOC system and chondrolysis make youre. Group using five different methods neck anteversion measurements based on the static and dynamic of!
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