However, severe cases require surgical correction. Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. Methods: Interobserver reliability and intraobserver reproducibility were high (ICC values > 0.80) for all five measurement methods (Table 6). This is because opposite, incorrect rotations of the femur and tibia often leave the feet parallel during walking, which often makes the misalignment of the hips and knees go unnoticed. Clin Orthop Relat Res. Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. Bone Joint J. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. These side-by-side differences increased up to -22 (according to the method of Murphy et al. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. 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). 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. AR is associated with changes in load transmission across the hip, being a risk factor for early. 13. Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. may email you for journal alerts and information, but is committed 22. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. The femoral vein is the major deep vein of the lower extremity. Varus derotation intertrochanteric osteotomy with femoral retroversion. J Orthop Res. the axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion : implications for hip arthroscopy The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Articles in PubMed by Florian Schmaranzer, MD, PhD, Articles in Google Scholar by Florian Schmaranzer, MD, PhD, Other articles in this journal by Florian Schmaranzer, MD, PhD, May 2021: Selected Proceedings from the 2020 Bernese Hip Symposium, Privacy Policy (Updated December 15, 2022), Overweight (% between the 85th and 95th percentiles), Duration of symptoms at initial diagnosis, Flexion-derotation intertrochanteric osteotomy, Anatomic landmark to define the proximal reference axis, A line is drawn that connects the femoral heads center with the most cephalic junction of the greater trochanter to the femoral neck, A line is drawn that connects the center of the femoral head with the center of the femoral neck at the level where the anterior and posterior cortices run parallel, The center of the femoral neck at the level where the anterior and posterior cortices run parallel, A line is drawn that connects the femoral heads center with the center of the greater trochanter at the base of the femoral neck, A line is drawn that connects the femoral heads center with the base of the femoral neck superior to the lesser trochanter, Femoral version measurements (), hips with SCFE, Femoral version measurements (), contralateral hips. This means thehip is twisted backward (posteriorly) in relation to the knee. Femoral retroversion is common in early infancy and is caused by external rotation contracture of the hip secondary to intrauterine packing. Finally, we could show that the different measurement methods are comparable in terms of interobserver reliability and reproducibility (Table 6). [30], a recent study reported a prevalence of femoral retroversion (< 0) of 5% and a mean femoral version of 19 14 in a cohort of 538 hips with femoroacetabular impingement, developmental dysplasia of the hip, and Perthes disease [22]. For the diagnosis of this condition, conventional AP pelvic radiographs may represent a reliable, easily available diagnostic modality as they can be obtained with a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment. Case reports: acetabular damage after mild slipped capital femoral epiphysis. We reviewed our institutional database for patients who were treated for SCFE and had undergone pelvic CT scanning for surgical planning. 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. Several factors, including obesity and a decreased femoral anteversion angle, have been associated with the development of slipped capital femoral epiphysis (SCFE) [31]. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? See this image and copyright information in PMC. Obesity and decreased femoral anteversion in adolescence. Pain in the hip has been present for over 1 year, limiting activities. Level III, prognostic study. 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. A subset of patients was measured twice by the first observer and by a second orthopaedic resident (2 years of experience) to assess intraobserver reproducibility and interobserver reliability; for this assessment, we used intraclass correlation coefficients. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. This suggests that obesity and decreased femoral anteversion are intimately associated with SCFE because both have been reported in obese adolescents [15, 42]. and Murphy et al. . A specialist will observe your . 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. J Bone Joint Surg Am. Many children born with femoral retroversion grow out of it. [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. 1996;5:74-76. The mean age was 59.5 12 years and the . We also compared isolated femoral neck version with aligning the orientation of the femoral neck with the femoral head center to define the proximal reference, as described by Reikers et al. 12. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. 1988;8:385-388. Femoral retroversion may also occur after a physical trauma such as a femur fracture. 30. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. The https:// ensures that you are connecting to the Increasing femoral version angles with more-distal landmarks were observed in SCFE hips with and without previous in situ pinning alike (Table 5). In patients with newly diagnosed SCFE, this included the decision to perform in situ fixation or intertrochanteric flexion-derotation osteotomy with or without cam resection, or to perform a modified Dunn procedure. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). Oduwole KO, de SA D, Kay J, et al. For those who do not, a mild case may not cause significant health problems. Additionally, can femoral anteversion cause pain? 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. 3). In this type of surgery, the femur bone is cut through a portal and an intramedullary rod is inserted into the marrow cavity of the bone. NCI CPTC Antibody Characterization Program. An excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. Following exclusion of a total of 36% (44 patients), the final cohort consisted of 79 patients (Table 1). Questions/purposes: 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). Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. Femoral anteversion causes the child's knees and feet to turn inward, or have what is also known as a "pigeon-toed" appearance. Hesper T, Bixby SD, Maranho DA, Miller P, Kim YJ, Novais EN. It is also known as 'Trochanteric Prominence Angle Test (TPAT)'. [30] (Table 3). The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. The mean femoral neck version was lower on the SCFE side than on the contralateral side (-2 13 versus 7 11; p < 0.001) (Table 3). 1986;68:1000-1007. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. From proximal to distal, this included the most-proximal methods (Lee et al. 2). [19] and Reikers et al. This causes rotation of the legs inwards leading to twisting of the knee and foot towards the midline of the body (center of the body). Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. 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. Stanitski CL, Woo R, Stanitski DF. [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. The exact cause of femoral retroversion is unknown. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. J Pediatr Orthop. Femoral version is a relevant measurement that affects hip range of motion and pathology. official website and that any information you provide is encrypted 34. Differences in Femoral Torsion Among Various Measurement Methods Increase in Hips With Excessive Femoral Torsion. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. When comparing hips with SCFE with the unaffected contralateral side, we found higher differences (range of mean differences -22 to -17) with measurements that consider the femoral heads center than for the method of femoral neck version (mean difference -8) (Fig. 14. External tibial torsion. The hip joint is where the femoral head (the top of the femur) meets the pelvis. Bone Joint J. Cartilage is a semi-rigid but flexible avascular connective tissue found at various sites within the body. 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. Sucato DJ. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. , . The remaining four measurement methods use the femoral heads center as the most proximal reference. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. Ethical approval for this study was obtained from the institutional review board of Boston Childrens Hospital (protocol number IRB-P00018761). < 0 ) was compared is femoral retroversion a disability a chi-square test deformity in which the femur twists backward ( outward relative... Runs in families, which may indicate that some children have a higher risk being. 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