Forty-eight percent (38 of 79 patients) were male, and 72% (57 of 79) were overweight (13 patients [17%] with a BMI between the 85th and 95th percentiles) or obese (44 patients [56%] with a BMI above the 95th percentile). J Child Orthop. Disclaimer, National Library of Medicine Arthroscopy. Said differently, the knee is excessively twisted inward relative to the hip. 1996;5:74-76. [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. 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. A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. 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. By contrast, Stanitski et al. Radiology. 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. Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate 12. After applying prespecified inclusion and exclusion criteria, we included 79 patients. The definition of the proximal reference axis differs among the five methods. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). 2. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. Further measurement methods included the femoral heads center and differed regarding the level of landmarks for the proximal femoral reference axis. Abnormalities in hip joint morphology, such as developmental dysplasia of the hip (DDH) and femoroacetabular impingement, have been shown to alter hip mechanics and promote the development of end-stage hip OA. 34. Rebello G, Spencer S, Millis MB, Kim Y-J. J Orthop Res. 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. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. 10. 2017;11:93-98. Femoral anteversion describes the inward rotation of the femur bone in the upper leg. Loder RT, Aronson DD, Greenfield ML. Lerch TD, Todorski IAS, Steppacher SD, et al. 6. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. Southwick WO. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. Femoral retroversion could result from developmental conditions such as focal femoral deficiency, and dysplasia or be acquired secondary to malunited subtrochanteric, intertrochanteric or femoral neck fracture, varus derotational osteotomies and slipped capital femoral epiphysis (SCFE). If you prefer
In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. Passive hip range of motion predicts femoral torsion and acetabular version. Bone Joint J. 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. 45. Time from SCFE diagnosis to CT was 1.8 2.5 years (Table 1). These differences ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on Tomczak et al.s [44] method to -22 13 (95% CI -25 to -19; p < 0.001) when applying Murphy et al.s [30] method (Fig. What is femoral anteversion? and Tomczak et al. The ischiofemoral distance was evaluated for patients with increased FV on preoperative MRI and was lower (17 5 mm, range 12-25) compared to the reported normal ischiofemoral distance [ 46] of 30.6 mm. 2006;44:895-906. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. 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). 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. Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). 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. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. Bookshelf 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). 2006;26:291-294. 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). Clin Orthop Relat Res. 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). The hip joint is where the femoral head (the top of the femur) meets the pelvis. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. The prevalence of femoral retroversion was high in patients with SCFE, and even higher when retroversion was defined and diagnosed using proximal anatomic landmarks. FEMORAL VEIN ANATOMY. [44] (Table 4). "Of key note on the 3D studies," says Dr. Kamath "is the low femoral version 2.2 degrees, which is relative retroversion of the femur, when compared to normative female populations of this age." Her diagnosis? Cartilage is a semi-rigid but flexible avascular connective tissue found at various sites within the body. 2. 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. 2009;467:724-731. The exact cause of femoral retroversion is unknown. Please try after some time. The data table on the chart reports the mean SD. In some cases, a minimally invasive version of a femoral osteotomy may be performed. Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. and Murphy et al. Imhauser G. Pathogenesis and therapy of hip dislocation in youth [in German]. Furthermore, the prevalence of actual femoral retroversion and the effect of different measurement methods has yet to be studied in SCFE. However, the association between reduced femoral anteversion and SCFE has yet to be fully elucidated because early studies were small and based on two-dimensional CT scans. 2) and hip ROM [ 32, 33 ]. femoroacetabular impingement. The hip joint is where the femoral head (the top of the femur) meets the pelvis. The condition is usually congenital, meaning children are born with it. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning for X-ray imaging may not reveal a rotation in the femoral neck. 23. Varus derotation intertrochanteric osteotomy with femoral retroversion. 3). [35], Tomczak et al. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. Children with femoral anteversion may trip and fall more than their peers, but the condition is rarely painful. 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. 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. 28. Abduction of the forefoot associated with pes planovalgus. . 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. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. In our institution, the method described by Murphy et al. 8. 2013 Jul;471(7):2163-72. doi: 10.1007/s11999-012-2715-7. Careers. 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). We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. 1999;81:1747-1770. Methods: J Orthop Res. What Is the Association Among Epiphyseal Rotation, Translation, and the Morphology of the Epiphysis and Metaphysis in Slipped Capital Femoral Epiphysis? Clin Orthop Relat Res. 3. 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. and Murphy et al.). [44]) (Table 3). Retroversion refers to an abnormal backward rotation of the hip relative to the knee. The five different measurement methods were applied in the same way in hips with SCFE and in healthy contralateral hips (Fig. 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. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. Lerch TD, Boschung A, Todorski IAS, et al. Furthermore, the reliability and reproducibility of these measurements in patients with SCFE is unknown. 2014;30:1314-1325. , and. Clin Orthop Relat Res. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. Galbraith RT, Gelberman RH, Hajek PC, et al. VDK is a continuous series of pathological changes from the lightest to the most severe degrees. The I-bars represent the corresponding 95% CI. Please enable it to take advantage of the complete set of features! This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. Femoral retroversion can result in the crushing of the labrum. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). The prevalence of femoral retroversion was high in our study and ranged from 47% to 91%, depending on the applied measurement method (Table 3). After applying prespecified inclusion and exclusion criteria, we included 79 patients. 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. and Reikers et al.) Congenital right femoral retroversion; Congenital right hip dysplasia; Present On Admission. Lerch TD, Novais EN, Schmaranzer F, et al. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. A study of children in Michigan. Measurement on axial HASTE images (proximal and distal femur): Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. 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. Studies using this imaging modality to measure femoral version are limited by long acquisition times that are prone to patient malpositioning [15, 42]. The right leg is 1.5 cm longer than normal. 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). To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. 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. Femoral anteversion is diagnosed through observation and examination. 15. A Type I error rate of 5% was used. The source of all of my pain was the retroversion of my femur. Out-toeing may be caused by: Femoral retroversion. We reviewed our institutional database for patients who were treated for SCFE and had undergone pelvic CT scanning for surgical planning. To develop effective prevention strategies, we must first understand what it is, what impact it . 25. [35] uses the center of the femoral neck as a reference at the level where both cortices run parallel. Please enable scripts and reload this page. 20. It has been reported that some degree of remodeling of the femoral head-neck junction can be expected after fixation of the epiphysis over time [1, 9]. [15] were the first to describe a method of measuring femoral neck version in patients with SCFE. 3). 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. 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. 3). This is the story of her diagnosis, operations and recovery to date: Hi I'm Elise and I live in Northern Ireland. 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. 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. Slipped capital femoral epiphysis. It becomes apparent as the child starts to stand or cruise between 6 and 9 months. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. where does bone formation occur during endochondral ossification? It is typically detected when the child is 4 years to 6 years old. A technical improvement. 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. A turning or tilting backward. 46. BMC Health Serv Res. and Tomczak et al. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. J Bone Joint Surg Am. 41. 2016;36:239-246. Liu RW, Armstrong DG, Levine AD, Gilmore A, Thompson GH, Cooperman DR. An anatomic study of the epiphyseal tubercle and its importance in the pathogenesis of slipped capital femoral epiphysis. My doctors would not treat me unless I had surgery to fix the retroversion. 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. Among these, the greatest differences were between the most-proximal methods and the more-distal methods. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. However, a comparison of measurement methods of femoral version is lacking in patients with SCFE. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA, F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA, F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland, Email: [emailprotected]. The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. Southwick WO. This graph shows a comparison of the different methods to measure femoral version, MeSH (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? 2020;30:5281-5297. Reduced femoral neck version is lacking in patients with SCFE to take advantage of the femur ) meets the.! Galbraith RT, Gelberman RH, Hajek PC, et al fractures ( PHF is! Underestimate the severity of the proximal reference axis is more common in adolescents with than! 471 ( 7 ):2163-72. doi: 10.1007/s11999-012-2715-7 ) is an option to increase primary. 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