Email is the best way to reach out for an appointment. Fourth, although we compared our observations in SCFE hips with the unaffected contralateral side, we note that these hips may not reflect a normal population. This surgery includes cutting and realigning the femur. From proximal to distal, this included the most-proximal methods (Lee et al. 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. Varus derotation intertrochanteric osteotomy with femoral retroversion. [44] (Table 4). Fabricant PD, Fields KG, Taylor SA, Magennis E, Bedi A, Kelly BT. SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. The right leg is 1.5 cm longer than normal. Lee YS, Oh SH, Seon JK, Song EK, Yoon TR. 1999;81:1747-1770. During this time period, 754 patients were diagnosed with SCFE. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. Bone Joint J. 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. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. You may notice that your child is walking with the toes turned inward. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. 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. Federal government websites often end in .gov or .mil. Fabricant PD, Bedi A, De La Torre K, Kelly BT. 9. 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. J Orthop Trauma. 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). Studies using this imaging modality to measure femoral version are limited by long acquisition times that are prone to patient malpositioning [15, 42]. Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach. The method of Reikers et al. Femoral retroversion is often a congenital condition, meaning children are born with it. An excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. 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). Southwick WO. Most proximally (Lee et al. Femoral retroversion is a condition in which the femoral neck is rotated backward in relation to the femoral shaft. In our institution, the method described by Murphy et al. 2013;37:2331-2336. 6. 26. This study has several limitations. Arthroscopy. Excessive femoral anteversion can cause instability, damage of the articular cartilage and acetabular labrum, and eventually osteoarthritis. The state of being turned or tilted back. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Further measurement methods included the femoral heads center and differed regarding the level of landmarks for the proximal femoral reference axis. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. If you prefer References 1 article features images from this case 2012;28:965-971. The femoral vein is the major deep vein of the lower extremity. Pain in the hip has been present for over 1 year, limiting activities. 3D femoral neck anteversion measurements based on the posterior femoral plane in ORTHODOC system. A specialist will observe your . Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. Following exclusion of a total of 36% (44 patients), the final cohort consisted of 79 patients (Table 1). 31. [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Top-view illustrations of excessive femoral retroversion. Int J Numer Method Biomed Eng. This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. From birth to 6 yrs. Femoral anteversion is diagnosed through observation and examination. Femoral version by measurement method and by side (affected versus contralateral) was summarized using the mean, SD, and 95% confidence interval. 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). The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. 10. Femorln retroverze. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. External rotation contracture of the hip. 19. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. and Reikers et al.) In the axial HASTE images over the proximal and distal femur a femoral retroversion can be seen, i.e. Using the method of Murphy et al. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? A turning or tilting backward. 1) [15]. and Tomczak et al. AR is associated with changes in load transmission across the hip, being a risk factor for early. Coxa valga and antetorta increases differences among different femoral version measurements : potential implications for derotational femoral osteotomy planning. Clin Orthop Relat Res. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Furthermore, the reliability and reproducibility of these measurements in patients with SCFE is unknown. 2020:296:381-390. may email you for journal alerts and information, but is committed [30] uses the center superior to the lesser trochanter at the base of the femoral neck as a landmark. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). This yielded a mean difference of -19 7 (95% CI -21 to -18; p < 0.001) between the methods of Lee et al. 27. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. 2017;11:284-288. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. 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]. The exact cause of femoral retroversion is unknown. 35. In our cohort, femoral neck version was asymmetrically decreased (-2 13 versus 7 11) and the prevalence of femoral retroversion was higher (58% versus 29%) in hips with SCFE than in the healthy contralateral side (Table 3). Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. 2016;98:21-27. By continuing to use this website you are giving consent to cookies being used. Femoral neck version was measured as the orientation of the femoral neck. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. [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]. 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. 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). (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? 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). 47. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. [44]) (Table 3). 40. retroversion, reduced thoracic kyphosis (TK), increased knee flexion, and increased pelvic shift to balance the SVA, indicat-ing that other sagittal parameters influence sagittal align-ment.9,10 Additionally, cervical sagittal parameters relate to HRQoL and disability, stressing the importance of considering 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]. Bali NS, Harrison JO, Bache CE. 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. and Murphy et al. and Murphy et al. 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. 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. Your message has been successfully sent to your colleague. 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.). Many children born with femoral retroversion grow out it. 2021 May 1;479(5):935-944. doi: 10.1097/CORR.0000000000001590. 2020;14:190-200. Bone Joint J. 1956;88:3-41. Abstract Slipped capital femoral epiphysiolysis (SCFE) may result in femoroacetabular. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. [35]. And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. 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). 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. 3). Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. Femoral version of the general population: does normal vary by gender or ethnicity? Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. 13. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. 1967;49:807-835. J Orthop Res. This is comparable to the femoral neck version of the contralateral hips in our study population. Medial joint line: medial meniscus, medial femoral condyle, and tibial and femoral insertions of the medial collateral ligament (MCL). In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. J Pediatr Orthop. A pathological increase in angle of torsion is called femoral anteversion, and a pathological decrease in the angle or reversal of torsion is known as femoral retroversion. Femoral Retroversion. To the best of our knowledge, there are no normal reference values for CT-based femoral neck version measurements in children. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. While both femoral anteversion and retroversion do not always cause discomfort, they can eventually bring about pain in the lower back, hip, and knee. How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? 2015;31:247-253. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. It is typically detected when the child is 4 years to 6 years old. This number was chosen based on a power analysis showing that 46 hips would be needed to determine an intraclass correlation coefficient (ICC) greater than 0.80 with an alpha 0.05 and a power of 80%. Please enable scripts and reload this page. Femoral anteversion occurs in up to 10 percent of children. 2012 Dec;470(12):3432-8. doi: 10.1007/s11999-012-2452-y. It also appears to be related to the position of the baby as it grows in the womb. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. Femoral retroversion is a condition in which the femoral neck is rotated backward on the femoral shaft. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. Clin Orthop Relat Res. Questions/purposes: is femoral anteversion a disability. 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. However, Koerner et al. The physician may also order an X-ray or CT scan to look for possible deformities. 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). Furthermore, the sample sizes in these studies that compared femoral version between the affected and unaffected hip in patients with unilateral SCFE were small. 1987;69:1169-1176. 46. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. J Bone Joint Surg Am. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. [30]: -4 16) (Fig. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. 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. However, severe cases require surgical correction. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. Results: 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. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. FEMORAL VEIN ANATOMY. A 10-year minimum followup study. 5 Femoral version, also referred to as femoral torsion, is another morphologic variable being investigated. [35]; range, -53 to 15) to 100 (Murphy et al. 2013;27:308-311. A labral tear, subspine and intertrochanteric impingement and femoral retroversion. CLINICAL FEATURES Symptoms Will cause out-toeing and may lead to disability and decrease physical performance. Additionally, can femoral anteversion cause pain? To rule out this potential bias, we measured leg abduction angle on coronal scout CT views between a line connecting the femoral head with the center of the femoral condyle relative to the neutral line connecting the tip of the coccyx with the pubic symphysis. Femoral Retroversion. 2017;6:472-480. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. 2021 May 1;479(5):960-961. doi: 10.1097/CORR.0000000000001704. Congenital right femoral retroversion; Congenital right hip dysplasia; Present On Admission. A technical improvement. I've recently turned 18 and I want to share my experience of femoral retroversion. 39. Fifty-one percent (40 of 79) of patients presented with severe SCFE based on the head-shaft angle described by Southwick [40] (< 30 mild, 30 to 60 moderate, and > 60 severe) measured on preoperative frog-leg lateral views. A preoperative 3D-CT-scan was performed for 3D simulation of hip impingement ( Fig. Please enable it to take advantage of the complete set of features! Retroversion refers to an abnormal backward rotation of the hip relative to the knee. , . The minimum slice thickness was 2 mm. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. Lerch TD, Boschung A, Todorski IAS, et al. Femoral anteversion can occur in one or both legs. J Child Orthop. 2019:47:3120-3132. Passive hip range of motion predicts femoral torsion and acetabular version. 1983;54:18-23. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. 2016;98:127-134. 1988;8:385-388. 34. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). 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. Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. Clin Orthop Relat Res. Elise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. For the definition of femoral neck version, the midpoint of the femoral neck axis is determined at the level where the cortices run parallel and serves as the proximal reference axis (Fig. 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. Theoretically, hip flexion/abduction could affect femoral version measurements. Right: Most patients with excessive hip retroversion compensate by walking out-toed. Rebello G, Spencer S, Millis MB, Kim Y-J. 25. This is also called in-toeing. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Purpose. 2011;31:153-158. 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. 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. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. Out-toeing or duck walk walking with the foot pointed outward instead of straight ahead, 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. The human hip is a modified spherical (ball-and-socket) joint. At the time of CT, the femoral growth plate of the asymptomatic contralateral side was already closed in 42% (33 of 79) of patients. Loder RT, Aronson DD, Greenfield ML. 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. Femoral retroversion can occur in one or both legs. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. 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. 1986;68:1000-1007. 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. External tibial torsion. Definition of the distal femoral reference: the medial and lateral posterior condyles are connected. Pritchett JW, Perdue KD. Common complications include secondary arthrosis and. Femoral anteversion. official website and that any information you provide is encrypted [44]: 0 13 and Murphy et al. 2009;467:724-731. Significantly increased femoral anteversion affects the rotational profile of the lower extremity, leading to increased internal rotation. Femoral anteversion is usually most noticeable in children between the ages of 4 and 6. A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. A study of children in Michigan. Liu RW, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral epiphysis. Unable to load your collection due to an error, Unable to load your delegates due to an error. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? The source of all of my pain was the retroversion of my femur. Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. 2. Is femoral Retroversion a disability? In these situations, a surgical procedure known as a. may be used. A modified Imhuser osteotomy: an assessment of the addition of an open femoral neck osteoplasty. The .gov means its official. She was treated with an open reduction and bracing in infancy. 2018 Apr;476(4):890-899. doi: 10.1007/s11999.0000000000000127. Erickson JB, Samora WP, Klingele KE. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? This surgery includes cutting and realigning the femur. This is the story of her diagnosis, operations and recovery to date: Hi I'm Elise and I live in Northern Ireland. The definition of the proximal reference axis differs among the five methods. External Tibial Torsion Much like internal tibial torsion, this condition improves in most children before or around the age of 10. Background: Before CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? These side-by-side differences increased up to -22 (according to the method of Murphy et al. 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). 4. More specifically, the prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. the axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. The hip joint and psoas muscle lie directly deep to the femoral . 2012;470:3432-3438. Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. Measurement on axial HASTE images (proximal and distal femur): It is also known as 'Trochanteric Prominence Angle Test (TPAT)'. January 31, 2022 . Out-toeing is the common name used for a condition known as femoral retroversion. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). J Orthop Res. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. 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. To date, the best treatment strategy in patients with symptomatic SCFE deformity is not known because of a lack of comparative studies with long-term follow-up [2, 47]. Bali K, Railton P, Kiefer GN, Powell JN. One radiology resident (FS) with 6 years of experience in hip imaging measured femoral version bilaterally using five previously described methods (Table 1). 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. During the early childhood some degree of internal rotation is always present. 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]. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. [30]; range, -39 to 61) using different measurement methods (Table 3). In some cases, the doctor may perform a less invasive version of a femoral osteotomy. 43. Clin Orthop Relat Res. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis?