Clin Orthop Relat Res. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. The hip joint is where the femoral head (the top of the femur) meets the pelvis. J Bone Joint Surg Am. Passive hip range of motion predicts femoral torsion and acetabular version. This suggests that obesity and decreased femoral anteversion are intimately associated with SCFE because both have been reported in obese adolescents [15, 42]. 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. Schmaranzer F, Todorski IAS, Lerch TD, Schwab J, Cullmann-Bastian J, Tannast M. Intra-articular lesions: imaging and surgical correlation. 11. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Unlike in- toeing, out-toeing may lead to pain and disability as the child grows into adulthood. 44. 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. Accessibility Femoral retroversion is a positional deformity caused by contracture of the external rotator muscles of the hip. In the remaining four patients with an open femoral growth plate at last clinical visit, radiographic follow-up was longer than 18 months (median 22 months, range 21 to 25), an observation period by which more than 90% of the subsequent contralateral SCFE reportedly occur [25]. 16. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. 38. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? 2023; 12(3):751. https: . to call, please leave a message and we will return your call. Int J Numer Method Biomed Eng. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. [35]. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. 2017;21:487-506. 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 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). Acta Orthop Scand. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. In cases where the child does not grow out of femoral retroversion, the condition may be mild enough not to cause any significant health challenges. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. To the best of our knowledge, there are no normal reference values for CT-based femoral neck version measurements in children. Stanitski CL, Woo R, Stanitski DF. Video case study femoral retroversion. You may be trying to access this site from a secured browser on the server. J Pediatr Orthop. Federal government websites often end in .gov or .mil. Bali K, Railton P, Kiefer GN, Powell JN. Finally, we could show that the different measurement methods are comparable in terms of interobserver reliability and reproducibility (Table 6). Retroversion refers to an abnormal backward rotation of the hip relative to the knee. A 10-year minimum followup study. What are the causes of femoral retroversion? The remaining four measurement methods use the femoral heads center as the most proximal reference. 13. Femoral neck version, the femoral version angles based on the measurement methods that include the femoral heads center (the methods of Lee et al. Top-view illustrations of excessive femoral retroversion. Purpose. 8. Gelberman et al. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. However, in excessive cases, surgery may be needed to correct the rotation. The right leg is 1.5 cm longer than normal. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Level III, prognostic study. This is also called in-toeing. 3). It is also known as 'Trochanteric Prominence Angle Test (TPAT)'. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. and Tomczak et al. 27. Am J Sports Med. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. J Child Orthop. 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. 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. Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. Radiology. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. By continuing to use this website you are giving consent to cookies being used. What is femoral anteversion? [44], and Murphy et al. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. 2. This work was performed at the Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA. Seventy-two percent of the patients in our cohort were overweight or obese. Femoral anteversion occurs in up to 10 percent of children; 99 percent of cases resolve over time without the need for surgery. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? 2006;26:291-294. Bob & Brad 3.9M views 5 years ago. Surgical dislocation in the management of pediatric and adolescent hip deformity. The data table on the chart reports the mean SD. The method of Reikers et al. Schmaranzer F, Kallini JR, Miller PE, Kim Y-J, Bixby SD, Novais EN. Novais EN, Hosseinzadeh S, Emami SA, Maranho DA, Kim YJ, Kiapour AM. 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). The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). Femorln retroverze. In patients with implant failure following in situ fixation, this included assessment of the femoral growth plate for planning of revision in situ fixation. We found that femoral neck version is asymmetrically decreased by -8 in unilateral hips with SCFE compared with contralateral hips. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. 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 impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion : implications for hip arthroscopy 22. Clin Orthop Relat Res. Please try after some time. J Pediatr Orthop. During this time period, 754 patients were diagnosed with SCFE. Journal of Clinical Medicine. Lee YS, Oh SH, Seon JK, Song EK, Yoon TR. Int Orthop. 1979;86:420-428. In other words the knee is excessively twisted inward relative to the hip. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. 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. 479(5):960-961, May 2021. Femoral Retroversion This condition rarely causes long-term problems, however, in some, it may predispose to slipped capital femoral epiphysis (SCFE). Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. 28. 2. It is typically detected when the child is 4 years to 6 years old. The epidemiology of bilateral slipped capital femoral epiphysis. AJR Am J Roentgenol. 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.