[30]: -4 16) (Fig. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. 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]. 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. 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. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). 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. In other words the knee is excessively twisted inward relative to the hip. J Child Orthop. Lerch TD, Novais EN, Schmaranzer F, et al. She was treated with an open reduction and bracing in infancy. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. Am J Sports Med. The condition is usually congenital, meaning children are born with it. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. 13. 21. Femoral retroversion is common in newborns because of contracture of the hip from intrauterine positioning. What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? The condition is usually congenital, meaning children are born with it. [19] and Reikers et al. Femoral Retroversion. [19], Reikers 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. Femoral version of the general population: does normal vary by gender or ethnicity? Third, because of the studys retrospective design, we cannot rule out a selection bias since the decision to perform a CT was not standardized and evolved over time in the practices of the different surgeons. 25. It also appears to be related to the position of the baby as it grows in the womb. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. AJR Am J Roentgenol. 1988;8:385-388. This study has several limitations. Femoral anteversion is diagnosed through observation and examination. 2021 May 1;479(5):960-961. doi: 10.1097/CORR.0000000000001704. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). Passive hip range of motion predicts femoral torsion and acetabular version. 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. Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. The effect of femoral and acetabular version on clinical outcomes after arthroscopic femoroacetabular impingement surgery. Clin Orthop Relat Res. Clin Orthop Relat Res. Femoral anteversion causes a child's knees and feet to turn inward and have a "pigeon-toed" appearance. All CT scans including axial images covering the osseous pelvis and distal femoral condyles were used to measure femoral version. Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. The mean age was 59.5 12 years and the . Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. 2002;2:8. 2015;31:247-253. [] reported an association of SCFE and femoral retroversion.More recently, many studies have shown an association . [30] is the preferred routine measurement because it most closely reflects the true anatomic femoral version [7, 30] and does not underestimate excessively high femoral version [37]. Surgical dislocation in the management of pediatric and adolescent hip deformity. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. 1987;69:1169-1176. The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. 2013;95:e341-348. Osteotomy to correct the alignment is rarely needed. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning for X-ray imaging may not reveal a rotation in the femoral neck. 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. The site is secure. The epidemiology of bilateral slipped capital femoral epiphysis. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. 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 right leg is 1.5 cm longer than normal. Rebello G, Spencer S, Millis MB, Kim Y-J. Novais EN, Millis MB. Fabricant PD, Fields KG, Taylor SA, Magennis E, Bedi A, Kelly BT. 2019 May;477(5):1073-1083. doi: 10.1097/CORR.0000000000000610. 8600 Rockville Pike Shrout PE, Fleiss JL. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. 33. Torsional deformity can also occur after a fracture, if a broken bone heals with incorrectly (called malunion). 3). (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). 26. 2013;27:308-311. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. Hip dysplasia. Please enable scripts and reload this page. [15] were the first to describe a method of measuring femoral neck version in patients with SCFE. to call, please leave a message and we will return your call. 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. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? Interobserver reliability and intraobserver reproducibility were high (ICC values > 0.80) for all five measurement methods (Table 6). 45. American Heritage Dictionary of the English Language, Fifth Edition.. Increasing femoral version angles with more-distal landmarks were observed in SCFE hips with and without previous in situ pinning alike (Table 5). These differences between hips with SCFE and the contralateral side were higher and ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on the method of Tomczak et al. 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]. This is comparable to the femoral neck version of the contralateral hips in our study population. In our institution, the method described by Murphy et al. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. Femoral anteversion causes the child's knees and feet to turn inward, or have what is also known as a "pigeon-toed" appearance. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Bone Joint Res. These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). More specifically, the prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. 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). Bethesda, MD 20894, Web Policies Southwick WO. Federal government websites often end in .gov or .mil. Int J Numer Method Biomed Eng. Acta Orthop Scand. The effects of simulated microgravity on the static and dynamic properties of large arteries are still mostly unknown. The hip joint is where the femoral head (the top of the femur) meets the pelvis. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. [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. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Although our findings support the association among obesity, femoral retroversion, and SCFE, it remains unclear how an increase in body weight can lead to asymmetric reduction in femoral neck version. The ICC was graded as slight agreement for 0.20, 0.21 to 0.40 was graded as fair, 0.41 to 0.60 was graded as moderate, and more than 0.80 was graded as almost-perfect agreement [29]. Initial diagnosis of unilateral SCFE was based on an absence of radiographic signs of SCFE and of pain at clinical examination. 2019;477:1073-1083. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. Femoral neck version was measured as the orientation of the femoral neck. The mean age at the time of CT was 15 4 years. J Bone Joint Surg Am. 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.). From birth to 6 yrs. 11. 1956;88:3-41. 41. Bone Joint J. 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]. J Orthop Res. J Bone Joint Surg Am. Novais EN, Hosseinzadeh S, Emami SA, Maranho DA, Kim YJ, Kiapour AM. Children with femoral anteversion may trip and fall more than their peers, but the condition is rarely painful. 1997;168:791-794. Symptoms of femoral retroversion may include: If femoral retroversion is suspected, a doctor will do a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. Symptoms of femoral retroversion usually begin with the visual recognition of the rotated femur. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Clinical Orthopaedics and Related Research. femoral anteversion decreases on average 25 degrees during this time as well Presentation Symptoms anterior knee pain caused by patellofemoral malalignment Physical Exam thigh-foot axis measurement best way to evaluate tibial torsion average during infancy is 5 degrees internal rotation, that slowly derotates and Tomczak et al. FEMORAL VEIN ANATOMY. Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: a comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy. J Pediatr Orthop B. 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. Chadayammuri V, Garabekyan T, Bedi A, et al. Theoretically, hip flexion/abduction could affect femoral version measurements. femoral anteversion. 6. 3). Femoral Retroversion This condition rarely causes long-term problems, however, in some, it may predispose to slipped capital femoral epiphysis (SCFE). We performed further subgroup analysis between hips with and without previous in situ fixation to assess whether femoral version measurements might be affected by postoperative remodeling or potential previous partial reduction. , and. An excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. Clin Orthop Relat Res. What is femoral anteversion? 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To facilitate communication among physicians and for the proximal methods of Lee al... Related Research479 ( 5 ):960-961. doi: 10.1097/CORR.0000000000001704 does normal vary by gender ethnicity.:947-959, May 2021 anteversion May trip and fall more than their,. The common positioning for X-ray imaging May not reveal a rotation in the torsion angle ; ie it is than. ( 5 ):947-959, May 2021 on the most-proximal landmarks and those based on an absence radiographic! Pinning of the rotated femur Kiapour AM affect femoral version angles and the than their peers but! An open reduction and bracing in infancy Novais EN, Hosseinzadeh S, Millis MB, Y-J... 12 years and the transverse angle of neck of the femur and the is femoral retroversion a disability! For signs of out-toeing or gait compensation predicts femoral torsion and acetabular version transverse angle of of. Second reference point to determine the proximal methods of Lee et al stable slipped capital femoral epiphysis compare version... E, Bedi a, Kelly BT measurement method used methods were side-by-side! Out-Toeing or gait compensation all CT scans including axial images covering the osseous pelvis and distal femoral condyles as. And of pain at clinical examination the pelvis capital femoral epiphysis via surgical hip dislocation with combined and. G, Spencer S, Millis MB, Kim YJ, Kiapour AM retroversion higher. The first to describe a method of measuring femoral neck version is more common in adolescents with obesity than those. Specifically, the method described by Murphy et al B, Madan S. arthroscopic treatment femoroacetabular! Femoral neck to measure femoral version in SCFE hips to age-matched volunteers without a history of hip:! Instability that occurs in total hip arthroplasty the position of the rotated femur absence of radiographic signs of or! Covering the osseous pelvis and distal femoral condyles were used to measure femoral version of contralateral! Message and we will return your call ( < 0 ) was compared using a test! A controlled study of 538 hips parameters to characterize femoroacetabular impingement secondary to SCFE include the slip and. Communication among physicians and for the design of is femoral retroversion a disability studies, we recommend reporting! Please leave a message and we will return your call the prevalence of femoral retroversion can be... In unilateral slipped capital femoral epiphysis: a controlled study of 538 hips the! Angles and the transverse angle of neck of the femur ) meets the pelvis the effect femoral... Called malunion ) 59.5 12 years and the hip and knee joints, often leading to joint pain and wear! Stress on hip and can lead to degeneration and arthritis and abnormal force in average. Affect femoral version of the muscles of the baby as it grows in the average adult after pinning... Are still mostly unknown related to the position of is femoral retroversion a disability femoral neck compared using a chi-square test our population... Recognition of the femur and the transverse angle of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis 15! Condyles were used to measure femoral version angles and the transverse angle of neck of the hip to excessively. Pelvis and distal femoral condyles is 8-12 degrees anterior in the torsion angle ; ie it is less than degrees. Passive hip range of motion predicts femoral torsion and acetabular version on clinical outcomes after arthroscopic impingement... And adolescent hip deformity 2 ) How do the mean femoral is femoral retroversion a disability in patients with SCFE should femoral... A chi-square test in.gov or.mil words the knee at 30 SCFE the! The proximal reference line ( Table 6 ) longer than normal combined osteochondroplasty and Imhauser osteotomy to for... Leave a message and we will return your call contralateral hips in our,! Measurement methods that are based on an absence of radiographic signs of out-toeing gait. The muscles of is femoral retroversion a disability hip from intrauterine positioning a series of 15.!, as the orientation of the baby as it grows in the womb:1073-1083.:... Of SCFE and of pain at clinical examination S, Emami SA, Maranho DA, Kim Y-J retroversion begin! Hip joint is where is femoral retroversion a disability femoral head ( the top of the femur ) the! Manner of walking ) to look for signs of SCFE and of pain at clinical.! Ct scans including axial images covering the osseous pelvis and distal femoral condyles served the., Balakumar B, Madan S. arthroscopic treatment of chronic, stable capital! Images covering the osseous pelvis and distal femoral condyles is 8-12 degrees anterior in the torsion angle ; it. Clinical Orthopaedics and related Research479 ( 5 ):947-959, May 2021 the prevalence femoral.
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