The effect of modality and landmark selection on MRI and CT femoral torsion angles. VDK is a continuous series of pathological changes from the lightest to the most severe degrees. The state of being turned or tilted back. 2014;30:1314-1325. 15 - 17 Furthermore, it can cause a decrease in the length of the abductor lever arm, 18 posterior extra-articular impingement, 9 and ischiofemoral impingement. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Clin Orthop Relat Res. However, in excessive cases, surgery may be needed to correct the rotation. Southwick WO. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. 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. 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. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? Initial diagnosis of unilateral SCFE was based on an absence of radiographic signs of SCFE and of pain at clinical examination. Before The prevalence of femoral retroversion (< 0) was compared using a chi-square test. 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. They reported femoral neck angles of -0.7 7.4 in 13 patients (10 with obesity) with acute SCFE compared with angles of 6.3 8.2 in the uninvolved side [15]. 15. Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. [44] (Table 4). 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. A 10-year minimum followup study. Arthroscopy. [30]; range, -39 to 61) using different measurement methods (Table 3). [44] and Murphy et al. Case reports: acetabular damage after mild slipped capital femoral epiphysis. J Orthop Res. 39. [44] (Table 4). 2021 May 1;479(5):935-944. doi: 10.1097/CORR.0000000000001590. Would you like email updates of new search results? Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. Please enable scripts and reload this page. 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. Czech. Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. 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. and Murphy et al. 27. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. 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. Femoral anteversion describes the inward rotation of the femur bone in the upper leg. Clinical Orthopaedics and Related Research. . This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. Limb Lengthening and Complex Reconstruction Service Akiyama M, Nakashima Y, Kitano T, et al. In the axial HASTE images over the proximal and distal femur a femoral retroversion can be seen, i.e. [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. Therefore, we asked: (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? Surgical dislocation in the management of pediatric and adolescent hip deformity. 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. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. This is the story of her diagnosis, operations and recovery to date: Hi I'm Elise and I live in Northern Ireland. n. 1. An excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. Depending on the measurement method, femoral version angles vary considerably in hips with high femoral anteversion [37]. 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. Femoral version by measurement method and by side (affected versus contralateral) was summarized using the mean, SD, and 95% confidence interval. [44]: 0 13 and Murphy et al. [19], Reikers et al. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. 8. This underlines the complex, multifactorial pathogenesis of SCFE, which further includes endocrine disorders [26] and altered epiphyseal orientation [24] and morphology [17, 23] and warrants further investigation. Balakumar B, Flatt E, Madan S. Moderate and severe SCFE (slipped capital femoral epiphysis) arthroscopic osteoplasty vs open neck osteotomy-a retrospective analysis of results. It also appears to be related to the position of the baby as it grows in the womb. Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities. coronary heart disease, and other diseases due to long-term disability, bringing economic and spiritual double blows to patients and families. To develop effective prevention strategies, we must first understand what it is, what impact it . 44. Obesity and decreased femoral anteversion in adolescence. 2. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. This work was performed at the Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA. J Bone Joint Surg Am. Abduction of the forefoot associated with pes planovalgus. Fabricant PD, Bedi A, De La Torre K, Kelly BT. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. During the early childhood some degree of internal rotation is always present. 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. . Before imaging analyses, both observers were trained using a different sample of 20 CT scans with SCFE by a senior orthopaedic hip surgeon (ENN, 17 years of experience). In severe cases, however, surgery may be needed to correct the rotation. your express consent. Clin Orthop Relat Res. J Pediatr Orthop. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. Hello friends, thankyou for watching my video, I am Physiotherapist with masters degree and working as Associate Professor in Mangalore.I love to teach and p. Schmaranzer F, Meier MK, Lerch TD, Hecker A, Steppacher SD, Novais EN, Kiapour AM. and Murphy et al.). 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. HHS Vulnerability Disclosure, Help (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? 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. 13. CLINICAL FEATURES Symptoms Will cause out-toeing and may lead to disability and decrease physical performance. [19] and Tomczak et al. 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. 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). SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. A turning or tilting backward. At a mean follow-up of 58 46 months, the femoral growth plate was closed in 95% (75 of 79) of patients. Video case study Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. Bethesda, MD 20894, Web Policies 3). 2011;31:153-158. Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. However, future studies are needed to investigate the value of different measurement methods in predicting the surgical outcome in patients with SCFE undergoing different procedures. 38. By contrast, Stanitski et al. 2019;37:1571-1579. 46. 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]. Further measurement methods included the femoral heads center and differed regarding the level of landmarks for the proximal femoral reference axis. You may notice that your child is walking with the toes turned inward. 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. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. Among these, the greatest differences were between the most-proximal methods and the more-distal methods. A comprehensive analysis of femoral version may provide valuable baseline information to optimize surgical planning in hips with sequalae of SCFE and to allow standardization of studies investigating surgical correction of SCFE deformities. 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. Arthroscopy. Elise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. the axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. Differences in Femoral Torsion Among Various Measurement Methods Increase in Hips With Excessive Femoral Torsion. New York, NY 10021 Bone Joint J. 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. Out-toeing may be caused by: Femoral retroversion. Femoral retroversion is a condition in which the femoral neck is rotated backward in relation to the femoral shaft. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. Novais EN, Millis MB. The definition of the proximal reference axis differs among the five methods. At birth the angle of torsion is 30-35 degrees and the femoral head faces anteriorly in the acetabulum. The prevalence of femoral retroversion was high in patients with SCFE, and even higher when retroversion was defined and diagnosed using proximal anatomic landmarks. Clin Orthop Relat Res. What Is the Association Among Epiphyseal Rotation, Translation, and the Morphology of the Epiphysis and Metaphysis in Slipped Capital Femoral Epiphysis? Significantly increased femoral anteversion affects the rotational profile of the lower extremity, leading to increased internal rotation. Arthroscopic treatment of mild to moderate deformity after slipped capital femoral epiphysis: intra-operative findings and functional outcomes. femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? Femoral retroversion is a condition in which the femoral neck is rotated backward on the femoral shaft. 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). Journal of Clinical Medicine. In healthy contralateral hips, we found differences for 9 of 10 pairwise comparisons (Table 4). and Reikers et al. 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. acetabulum - tends to be deformed in front, there may be eversion of the labrum, the bony + cartilaginous part of the acetabulum is broken, the dislocation is directed ventrally and proximally; neck of the femur - antetorsion associated with valgus, pressure change on the edge of the acetabulum 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. Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. The minimum slice thickness was 2 mm. 2016;98:21-27. The right leg is 1.5 cm longer than normal. Your message has been successfully sent to your colleague. 2020;14:98-105. 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. 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. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Some abnormalities may resolve spontaneously. 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. 12. 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]. By contrast, femoral osteotomies, most frequently performed at the intertrochanteric level, combined with femoral osteochondroplasty, allow correction of femoral retroversion especially in severe and moderate slips [3-5, 10, 32]. In some cases, a minimally invasive version of a femoral osteotomy may be performed. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia.
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