2019;477:1111-1122. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. 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. Finally, we could show that the different measurement methods are comparable in terms of interobserver reliability and reproducibility (Table 6). 3). Video case study and Tomczak et al. Subcapital osteotomy of the femoral neck for patients with healed slipped capital femoral epiphysis. Your message has been successfully sent to your colleague. [35], Tomczak et al. The epidemiology of bilateral slipped capital femoral epiphysis. Excessive femoral anteversion can cause instability, damage of the articular cartilage and acetabular labrum, and eventually osteoarthritis. 4. Femoral neck version was measured as the orientation of the femoral neck. [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. 1986;68:1000-1007. He may also order an X-ray or CT scan to look for possible deformities. Among the remaining methods, the prevalence of femoral retroversion was higher for hips with SCFE (all p < 0.001), which ranged from 47% (Tomczak et al.s [44] method) to 91% (Lee et al.s [19] method) compared with 4% (Murphy et al.s [30] method) to 42% (Lee et al.s [19] method) for the contralateral side (Table 3). The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. Femoral Retroversion. Bone Joint Res. 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. 16. These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). 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. 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. For those who do not grow out of it, a mild femoral retroversion may not cause any significant issues. 29. 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. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Lee YS, Oh SH, Seon JK, Song EK, Yoon TR. However, in excessive cases, surgery may be needed to correct the rotation. However, in some cases, this may be difficult to identify, especially if femoral retroversion is combined with a separate rotation deformity such as tibial torsion. The first symptom of femoral retroversion is usually a visual recognition of the rotated femur. Ethical approval for this study was obtained from the institutional review board of Boston Childrens Hospital (protocol number IRB-P00018761). Femoral anteversion causes a child's knees and feet to turn inward and have a "pigeon-toed" appearance. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. [44]) (Table 3). If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. In patients with implant failure following in situ fixation, this included assessment of the femoral growth plate for planning of revision in situ fixation. Abstract Slipped capital femoral epiphysiolysis (SCFE) may result in femoroacetabular. 10. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. Slipped capital femoral epiphysis. 2014;30:1314-1325. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. Many children born with femoral retroversion grow out of it. Because there is a wide range of femoral anteversion values both in the healthy population and in patients with femoroacetabular impingement, it is recommended that femoral anteversion is assessed individually in all patients with suspected femoroacetabular impingement. Am J Sports Med. Unable to load your collection due to an error, Unable to load your delegates due to an error. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Data is temporarily unavailable. 1) [15]. Femoral anteversion can occur in one or both legs. 2021 May 1;479(5):935-944. doi: 10.1097/CORR.0000000000001590. 24. For more information, please refer to our Privacy Policy. Shrout PE, Fleiss JL. 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. The five different measurement methods were applied in the same way in hips with SCFE and in healthy contralateral hips (Fig. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Left: Position of a retroverted femoral head with the foot facing straight forward. Measurement of femoral version has been recommended in patients eligible for hip preservation surgery [27, 38] because of the high prevalence of abnormal femoral version in patients with hip pain [21, 22] and its effect on ROM [8, 20] and the outcome of surgery for femoroacetabular impingement [11, 12]. Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. New York, NY 10021 and Murphy et al. 2023; 12(3):751. https: . 2014;96:1119-1123. AR is associated with changes in load transmission across the hip, being a risk factor for early. An important mark of this deformity is the reduced or absent offset between the femoral head and the neck, which can be radiographically graded. Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). Since the range of femoral version angles is wide, no general prediction regarding the degree of rotational deformity can be made on an individual basis. For those who do not, a mild case may not cause significant health problems. Causes of the Anteversion and Retroversion of the Hip The association of femoral retroversion with slipped capital femoral epiphysis. Measuring the femoral neck version alone underestimates the asymmetric decrease in femoral version caused by displacement of the femoral epiphysis. The femoral vein is the major deep vein of the lower extremity. 5. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. [19] and Reikers et al. Bali NS, Harrison JO, Bache CE. SCFE: clinical aspects, diagnosis, and classification. BMC Health Serv Res. Common complications include secondary arthrosis and. 2017;11:93-98. The human hip is a modified spherical (ball-and-socket) joint. My doctors would not treat me unless I had surgery to fix the retroversion. 8600 Rockville Pike [30]) when including the femoral heads center as a reference to account for displacement of the epiphysis (Fig. One radiology resident (FS) with 6 years of experience in hip imaging measured femoral version bilaterally using five previously described methods (Table 1). 14. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. Femoral retroversion is a condition in which the femoral neck is rotated backward in relation to the femoral shaft. Level of evidence: 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. These side-by-side differences increased up to -22 (according to the method of Murphy et al. Schmaranzer F, Kallini JR, Miller PE, Kim Y-J, Bixby SD, Novais EN. [35] yielded the lowest mean femoral version angles (-19 16 and -15 14, respectively), while the methods that use more-distal definitions of the proximal reference yielded higher (all p < 0.005) femoral version angles (Tomczak et al. After applying prespecified inclusion and exclusion criteria, we included 79 patients. In some cases, a minimally invasive version of a femoral osteotomy may be performed. J Child Orthop. Femoral retroversion can occur in one or both legs. The role of cartilage in joints is to protect bone, smooth the friction between bones, and prevent femoral retroversion (___ degrees), femoral retroversion (physical finding), femoral retroversion, Femoral retroversion. Clin Orthop Relat Res. 45. 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). See also: retroversion Japanese. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. 2). You may be trying to access this site from a secured browser on the server. Novais EN, Millis MB. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. femoral anteversion. By continuing to use this website you are giving consent to cookies being used. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. The source of all of my pain was the retroversion of my femur. J Orthop Trauma. This surgery includes cutting and realigning the femur. Copyright 2020 by the Association of Bone and Joint Surgeons. 519 East 72nd St., Suite 204 2019;37:1571-1579. 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. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. Femoral version in acute slipped capital femoral epiphysis. Clin Orthop Relat Res. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. A labral tear, subspine and intertrochanteric impingement and femoral retroversion. Any treatment of my symptoms was going to be ineffective due to the alignment still being off. Said differently, the knee is excessively twisted inward relative to the hip. Bone Jt Open. femoral retroversion. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. Furthermore, we found that SCFE does not necessarily lead to femoral retroversion, and that femoral version angles differ widely, ranging from 68 (Reikers et al. Symptoms, Causes, Treatment for Out-Toeing, the common name used for a condition known as femoral retroversion. In this position, the femoral head is not positioned normally in the hip joint. Conclusion: 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. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. 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 Radiology. The Lisbon agreement on femoroacetabular impingement imaging-part 1: overview. In our study, the prevalence of femoral retroversion was higher (60%) in hips with SCFE and the mean femoral version was decreased (-4 16) using the same method described by Murphy et al. 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. , and. 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). Example Sentences: (1) The measurement mean for anteversion among these specimens was 7.4 degrees with a range from -10.8 degrees (retroversion) to 22.1 degrees. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? The prevalence of femoral retroversion (< 0) was compared using a chi-square test. J Orthop Res. SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. to maintaining your privacy and will not share your personal information without 19. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. . 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]. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. Disclaimer, National Library of Medicine Bone Joint J. 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). This is the story of her diagnosis, operations and recovery to date: Hi I'm Elise and I live in Northern Ireland. The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. Using the method of Murphy et al. 32. (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 orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. Femoral neck version, the femoral version angles based on the measurement methods that include the femoral heads center (the methods of Lee et al. and Reikers et al. [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. to call, please leave a message and we will return your call. A turning or tilting backward. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. 2019;43:2375-2382. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. 18. [19] and Tomczak et al. 6 It is the angular Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate J Bone Joint Surg Am. Southwick WO. 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. Sucato DJ. Please enable scripts and reload this page. We performed a subgroup analysis, and with the numbers available, we observed any differences in femoral version angles between patients with and without previous in situ fixation (Table 5). femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Femoral version of the general population: does normal vary by gender or ethnicity? [19], Reikers et al. External tibial torsion. 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. Time from SCFE diagnosis to CT was 1.8 2.5 years (Table 1). The method of Reikers et al. Femoral anteversion is an inward twisting of the thigh bone, also known as the femur (the bone that is located between the hip and the knee). to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. [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]. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? 3D femoral neck anteversion measurements based on the posterior femoral plane in ORTHODOC system. The torsional deformity is corrected by re-establishing the normal rotation between the hip and the knee. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. Femoral Anteversion Angle (Clinical Hip Anatomy) The Anatomist Elif Craig's Test The Student Physical Therapist 7 Exercises You Should Do Absolutely Every Day. "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? 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. From birth to 6 yrs. The mean age at the time of CT was 15 4 years. The hip joint is where the femoral head (the top of the femur) meets the pelvis. This work was performed at the Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. 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. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative 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. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. If you prefer Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. 36. As mentioned, measurement of femoral version in children with SCFE should include the femoral heads center as a proximal reference axis; that is, it should not be solely based on the orientation of the femoral neck. The effect of modality and landmark selection on MRI and CT femoral torsion angles. 2011;31:153-158. Millis MB. POA Help "Present On Admission" is defined as present at the time the order for inpatient admission occurs conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA The articular cartilage is intact. 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. 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). Eur Radiol. J Orthop Res. Despite increasing evidence that SCFE reflects a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion [23], femoral version has rarely been reported, and the prevalence and degree of femoral retroversion is currently unknown in this population. Liu RW, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral epiphysis. FEMORAL VEIN ANATOMY. 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. 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 479(5):960-961, May 2021. Contact Dr. Jarman, DPM Phoenix Podiatrist. 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. [] reported an association of SCFE and femoral retroversion.More recently, many studies have shown an association . 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. and Murphy 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). 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. 39. Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. By contrast, Stanitski et al. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. In other words the knee is excessively twisted inward relative to the hip. The state of being turned or tilted back. 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]. Further measurement methods included the femoral heads center and differed regarding the level of landmarks for the proximal femoral reference axis. It also appears to be related to the position of the baby as it grows in the womb. 3). Femoral anteversion is an inward twisting of the thigh bone, also known as the femur (the bone that is located between the hip and the knee). 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. 13. the axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. 5 Femoral version, also referred to as femoral torsion, is another morphologic variable being investigated. Pritchett JW, Perdue KD. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. 44. The data table on the chart reports the mean SD.
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