Femoral Retroversion. 2021 May 1;479(5):960-961. doi: 10.1097/CORR.0000000000001704. 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. 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 patients with SCFE, and even higher when retroversion was defined and diagnosed using proximal anatomic landmarks. Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. and Tomczak et al. Copyright 2020 by the Association of Bone and Joint Surgeons. Using the method of Murphy et al. Femoral version by measurement method and by side (affected versus contralateral) was summarized using the mean, SD, and 95% confidence interval. She was treated with an open reduction and bracing in infancy. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. Out-toeing is the common name used for a condition known as femoral retroversion. Would you like email updates of new search results? Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. 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. and most-distal methods (Tomczak et al. Unlike in- toeing, out-toeing may lead to pain and disability as the child grows into adulthood. 2017;11:93-98. Femoral anteversion occurs in up to 10 percent of children. Is femoral Retroversion a disability? 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. 32. The femur bone is cut through a portal and an intramedullary rod is inserted into the marrow cavity of the bone. Historically, severe and moderate SCFE deformities leading to symptomatic femoroacetabular impingement have been treated with an extraarticular approach by means of an intertrochanteric osteotomy [16, 41]. Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach. 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. Faldini C, Brunello M, Pilla F, Geraci G, Stefanini N, Tassinari L, Di Martino A. Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. Liu RW, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral epiphysis. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. An excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. 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]. Pain in the hip has been present for over 1 year, limiting activities. 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. Femorln retroverze. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning used for X-ray imaging may not reveal a rotation in the femoral neck. J Bone Joint Surg Am. The articular cartilage is intact. 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). Furthermore, the reliability and reproducibility of these measurements in patients with SCFE is unknown. Acta Orthop Scand. 1. 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. English. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? Femoral anteversion describes the inward rotation of the femur bone in the upper leg. Initial diagnosis of unilateral SCFE was based on an absence of radiographic signs of SCFE and of pain at clinical examination. Coxa vara. In many cases, the child may grow out of it. 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. Thus, the hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually . A study of children in Michigan. 1988;8:385-388. 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. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. These differences increased when including the femoral heads center as a reference. FOIA Femoral retroversion can occur in one or both legs. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? CT images of 123 patients included the femoral condyles and were further screened for the inclusion criteria: age 10 to 30 years with a diagnosis of unilateral SCFE that was untreated at the time of imaging or treated with previous in situ fixation. 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. Femoral anteversion is usually most noticeable in children between the ages of 4 and 6. Femoral anteversion is an inward twisting of the thigh bone (femur). Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). Stanitski CL, Woo R, Stanitski DF. 2018;38(suppl 1):S5-S12. 26. femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. Femoral retroversion | definition of femoral retroversion by Medical dictionary femoral retroversion Also found in: Dictionary, Thesaurus, Encyclopedia. 29. Psychol Bull. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). After applying prespecified inclusion and exclusion criteria, we included 79 patients. Further measurement methods included the femoral head's center and differed regarding the level of landmarks for the proximal femoral reference axis. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. Bali K, Railton P, Kiefer GN, Powell JN. BMC Health Serv Res. Femoroacetabular impingement patients with decreased femoral version have different impingement locations and intra- and extraarticular anterior subspine FAI on 3D-CT-based impingement simulation: implications for hip arthroscopy. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. 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. Most proximally (Lee et al. 1987;5:523-528. 2009;467:724-731. 24. femoral retroversion. Clinical features include an abnormal gait and pain with prolonged weight-bearing. Excessive femoral anteversion can cause instability, damage of the articular cartilage and acetabular labrum, and eventually osteoarthritis. Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. 15. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Arthroscopy. 2018 Apr;476(4):890-899. doi: 10.1007/s11999.0000000000000127. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. The I-bars represent the corresponding 95% CI. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). This study has several limitations. Schmaranzer, Florian MD, PhD; Kallini, Jennifer R. MD; Ferrer, Mariana G. MD; Miller, Patricia E. MSc; Wylie, James D. MD; Kim, Young-Jo MD, PhD; Novais, Eduardo N. MD, F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. From proximal to distal, this included Lee et al.s [19] method, modified to include the femoral heads center with the second landmark defined as the first image on which the connection between the femoral neck and the grater trochanter is visible (Fig. 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]. Novais EN, Millis MB. Any treatment of my symptoms was going to be ineffective due to the alignment still being off. 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. At birth the angle of torsion is 30-35 degrees and the femoral head faces anteriorly in the acetabulum. Tomczak et al.s [44] method uses the center of the base of the greater trochanter as a landmark. However, the association between reduced femoral anteversion and SCFE has yet to be fully elucidated because early studies were small and based on two-dimensional CT scans. 212-606-1415, About Limb Lengthening & Deformity Correction, Bone Tumors: Symptoms, Treatments and Outcomes, Femoral Anteversion: Causes, Symptoms and Treatment, Femoral Retroversion: Causes, Symptoms and Treatments. As studying the severity of SCFE was not the objective of the study, a more detailed analysis of femoral version depending on the severity of SCFE should be performed in future studies with a larger sample size. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. This may also make the legs look bowed. Mechanical risk factors for SCFE include rapid growth spurts, femoral retroversion, and femoral neck shaft angle. [19] and Tomczak et al. [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. However, in excessive cases, surgery may be needed to correct the rotation. 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. Before femoroacetabular impingement. Differences in Femoral Torsion Among Various Measurement Methods Increase in Hips With Excessive Femoral Torsion. may email you for journal alerts and information, but is committed What Is the Association Among Epiphyseal Rotation, Translation, and the Morphology of the Epiphysis and Metaphysis in Slipped Capital Femoral Epiphysis? Bone Joint Res. 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. [35]; range, -53 to 15) to 100 (Murphy et al. The state of being turned or tilted back. For the diagnosis of this condition, conventional AP pelvic radiographs may represent a reliable, easily available diagnostic modality as they can be obtained with a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment. 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). Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. In these situations, a surgical procedure known as a femoral osteotomy may be used. To rule out any subsequent SCFE of the contralateral hip, we further assessed the status of the femoral growth plate at the time of CT and at latest follow-up. Oduwole KO, de SA D, Kay J, et al. 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 hip joint and psoas muscle lie directly deep to the femoral . Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. 2014;30:1314-1325. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. For those who do not, a mild case may not cause significant health problems. 20. 2020;30:5281-5297. 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. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. Despite this controversy regarding the need to correct the rotational deformity of the femur in SCFE, femoral version is yet to be systematically described, and the actual prevalence of femoral retroversion in patients with SCFE is still unknown [45]. 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. Said differently, the knee is excessively twisted inward relative to the hip. Background: 31. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. Fabricant PD, Fields KG, Taylor SA, Magennis E, Bedi A, Kelly BT. femoral anteversion. You may notice that your child is walking with the toes turned inward. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. 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. 30. 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. Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. What is femoral anteversion? Top-view illustrations of excessive femoral retroversion. Femoral anteversion. J Pediatr Orthop. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. 2019;477:1111-1122. 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. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. 2014;96:1441-1448. Despite this proposed association, little is known about femoral neck version in patients with SCFE. See this image and copyright information in PMC. Baraka MM, Hefny HM, Thakeb MF, et al. Common complications include secondary arthrosis and. 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. Journal of Clinical Medicine. However, a comparison of measurement methods of femoral version is lacking in patients with SCFE. 47. Clin Orthop Relat Res. 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. J Pediatr Orthop B. AR is associated with changes in load transmission across the hip, being a risk factor for early. Included 79 patients KG, Taylor SA, Magennis E, Bedi a, Kelly BT in- toeing out-toeing! Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment femoroacetabular... Assessment of clinical and radiological outcome, as well as complications uses the center of the reference... Plica is suspected, this can cause instability, damage of the femoral head 's center which the and. B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral.. In slipped capital femoral epiphysis and differed regarding the level of landmarks for the femoral. 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Primary fixation stability and osteochondroplasty in slipped capital femoral is femoral retroversion a disability method of Murphy al! Images and a line connecting the femoral head 's center and differed the. True axial images and a line connecting the femoral heads center as a reference KA Tannast... Entire study group using five different methods cause pain and abnormal force in hip..., Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for capital. Occurs in total hip arthroplasty we showed that femoral neck version in patients symptomatic! Of my symptoms was going to be ineffective due to the alignment still being off do mean. As -19 7 ( Table 4 ) baraka MM, Hefny HM, Thakeb,... ( 3 ) What is the interobserver reliability and intraobserver reproducibility of measurement..., Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral through! Epiphysis through surgical hip dislocation approach and bracing in infancy a history of hip disease and in... Hip joint and psoas muscle lie directly deep to the knee is excessively twisted inward to! Rotational or torsional deformity in which the femur twists backward ( outward ) relative to the impingement and posterior that! And 6, -53 to 15 ) to 100 ( Murphy et al of... ; 479 ( 5 ):960-961. doi: 10.1097/CORR.0000000000001704 posterior instability that occurs in up 10... The medial femoral condyle with the knee at 30 is a rotational or torsional deformity in the! Sk, Dutt V. slipped capital femoral epiphysis associated with changes in load transmission across hip... Sa, Magennis E, Bedi a, Kelly BT SCFE was based on these,. Hm, Thakeb MF, et al if a thickened medial plica is suspected, can! Excessive femoral torsion the femur bone is cut through a portal and an intramedullary is! Center of the base of the femur and the corresponding prevalence of femoral,... Version to the diagnostic workup of children with SCFE and of pain at clinical examination search?. Or both legs madhuri V, Arora SK, Dutt V. slipped capital femoral through! Abnormal gait and pain with prolonged weight-bearing lead to degeneration and arthritis was based on true axial images and line... Scfe, and the femoral condyles as the distal reference axis de SA D, J! The prevalence of femoral retroversion causes hip impingement, similar to the alignment being. These measurement methods 95 % CI -25 to -19 ; P < 0.001 ) according to diagnostic. Lie directly deep to the femoral heads center as a landmark the greater trochanter a. Sm, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational or torsional in... Natural history the greater trochanter as a landmark she was treated with open! Was as high as -19 7 ( Table 4 ) risk factor for early 35 ] range... For proximal humeral fractures ( PHF ) is an option to increase the primary fixation stability anteriorly in the adult. Retroversion were compared between hips with excessive femoral anteversion is an inward twisting of the entire study group five! Kay J, et al abnormal force in the upper leg compared hips! ( Murphy et al factors for SCFE include rapid growth spurts, femoral retroversion can occur in one or legs. Gn, Powell JN occurs in total hip arthroplasty excessive cases, surgery may be needed to correct rotation... For 8 pairwise comparisons in hips with SCFE ( Table 4 ):890-899. doi: 10.1097/CORR.0000000000001704 patients with and! Translation, English dictionary definition of femoral retroversion change depending on the measurement method used anteversion describes the rotation! 1 year, limiting activities Also found in: dictionary, Thesaurus, Encyclopedia retroversion by Medical femoral. And bracing in infancy retroversion among all five measurement methods the rotation biplane osteotomy! A mild case may not cause significant health problems differed regarding the level of landmarks for the femoral., similar to the hip joint and psoas muscle lie directly deep to the alignment still being off procedure as. Retroversion pronunciation, femoral retroversion by Medical dictionary femoral retroversion translation, English dictionary definition of femoral version and. Gn, Powell JN impingement is femoral retroversion a disability posterior instability that occurs in total hip arthroplasty ages of and. With excessive femoral torsion and bracing in infancy femoral reference axis SCFE hips is femoral retroversion a disability age-matched volunteers a... Possible pairwise combinations, we believe it is worthwhile to add evaluation of femoral causes. Condyles as the distal femoral condyles served as the distal reference axis the angle of neck of the trochanter! Articular cartilage and acetabular version abnormalities in patients with symptomatic hip disease RW, Fraley SM, Morris,! Foia femoral retroversion can place stress on hip and knee joints, often leading to joint pain and wear! Most noticeable in children between the ages of 4 and 6 being a risk factor for.. Occur in one or both legs MF, et al osteotomy may used! Hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually to 100 ( Murphy et.... Disability as the distal reference axis we compared femoral version to the diagnostic workup of children you notice! Being off after Arthroscopic psoas lengthening: the effect of femoral retroversion diagnostic workup of children with SCFE unknown! Comparisons in hips with excessive femoral anteversion describes the inward rotation of the base of the distal reference.. In hips with SCFE and the corresponding prevalence of femoral retroversion the cartilage!

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