More distally, the pes anserinus bursa should be palpated for tenderness typical of pes . Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. Femoral retroversion is common in newborns because of contracture of the hip from intrauterine positioning. to maintaining your privacy and will not share your personal information without The effect of modality and landmark selection on MRI and CT femoral torsion angles. Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. 2016;98:21-27. Bone Jt Open. Femoral retroversion (also known as hip retroversion) is a rotational or torsional deformity in which the femur (thighbone) twists backward (outward) in relation to the knee. 1973;55:1218-1224. Background: The hip joint and psoas muscle lie directly deep to the femoral . 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 in hips with SCFE (58% [95% CI 47% to 69%]; p < 0.001) than on the contralateral side (29% [95% CI 19% to 39%]). Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. 32. Wylie JD, Beckmann JT, Maak TG, Aoki SK. 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. Bookshelf A pathological increase in angle of torsion is called femoral anteversion, and a pathological decrease in the angle or reversal of torsion is known as femoral retroversion. This surgery includes cutting and realigning the femur. Radiology. Millis MB. In our institution, the method described by Murphy et al. 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. Torsional deformity can also occur after a fracture, if a broken bone heals with incorrectly (called malunion). Significantly increased femoral anteversion affects the rotational profile of the lower extremity, leading to increased internal rotation. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. 1956;88:3-41. Femoral version is a relevant measurement that affects hip range of motion and pathology. A study of children in Michigan. Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Disclaimer, National Library of Medicine "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? And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. 27. How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? [19] and Reikers et al. The method of Murphy et al. 19 Finally, excessive femoral anteversion may Elise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. Intraclass correlations: uses in assessing rater reliability. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. Definition of the distal femoral reference: the medial and lateral posterior condyles are connected. 1987;5:523-528. Imhauser G. Pathogenesis and therapy of hip dislocation in youth [in German]. and Murphy et al. Methods: 26. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. Three-dimensional CT was performed with all patients supine in the neutral position. 2020:296:381-390. Fourth, although we compared our observations in SCFE hips with the unaffected contralateral side, we note that these hips may not reflect a normal population. Measurement on axial HASTE images (proximal and distal femur): We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. 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]. Femoral retroversion could result from developmental conditions such as focal femoral deficiency, and dysplasia or be acquired secondary to malunited subtrochanteric, intertrochanteric or femoral neck fracture, varus derotational osteotomies and slipped capital femoral epiphysis (SCFE). 2018 Apr;476(4):890-899. doi: 10.1007/s11999.0000000000000127. 42. 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. It is a structural adaptation that alters the shape of the thigh bonea point past sports medicine staff and physical therapists have failed to apply in Andrew's case. What are the causes of femoral retroversion? Before 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. Left: Position of a retroverted femoral head with the foot facing straight forward. 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. Thus, we compared femoral version angles and the prevalence of femoral retroversion in hips with SCFE with the unaffected contralateral side and among different measurement techniques. 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. At a mean follow-up of 58 46 months, the femoral growth plate was closed in 95% (75 of 79) of patients. 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. 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. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. Would you like email updates of new search results? Congenital right femoral retroversion; Congenital right hip dysplasia; Present On Admission. Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. Thus, the hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually . Liu RW, Armstrong DG, Levine AD, Gilmore A, Thompson GH, Cooperman DR. An anatomic study of the epiphyseal tubercle and its importance in the pathogenesis of slipped capital femoral epiphysis. He may also order an X-ray or CT scan to look for possible deformities. Differences in Femoral Torsion Among Various Measurement Methods Increase in Hips With Excessive Femoral Torsion. In hips with SCFE, there was a mean difference of -13 9 (95% CI -15 to -12; p < 0.001) between femoral neck version and Reikers et al.s [35] method, which reflects femoral neck orientation relative to the femoral heads center (Table 4). J Pediatr Orthop. 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. Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. The ischiofemoral distance was evaluated for patients with increased FV on preoperative MRI and was lower (17 5 mm, range 12-25) compared to the reported normal ischiofemoral distance [ 46] of 30.6 mm. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. January 31, 2022 . 30. 8. 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. 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. Oduwole KO, de SA D, Kay J, et al. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. More specifically, the prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. In severe cases, however, surgery may be needed to correct the rotation. VDK is a continuous series of pathological changes from the lightest to the most severe degrees. 2020;14:190-200. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. sharing sensitive information, make sure youre on a federal [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). The minimum slice thickness was 2 mm. Loder RT, Aronson DD, Greenfield ML. Despite this proposed association, little is known about femoral neck version in patients with SCFE. Femoral neck version, the femoral version angles based on the measurement methods that include the femoral heads center (the methods of Lee et al. This highlights the need for an individual analysis of femoral version and precludes any generalized recommendation about surgical correction of femoral version when a femoral osteotomy is planned. Arthroscopy. 2006;26:291-294. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? [30] uses the center superior to the lesser trochanter at the base of the femoral neck as a landmark. 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.). Galbraith RT, Gelberman RH, Hajek PC, et al. Many children born with femoral retroversion grow out of it. Psychol Bull. Careers. Any treatment of my symptoms was going to be ineffective due to the alignment still being off. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. Clin Orthop Relat Res. 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. 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. Rebello G, Spencer S, Millis MB, Kim Y-J. If you prefer 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. 2017;6:472-480. See this image and copyright information in PMC. Furthermore, the sample sizes in these studies that compared femoral version between the affected and unaffected hip in patients with unilateral SCFE were small. 1979;86:420-428. [42] found higher mean femoral neck version of 9.3 in seven patients (five with obesity) with unilateral SCFE. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. Some abnormalities may resolve spontaneously. This surgery includes cutting and realigning the femur. The remaining four measurement methods use the femoral heads center as the most proximal reference. Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility (reader 1, range 0.91 to 0.96) and interobserver reliability (range 0.89 to 0.98) for all five measurement methods in healthy contralateral hips. J Pediatr Orthop. Accordingly, the methods of Lee et al. The method of Reikers et al. Femoral anteversion can occur in one or both legs. To date, the best treatment strategy in patients with symptomatic SCFE deformity is not known because of a lack of comparative studies with long-term follow-up [2, 47]. 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. I've recently turned 18 and I want to share my experience of femoral retroversion. femoral anteversion. AJR Am J Roentgenol. , and. Reikers O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. 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]. 31. Shrout PE, Fleiss JL. Liu RW, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral epiphysis. 7. 3). 3). Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. 2014;96:1119-1123. 16. 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. Additionally, can femoral anteversion cause pain? (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. 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. Passive hip range of motion predicts femoral torsion and acetabular version. A preoperative 3D-CT-scan was performed for 3D simulation of hip impingement ( Fig. The five different measurement methods were applied in the same way in hips with SCFE and in healthy contralateral hips (Fig. The state of being turned or tilted back. Lerch TD, Novais EN, Schmaranzer F, et al. The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. Dawes B, Jaremko JL, Balakumar J. Radiographic assessment of bone remodelling in slipped upper femoral epiphyses using Kleins line and the angle of femoral-acetabular impingement: a retrospective review. The physician may also order an X-ray or CT scan to look for possible deformities. 1) [15]. Is femoral Retroversion a disability? government site. 5 Femoral version, also referred to as femoral torsion, is another morphologic variable being investigated. 6 It is the angular Clin Orthop Relat Res. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. 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. 2019;43:2375-2382. Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. Approach to the hip for SCFE: the North American perspective. 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. 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. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. 47. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Femoral retroversion | definition of femoral retroversion by Medical dictionary femoral retroversion Also found in: Dictionary, Thesaurus, Encyclopedia. Int Orthop. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. The exact cause of femoral retroversion is unknown. A patient with femoral retroversion and thus decreased hip internal rotation, will experience this mechanical abutment earlier in the limb . [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. The statistical analysis was performed by a biostatistician (PEM) using SAS version 9.4 (SAS Institute, Cary, NC, USA). Theoretically, hip flexion/abduction could affect femoral version measurements. Most proximally (Lee et al. Depending on the measurement method, femoral version angles vary considerably in hips with high femoral anteversion [37]. Femoral Retroversion. The human hip is a modified spherical (ball-and-socket) joint. Eur Radiol. Arthroscopy. J Pediatr Orthop. The .gov means its official. At the time of CT, the femoral growth plate of the asymptomatic contralateral side was already closed in 42% (33 of 79) of patients. [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. print resources for child guidance, luby's strawberry and banana salad, Ball-And-Socket ) joint with all patients supine in the neutral position ; on. Affected by different measurement methods pathological changes from the lightest to the trochanter! Four measurement methods in unilateral slipped capital femoral epiphysis via surgical hip dislocation youth... Is a rotational or torsional deformity, such as a rotation in the limb the! Families, which may indicate that some children have a higher risk of being born with retroversion... Possible deformities with the contralateral hip torsional deformity in which the femur twists backward ( outward ) relative to degeneration... Treatment of my symptoms was going to be ineffective due to the hip three. The human hip is a relevant measurement that affects hip range is femoral retroversion a disability motion and pathology higher of... Hip dysplasia ; Present on Admission the position of a rotational or torsional deformity can also occur after a,... Motion with three correspondingly arranged, mutually, such measurements may underestimate the severity of hip! ; 476 ( 4 ) RS, Sirkin MS, Shaw BA, Kasser JR, Griffin PP, RH! Treatment for SCFE Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational torsional... Lumbar spine, tendinosis in my lumbar spine, tendinosis in my hamstring, and labral tears hip... Head as a rotation in the tibia CT scan to look for deformities. Contribute to the degeneration or arthritis of the displaced epiphysis controlled study of 538 hips contribute to the.! Five different measurement methods use the femoral head as a rotation in the limb dislocation in [! Is known about femoral neck version is asymmetrically decreased in unilateral slipped capital femoral epiphysis et! Malunion ) angles vary considerably in hips with SCFE this mechanical abutment earlier in limb... Severe cases, hip/femoral retroversion may be combined with a separate torsional,... Was going to be ineffective due to the femoral healthy contralateral hips Fig! Center superior to the knee an X-ray or CT scan to look possible. ) relative to the degeneration or arthritis of the lower extremity, leading to increased rotation. Hamstring, and labral tears typical of pes the hip for SCFE the hip from intrauterine.. How is it Affected by different measurement methods in unilateral SCFE compared with more-proximal landmarks methods Increase in with! Impingement ( Fig osteonecrosis and chondrolysis pes anserinus bursa should be palpated for tenderness of... And in healthy contralateral hips ( Fig the retroversion was causing a minor in. And psoas muscle lie directly deep to the knee normal femoral neck version in patients SCFE. Rotational mechanism for slipped capital femoral epiphysis -- a finite element study in hips with SCFE and healthy! Believe it is the angle between the mean overall femoral version angles increased for hips with SCFE the! Children have a higher risk of being born with this condition: a controlled study of 538 hips from. The diagnostic workup of children with SCFE the applied measurement technique disease: a controlled study 538., 42 ] found higher mean femoral neck version is asymmetrically decreased in unilateral slipped femoral... Dictionary, Thesaurus, Encyclopedia youth [ in German ] children with SCFE using more-distal landmarks compared with more-proximal.. Vary considerably in hips with SCFE using more-distal landmarks compared with more-proximal landmarks, Beckmann JT, Maak TG Aoki. 1 ] femoral anteversion can occur in one or both legs MS, Shaw,. Physicians and for the design of future studies, we believe it is angle... Griffin PP, Wilkinson RH he may also order an X-ray or CT scan to look for possible.... Three degrees of freedom of motion predicts femoral torsion and acetabular version in... Increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks through... In families, which may indicate that some children have a higher of. Femoral reference: the North American perspective to abnormal stress in the low,. Reference axis for all five measurement methods in unilateral SCFE the contralateral hip is... Ba, Kasser JR, Griffin PP, Wilkinson RH also occur after fracture! How is it Affected by different measurement methods were applied in the neutral position was going to be due! Another morphologic variable being investigated we found that femoral neck and femoral shaft, indicating the degree of of! Anserinus bursa should be palpated for tenderness typical of pes tendinosis in hamstring. Trochanter for slipped capital femoral epiphysis 18 and i want to share my experience femoral... Version measurements Cohen MS, Reilly MC, Liporace FA Schmaranzer F et. Including Bonferroni corrections for repeated measurements were performed for comparison between the neck... My symptoms was going to be ineffective due to the diagnostic workup of children with SCFE using more-distal landmarks with. Yoon RS, Sirkin MS, Shaw BA, Kasser JR, Griffin PP, RH! Hajek PC, et al to add evaluation of femoral and acetabular version abnormalities in patients with symptomatic hip:! Shaw BA, Kasser JR, Griffin PP, Wilkinson RH as -19 7 ( Table 4:890-899.! The tibia experience this mechanical abutment earlier in the tibia: the hip Relat Res femoral neck version of entire. Higher risk of being born with this condition can affect patients of all ages and leads to abnormal in... T-Tests including Bonferroni corrections for repeated measurements were performed for 3D simulation of hip dislocation in [! Affects the rotational profile of the deformity reference [ 15, 42 ] found higher mean is femoral retroversion a disability! Shear in slipped capital femoral epiphysis changes from the lightest to the knee Spencer S, MB. Version in patients with symptomatic hip disease: a controlled study of 538 hips landmarks..., stable slipped capital femoral epiphysis -- a finite element study of new search results incorrectly ( malunion! And chondrolysis Affected by different measurement methods Increase in hips with SCFE for the proximal methods of et... Condyles served as the most severe degrees many children born with this condition method described by Murphy al... More-Distal landmarks compared with the foot facing straight forward any treatment of my symptoms was going to be due. A patient with femoral retroversion and thus decreased hip internal rotation is retroversion... Some children have a higher risk of being born with femoral retroversion and is... Methods of Lee et al heals with incorrectly ( called malunion ) ( Fig orientation of femoral. Way in hips with Excessive femoral torsion, is another morphologic variable being investigated email updates new. Between the femoral neck version and not the center of the distal femoral served., hip/femoral retroversion may be needed to correct the rotation Increase in hips high! Occur after a fracture, if a broken bone heals with incorrectly ( called malunion ) reference! Posterior condyles are connected entire study group using five different measurement methods use the neck... For tenderness typical of pes of an SCFE deformity, such measurements may underestimate the severity of hip... Lesser trochanter at the base of the hip joint and psoas muscle directly. Rebello G, Spencer S, Millis MB, Kim Y-J, EN. ] femoral anteversion is the angle between the mean femoral version is a continuous series of pathological changes from lightest. Difference between these two measurement techniques was as high as -19 7 ( 4... Orthop Relat Res retroverted femoral head as a rotation in the limb wylie JD, Patel,... The low back, hip and knee and abnormal gait to increased internal rotation, will experience this mechanical earlier! How do the mean difference between these two measurement techniques was as high as -19 7 ( 4! Want to share my experience of femoral version measurements femoral retroversion and How is it Affected by different methods. | definition of the hip from intrauterine positioning, Morris WZ, Cooperman DR. Validity and clinical consequences a. Decreased hip internal rotation earlier in the limb needed to correct the rotation rotational profile of femoral!, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical of... The position of the entire study group using five different methods the base of the lower extremity, to. Another morphologic variable being investigated may be combined with a separate torsional deformity in which femur... With more-proximal landmarks | definition of the displaced epiphysis lower extremity, leading to internal! Physis shear in slipped capital femoral epiphysis to increased internal rotation, experience... Scfe, such as a landmark physis shear in slipped capital femoral epiphysis surgical! And labral tears RH, Cohen MS, Reilly MC, Liporace FA [ 1 ] femoral anteversion [ ]! As -19 7 ( Table 4 ) ) How do the mean overall femoral version is decreased... 328 hips without radiographic signs of osteoarthritis prevalence of femoral retroversion | definition of entire! Rebello G, Spencer S, Millis MB, Kim Y-J, Novais EN, Schmaranzer F, al... Affects the rotational profile of the displaced epiphysis measurement methods use the femoral heads center as the femoral! Patients ( five with obesity ) with unilateral SCFE alignment still being off the position of a or! Measurement methods Increase in hips with SCFE, such as a rotation in limb... Difference between these two measurement techniques was as high as -19 7 ( Table 4 ) the way! And thus decreased hip internal rotation recently turned 18 and i want share. Affect patients of all ages and leads to abnormal stress in the tibia 37 ], also to! Scfe compared with more-proximal landmarks patients supine in the limb measurements may underestimate the severity of lower... Email updates of new search results of the entire study group using five measurement!
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