All CT scans including axial images covering the osseous pelvis and distal femoral condyles were used to measure femoral version. Out-toeing is the common name used for a condition known as femoral retroversion. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. 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]. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. 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). 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. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. In the remaining four patients with an open femoral growth plate at last clinical visit, radiographic follow-up was longer than 18 months (median 22 months, range 21 to 25), an observation period by which more than 90% of the subsequent contralateral SCFE reportedly occur [25]. J Child Orthop. 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. In the axial HASTE images over the proximal and distal femur a femoral retroversion can be seen, i.e. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. Osteotomy to correct the alignment is rarely needed. 1983;54:18-23. This graph shows a comparison of the different methods to measure femoral version, MeSH 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 articular cartilage is intact. 2006;26:291-294. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). Femoral version in acute slipped capital femoral epiphysis. 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. 20. [] reported an association of SCFE and femoral retroversion.More recently, many studies have shown an association . , and. 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. [35], Tomczak et al. Journal of Clinical Medicine. 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. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. is femoral anteversion a disability. A labral tear, subspine and intertrochanteric impingement and femoral retroversion. 2014;96:1441-1448. 2015;97:537-543. We found that femoral neck version is asymmetrically decreased by -8 in unilateral hips with SCFE compared with contralateral hips. To develop effective prevention strategies, we must first understand what it is, what impact it . HHS Vulnerability Disclosure, Help The condition is usually congenital, meaning children are born with it. 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. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). Intraclass correlations: uses in assessing rater reliability. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning for X-ray imaging may not reveal a rotation in the femoral neck. 42. [15] were the first to describe a method of measuring femoral neck version in patients with SCFE. [19], Reikers et al. This is also called in-toeing. 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). The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. 2). Imhauser G. Pathogenesis and therapy of hip dislocation in youth [in German]. femoral retroversion. The association of femoral retroversion with slipped capital femoral epiphysis. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. 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. 9. At times, pure femoral retroversion may be the only source of hip impingement. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. To the best of our knowledge, there are no normal reference values for CT-based femoral neck version measurements in children. The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. [30] is the preferred routine measurement because it most closely reflects the true anatomic femoral version [7, 30] and does not underestimate excessively high femoral version [37]. Disclaimer, National Library of Medicine 41. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. My doctors would not treat me unless I had surgery to fix the retroversion. Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach. 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. Gelberman et al. and Tomczak et al. New York, NY 10021 Int Orthop. This position keeps the femoral head within the socket which minimizes pain. 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]. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. External rotation contracture of the hip. 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. Femoral retroversion | definition of femoral retroversion by Medical dictionary femoral retroversion Also found in: Dictionary, Thesaurus, Encyclopedia. Out-toeing may be caused by: Femoral retroversion. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate 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. Additionally, can femoral anteversion cause pain? 18. It also appears to be related to the position of the baby as it grows in the womb. J Child Orthop. "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? Czech. 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. 46. . 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. The method of Murphy et al. 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 J Bone Joint Surg Am. 3). Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. Said differently, the knee is excessively twisted inward relative to the hip. Schmaranzer F, Todorski IAS, Lerch TD, Schwab J, Cullmann-Bastian J, Tannast M. Intra-articular lesions: imaging and surgical correlation. 2. 45. Please enable it to take advantage of the complete set of features! Lerch TD, Boschung A, Todorski IAS, et al. J Bone Joint Surg Am. Despite this proposed association, little is known about femoral neck version in patients with SCFE. Femoral retroversion may also occur after a physical trauma such as a femur fracture. Unlike in- toeing, out-toeing may lead to pain and disability as the child grows into adulthood. Is femoral Retroversion a disability? The effects of simulated microgravity on the static and dynamic properties of large arteries are still mostly unknown. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? 2014;30:1314-1325. 2014;96:1119-1123. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. I've recently turned 18 and I want to share my experience of femoral retroversion. 5. Southwick WO. 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. 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. These side-by-side differences increased up to -22 (according to the method of Murphy et al. Femoral retroversion is common in early infancy and is caused by external rotation contracture of the hip secondary to intrauterine packing. Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). 6 It is the angular Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. 2021 May 1;479(5):935-944. doi: 10.1097/CORR.0000000000001590. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. 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