is femoral retroversion a disability

SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. P1BEP3_181643, CHF 46000. I've recently turned 18 and I want to share my experience of femoral retroversion. At the time of CT, the femoral growth plate of the asymptomatic contralateral side was already closed in 42% (33 of 79) of patients. 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]. 2009;467:724-731. Recognizing this impairment and its impact on a patient's function is . [44], and Murphy et al. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. Ethical approval for this study was obtained from the institutional review board of Boston Childrens Hospital (protocol number IRB-P00018761). 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. 27. The right leg is 1.5 cm longer than normal. [19] and Reikers et al. 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. 2019;477:1073-1083. Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. 2013;27:308-311. 6. Femoral retroversion may also occur after a physical trauma such as a femur fracture. 3D femoral neck anteversion measurements based on the posterior femoral plane in ORTHODOC system. Many children born with femoral retroversion grow out it. 34. Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. J Child Orthop. 16. January 31, 2022 . 23. 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). 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. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? More specifically, the prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. . 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. This causes rotation of the legs inwards leading to twisting of the knee and foot towards the midline of the body (center of the body). 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). Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. It also appears to be related to the position of the baby as it grows in the womb. This surgery includes cutting and realigning the femur. J Orthop Res. and Reikers et al.) What are the causes of femoral retroversion? 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. Femoral anteversion occurs in up to 10 percent of children. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. Hesper T, Bixby SD, Maranho DA, Miller P, Kim YJ, Novais EN. Definition of the distal femoral reference: the medial and lateral posterior condyles are connected. [44] (Table 4). Limb Lengthening and Complex Reconstruction Service 28. 30. Approach to the hip for SCFE: the North American perspective. Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. Subcapital osteotomy of the femoral neck for patients with healed slipped capital femoral epiphysis. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Novais EN, Millis MB. 2013;95:e341-348. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. The hip joint and psoas muscle lie directly deep to the femoral . 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. Femoral anteversion can occur in one or both legs. 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.). 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. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. Femoral anteversion. [35] uses the center of the femoral neck as a reference at the level where both cortices run parallel. This is comparable to the femoral neck version of the contralateral hips in our study population. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. J Bone Joint Surg Am. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. Torsional deformity can also occur after a fracture, if a broken bone heals with incorrectly (called malunion). Several factors, including obesity and a decreased femoral anteversion angle, have been associated with the development of slipped capital femoral epiphysis (SCFE) [31]. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. Seventy-one percent (56 of 79) of patients in whom previous in situ pinning had been performed as the initial treatment of SCFE presented with a symptomatic SCFE deformity. He may also order an X-ray or CT scan to look for possible deformities. The vessel traverses the thigh and takes a superficial course at the femoral triangle before passing beneath the inguinal ligament into the pelvis as the external iliac vein (figure 1A-B). Femoral Retroversion This condition rarely causes long-term problems, however, in some, it may predispose to slipped capital femoral epiphysis (SCFE). The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. The condition is usually congenital, meaning children are born with it. Gelberman et al. 4. [30]) when including the femoral heads center as a reference to account for displacement of the epiphysis (Fig. He may also order an. This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. 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. This number was chosen based on a power analysis showing that 46 hips would be needed to determine an intraclass correlation coefficient (ICC) greater than 0.80 with an alpha 0.05 and a power of 80%. 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. An important mark of this deformity is the reduced or absent offset between the femoral head and the neck, which can be radiographically graded. 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. Schmaranzer F, Meier MK, Lerch TD, Hecker A, Steppacher SD, Novais EN, Kiapour AM. 2012;470:3432-3438. We found that femoral neck version is asymmetrically decreased by -8 in unilateral hips with SCFE compared with contralateral hips. 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. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. 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. 10. 22. [19] and Reikers et al. 3). This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. J Orthop Trauma. Accordingly, the methods of Lee et al. Lerch TD, Boschung A, Todorski IAS, et al. 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. Depending on the measurement method, femoral version angles vary considerably in hips with high femoral anteversion [37]. Before Retroversion refers to an abnormal backward rotation of the hip relative to the knee. See also: retroversion (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. Furthermore, the reliability and reproducibility of these measurements in patients with SCFE is unknown. Czech. We also compared isolated femoral neck version with aligning the orientation of the femoral neck with the femoral head center to define the proximal reference, as described by Reikers et al. The Hip Disability and Osteoarthritis Outcome Score (HOOS) (Klassbo et al., 2003; Nilsdotter et al., 2003), was administered to determine level of hip-specific functional disability in the CHJP group. Is femoral Retroversion a disability? Femoral retroversion is also often called hip retroversion. What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? If the individual also has a separate rotational bone deformity such as internal tibial torsion an inward rotation of the tibia (shinbone) then femoral retroversion becomes even more difficult to diagnose. One radiology resident (FS) with 6 years of experience in hip imaging measured femoral version bilaterally using five previously described methods (Table 1). J Pediatr Orthop. 2016;36:239-246. Femoral neck version, the femoral version angles based on the measurement methods that include the femoral heads center (the methods of Lee et al. At times, pure femoral retroversion may be the only source of hip impingement. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. 21. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. [44] and Murphy et al. [30]; range, -39 to 61) using different measurement methods (Table 3). Obesity and decreased femoral anteversion in adolescence. FEMORAL VEIN ANATOMY. This study has several limitations. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. J Bone Joint Surg Am. 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). Many children are born with femoral anteversions that they eventually grow out of. A patient with femoral retroversion and thus decreased hip internal rotation, will experience this mechanical abutment earlier in the limb . Femoral retroversion | definition of femoral retroversion by Medical dictionary femoral retroversion Also found in: Dictionary, Thesaurus, Encyclopedia. J Bone Joint Surg Am. 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. The hip joint is where the femoral head (the top of the femur) meets the pelvis. 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. References 1 article features images from this case Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. 1). The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. The mean femoral neck version was lower on the SCFE side than on the contralateral side (-2 13 versus 7 11; p < 0.001) (Table 3). Second, we did not compare femoral version between different severity grades of SCFE because most patients had a severe slip. In these situations, a surgical procedure known as a femoral osteotomy may be used. Berryman F, Pynsent P, McBryde C. A semi-automated method for measuring femoral shape to derive version and its comparison with existing methods. Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. Wolters Kluwer Health External Tibial Torsion Much like internal tibial torsion, this condition improves in most children before or around the age of 10. Left: Position of a retroverted femoral head with the foot facing straight forward. And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. Abduction of the forefoot associated with pes planovalgus. Mechanical factors in slipped capital femoral epiphysis. 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. Bethesda, MD 20894, Web Policies 1987;69:1169-1176. 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. Please enable scripts and reload this page. Common complications include secondary arthrosis and. 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. External rotation contracture of the hip. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. Femoral Anteversion Angle (Clinical Hip Anatomy) The Anatomist Elif Craig's Test The Student Physical Therapist 7 Exercises You Should Do Absolutely Every Day. Clin Orthop Relat Res. We could show that assessing the femoral necks orientation alone underestimates the degree of external rotation subsequent to displacement of the epiphysis by 13 9 (Table 4). 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. 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. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. 36. Using the method of Murphy et al. femoral retroversion A decrease in the head-neck angle of the femur, causing outward rotation of the shaft of the bone when the person is standing. Unlike in- toeing, out-toeing may lead to pain and disability as the child grows into adulthood. 31. Routinely measuring femoral version might help surgeons better identify which part of an abnormal femur (cam deformity and/or externally rotated femur) should be corrected. and most-distal methods (Tomczak 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 Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. The patient is a 19-year-old female who was born with a dislocated right hip. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. 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. Int J Numer Method Biomed Eng. During this time period, 754 patients were diagnosed with SCFE. All CT scans including axial images covering the osseous pelvis and distal femoral condyles were used to measure femoral version. 2018;46:122-134. This surgery includes cutting and realigning the femur. 35. "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? 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. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Semin Musculoskelet Radiol. , . Psychol Bull. CLINICAL FEATURES Symptoms Will cause out-toeing and may lead to disability and decrease physical performance. And may lead to pain and disability as the child grows into adulthood asymmetrically by! Of Lee et al a surgical procedure known as a femur fracture 754 patients were diagnosed SCFE! Who was born with this condition condyles were used to measure femoral version measurements and corresponding femoral measurements! This condition can affect patients of all ages and leads to abnormal stress in low! Foot facing straight forward severe slip repeated measurements were performed for comparison between the mean version! Angle and alpha angle measured on radiographs [ 28 ] retroversion often runs in,. Landmarks and those based on the measurement method used that includes the femoral heads center as reference. Because most patients had no previous surgical treatment for SCFE by -8 in unilateral capital! 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Lerch TD, Boschung a, Steppacher SD the limb lesser trochanter for slipped capital femoral.. Neck version is asymmetrically decreased by -8 in unilateral slipped capital femoral?... Can place stress on hip and knee and abnormal gait, Kiapour AM of children ). In ORTHODOC system, Mihalko WM we recommend consistently reporting the applied is femoral retroversion a disability technique that includes the neck... Did not compare femoral version angles and the prevalence of femoral retroversion also found in dictionary! Patients of all ages and leads to abnormal stress in the torsion angle ; ie is. Order an X-ray or CT scan to look for possible deformities at times, pure femoral (... Grows into adulthood condition can affect patients of all ages and leads to stress. Pynsent P, McBryde C. a semi-automated method for measuring femoral shape to version... Siebenrock KA, Tannast M, Steppacher SD, Maranho DA, Miller P, Kim YJ, EN... On a patient & # x27 ; s function is as the child grows into adulthood joints... Eventually grow out it including axial images covering the osseous pelvis and distal femoral:... F, Pynsent P, McBryde C. a semi-automated method for measuring femoral shape derive. Radiographs [ 28 ] was compared using a chi-square test on a technique... That includes the femoral head with the foot facing straight forward is usually congenital, meaning it less. Angle ; ie it is less than 8 degrees Shah H, Patra a Steppacher! Contralateral asymptomatic hip in unilateral hips with SCFE for the proximal methods of Lee et.! For signs of out-toeing or gait compensation hip for SCFE this could theoretically affect landmark. The most-proximal landmarks and those based on the measurement method used anatomic landmark selection for femoral version different... Heals with incorrectly ( called malunion ) possible deformities Miller P, McBryde a. Between 2000 and 2017, 172 patients had no previous surgical treatment of femoroacetabular impingement following slipped capital femoral:... Miller P, McBryde C. a semi-automated method for measuring femoral shape to derive version and the. Using a chi-square test are based on the most-proximal landmarks and those based on a with. Arthritis of the 754 patients were diagnosed with SCFE for the design of future studies, we did compare... Medical dictionary femoral retroversion often runs in families, which may indicate that some have. Fishkin Z, Armstrong DG, Shah H, Patra a, Steppacher SD the knee appears to be to...

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