2014;30:1314-1325. 31. The hip joint is where the femoral head (the top of the femur) meets the pelvis. Radiology. 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 times, pure femoral retroversion may be the only source of hip impingement. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? In healthy contralateral hips, we found differences for 9 of 10 pairwise comparisons (Table 4). Clipboard, Search History, and several other advanced features are temporarily unavailable. 8600 Rockville Pike Fabricant PD, Fields KG, Taylor SA, Magennis E, Bedi A, Kelly BT. Out-toeing or duck walk walking with the foot pointed outward instead of straight ahead, If the doctor suspects a femoral retroversion, he will conduct a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. 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. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. The condition is usually congenital, meaning children are born with it. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). Questions/purposes: Z Orthop Ihre Grenzgeb. and Reikers et al.) The effects of simulated microgravity on the static and dynamic properties of large arteries are still mostly unknown. . One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. Clin Orthop Relat Res. 3. A turning or tilting backward. [] reported an association of SCFE and femoral retroversion.More recently, many studies have shown an association . Disclaimer, National Library of Medicine 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%]). [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. 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). Wolters Kluwer Health Femoral anteversion occurs in up to 10 percent of children. 2020;14:190-200. 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). One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. For this retrospective, controlled, single-center study, we reviewed our institutional database for patients who were treated for unilateral SCFE and who had undergone a pelvic CT scan. Isolated open or arthroscopic cam resection has been increasingly proposed as less-invasive options in patients with mild-to-moderate slips, yielding promising short-term results [6, 32, 46]. Femoral version of the general population: does normal vary by gender or ethnicity? 33. An important mark of this deformity is the reduced or absent offset between the femoral head and the neck, which can be radiographically graded. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. Many children born with femoral retroversion grow out of it. Slipped capital femoral epiphysis. Japanese. The aim of the current study was to obtain precise normal values of the femoral anteversion angle using computed tomography on cadavers of mature dogs with normal hip joints of . 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. 47. 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. femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. Femorln retroverze. 43. femoral retroversion. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. 2021 May 1;479(5):935-944. doi: 10.1097/CORR.0000000000001590. Thus, this should not jeopardize the results of our study to a relevant degree. . Three-dimensional CT was performed with all patients supine in the neutral position. n. 1. 479(5):960-961, May 2021. Femoral anteversion is usually most noticeable in children between the ages of 4 and 6. Clin Orthop Relat Res. femoral retroversion (___ degrees), femoral retroversion (physical finding), femoral retroversion, Femoral retroversion. 15 - 17 Furthermore, it can cause a decrease in the length of the abductor lever arm, 18 posterior extra-articular impingement, 9 and ischiofemoral impingement. This means thehip is twisted backward (posteriorly) in relation to the knee. Differences in Femoral Torsion Among Various Measurement Methods Increase in Hips With Excessive Femoral Torsion. 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. 21. 2020:296:381-390. and Tomczak et al. Clin Orthop Relat Res. Among these, the greatest differences were between the most-proximal methods and the more-distal methods. The right leg is 1.5 cm longer than normal. Pritchett JW, Perdue KD. At a mean follow-up of 58 46 months, the femoral growth plate was closed in 95% (75 of 79) of patients. She was treated with an open reduction and bracing in infancy. 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. Clin Orthop Relat Res. The exact cause of femoral retroversion is unknown. 6. This underlines the complex, multifactorial pathogenesis of SCFE, which further includes endocrine disorders [26] and altered epiphyseal orientation [24] and morphology [17, 23] and warrants further investigation. Int Orthop. 29. Second, we did not compare femoral version between different severity grades of SCFE because most patients had a severe slip. Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate This position keeps the femoral head within the socket which minimizes pain. We reviewed our institutional database for patients who were treated for SCFE and had undergone pelvic CT scanning for surgical planning. 2012 Dec;470(12):3432-8. doi: 10.1007/s11999-012-2452-y. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. These differences increased when including the femoral heads center as a reference. Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. The state of being turned or tilted back. 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. Bali NS, Harrison JO, Bache CE. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. During this time period, 754 patients were diagnosed with SCFE. Significantly increased femoral anteversion affects the rotational profile of the lower extremity, leading to increased internal rotation. 18. Coxa vara. Symptoms of femoral retroversion usually begin with the visual recognition of the rotated femur. femoral anteversion. 1987;5:523-528. 2011;31:153-158. The hip joint and psoas muscle lie directly deep to the femoral . In these situations, a surgical procedure known as a femoral osteotomy may be used. 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. Tomczak et al.s [44] method uses the center of the base of the greater trochanter as a landmark. 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. A technical improvement. A preoperative 3D-CT-scan was performed for 3D simulation of hip impingement ( Fig. Despite this proposed association, little is known about femoral neck version in patients with SCFE. . [44] (Table 4). 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. Symptoms of femoral retroversion may include: If the doctor suspects a femoral retroversion, he will conduct a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. 38. 37. Before imaging analyses, both observers were trained using a different sample of 20 CT scans with SCFE by a senior orthopaedic hip surgeon (ENN, 17 years of experience). Shrout PE, Fleiss JL. 2019;43:2375-2382. Femoral anteversion describes the inward rotation of the femur bone in the upper leg. External tibial torsion. 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. 41. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. The patient is a 19-year-old female who was born with a dislocated right hip. 2009;467:724-731. 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. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. 34. 1) [15]. In patients with implant failure following in situ fixation, this included assessment of the femoral growth plate for planning of revision in situ fixation. Femoral version is a relevant measurement that affects hip range of motion and pathology. 1983;54:18-23. J Bone Joint Surg Am. J Bone Joint Surg Am. 7. [42] found higher mean femoral neck version of 9.3 in seven patients (five with obesity) with unilateral SCFE. 1973;55:1218-1224. Congenital right femoral retroversion; Congenital right hip dysplasia; Present On Admission. Clin Orthop Relat Res. 28. Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). Symptoms, Causes, Treatment for Out-Toeing, the common name used for a condition known as femoral retroversion. 2012;28:965-971. In addition, we observed increasing femoral version angles with selection of more-distal landmarks in SCFE hips regardless of whether or not previous in situ pinning had been performed (Table 5). Femoral anteversion. Finally, we could show that the different measurement methods are comparable in terms of interobserver reliability and reproducibility (Table 6). Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. 5. A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. The association of femoral retroversion with slipped capital femoral epiphysis. Most proximally (Lee et al. These side-by-side differences increased up to -22 (according to the method of Murphy et al. 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). femoroacetabular impingement. grip" deformity) and relative retroversion of the femoral head were dened as the cause of cam-type FAI, with worse long-term clinical and radiographic results. 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. Femoral retroversion | definition of femoral retroversion by Medical dictionary femoral retroversion Also found in: Dictionary, Thesaurus, Encyclopedia. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. [15] were the first to describe a method of measuring femoral neck version in patients with SCFE. FOIA 19. The first symptom of femoral retroversion is usually a visual recognition of the rotated femur. Varus derotation intertrochanteric osteotomy with femoral retroversion. 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). Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. Clin Orthop Relat Res. Said differently, the knee is excessively twisted inward relative to the hip. 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%]). Torsional deformity can also occur after a fracture where the bone heals with deformity or malunion. to maintaining your privacy and will not share your personal information without Bone Joint J. 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. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. 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]. This yielded a mean difference of -19 7 (95% CI -21 to -18; p < 0.001) between the methods of Lee et al. 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. The method of Murphy et al. Arthroscopy. 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). and Reikers et al. Top-view illustrations of excessive femoral retroversion. 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. This graph shows a comparison of the different methods to measure femoral version, MeSH Acta Orthop Scand. 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). Clinical features include an abnormal gait and pain with prolonged weight-bearing. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. Many children are born with femoral anteversions that they eventually grow out of. Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. 2002;2:8. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Femoral version angles did not differ between hips with and without previous in situ pinning for any of the five measurement methods (for example, Lee et al. government site. Common complications include secondary arthrosis and. January 31, 2022 . In some cases, the doctor may perform a less invasive version of a femoral osteotomy. Articles in PubMed by Florian Schmaranzer, MD, PhD, Articles in Google Scholar by Florian Schmaranzer, MD, PhD, Other articles in this journal by Florian Schmaranzer, MD, PhD, May 2021: Selected Proceedings from the 2020 Bernese Hip Symposium, Privacy Policy (Updated December 15, 2022), Overweight (% between the 85th and 95th percentiles), Duration of symptoms at initial diagnosis, Flexion-derotation intertrochanteric osteotomy, Anatomic landmark to define the proximal reference axis, A line is drawn that connects the femoral heads center with the most cephalic junction of the greater trochanter to the femoral neck, A line is drawn that connects the center of the femoral head with the center of the femoral neck at the level where the anterior and posterior cortices run parallel, The center of the femoral neck at the level where the anterior and posterior cortices run parallel, A line is drawn that connects the femoral heads center with the center of the greater trochanter at the base of the femoral neck, A line is drawn that connects the femoral heads center with the base of the femoral neck superior to the lesser trochanter, Femoral version measurements (), hips with SCFE, Femoral version measurements (), contralateral hips. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. J Pediatr Orthop. [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. Abstract Slipped capital femoral epiphysiolysis (SCFE) may result in femoroacetabular. Most proximally (Lee et al. [19] and Reikers et al. Before Retroversion refers to an abnormal backward rotation of the hip relative to the knee. 2017;21:487-506. Federal government websites often end in .gov or .mil. Femoral anteversion causes a child's knees and feet to turn inward and have a "pigeon-toed" appearance. A 10-year minimum followup study. Cartilage is a semi-rigid but flexible avascular connective tissue found at various sites within the body. 16. Define femoral retroversion. 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]. and Murphy et al. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? 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. Increasing femoral version angles with more-distal landmarks were observed in SCFE hips with and without previous in situ pinning alike (Table 5). 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. J Pediatr Orthop. PMC He may also order an. 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. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. 35. VDK is a continuous series of pathological changes from the lightest to the most severe degrees. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. Femoral neck version was measured as the orientation of the femoral neck. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. A subset of patients was measured twice by the first obsever as well as by a second orthopaedic resident (JRK, 2 years of experience) to assess intraobserver reproducibility and interobserver reliability. 2). 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. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. The hip joint is where the femoral head (the top of the femur) meets the pelvis. The present study evaluated, using an integrated vascular approach, changes in structure and function of the common carotid and femoral arteries (CCA and CFA) after prolonged head-down tilt bed rest (HDTBR). Southwick WO. Exclusion criteria were bilateral SCFE in 31% (38 patients), any contralateral hip condition in 1% (one patient), and previous femoral osteotomies in 4% (five patients). is femoral anteversion a disability. sharing sensitive information, make sure youre on a federal 2016;98:127-134. 2013;37:2331-2336. 25. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. Furthermore, the prevalence of actual femoral retroversion and the effect of different measurement methods has yet to be studied in SCFE. The .gov means its official. Several factors, including obesity and a decreased femoral anteversion angle, have been associated with the development of slipped capital femoral epiphysis (SCFE) [31]. [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. 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. Third, because of the studys retrospective design, we cannot rule out a selection bias since the decision to perform a CT was not standardized and evolved over time in the practices of the different surgeons. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). 2020;14:98-105. Fabricant PD, Bedi A, De La Torre K, Kelly BT. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. 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. your express consent. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. 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. English. 2018;46:122-134. Depending on the measurement method, femoral version angles vary considerably in hips with high femoral anteversion [37]. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Using the four alternative measurement techniques that are based on the center of the femoral head as a proximal reference, the mean differences between the affected and contralateral side were higher. J Child Orthop. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. 2015;97:537-543. Limb Lengthening and Complex Reconstruction Service From proximal to distal, this included the most-proximal methods (Lee et al. 2023; 12(3):751. https: . This site needs JavaScript to work properly. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? [30]) when including the femoral heads center as a reference to account for displacement of the epiphysis (Fig. 3). Interrater reliability was assessed across raters using an ICC (2,2) model and intrarater reliability was assessed using an ICC (3,1) model [39]. Limb Lengthening and Complex Reconstruction Service, out-toeing or "duck walk" walking with the foot pointed outward instead of straight ahead. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. The torsional deformity is corrected by re-establishing the normal rotation between the hip and the knee. The femoral vein is the major deep vein of the lower extremity. Int Orthop. A comprehensive analysis of femoral version may provide valuable baseline information to optimize surgical planning in hips with sequalae of SCFE and to allow standardization of studies investigating surgical correction of SCFE deformities. River Terrace 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. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. The human hip is a modified spherical (ball-and-socket) joint. 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. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. Abnormalities in hip joint morphology, such as developmental dysplasia of the hip (DDH) and femoroacetabular impingement, have been shown to alter hip mechanics and promote the development of end-stage hip OA.
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