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. Interrater reliability was assessed across raters using an ICC (2,2) model and intrarater reliability was assessed using an ICC (3,1) model [39]. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. Med Biol Eng Comput. 2006;44:895-906. The condition is usually congenital, meaning children are born with it. [44] and Murphy 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. For more information, please refer to our Privacy Policy. Define femoral retroversion. 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. 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. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. 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. The mean age was 59.5 12 years and the . 2017;6:472-480. Out-toeing is the common name used for a condition known as femoral retroversion. Clin Orthop Relat Res. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. While both femoral anteversion and retroversion do not always cause discomfort, they can eventually bring about pain in the lower back, hip, and knee. 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 prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. Arthroscopy. Bethesda, MD 20894, Web Policies . Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. Schmaranzer F, Kallini JR, Miller PE, Kim Y-J, Bixby SD, Novais EN. The right leg is 1.5 cm longer than normal. 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. At a mean follow-up of 58 46 months, the femoral growth plate was closed in 95% (75 of 79) of patients. 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. 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]. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA, F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA, F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland, Email: [emailprotected]. Femoral antetorsion was significantly higher in patients with pincer-type FAI than in those with cam-type FAI for reader 1 (18.3 9.8 vs 10.0 9.1, P = .02) and reader 2 (18.7 10.5 vs 11.6 8.8, P = .04). Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. Finally, we could show that the different measurement methods are comparable in terms of interobserver reliability and reproducibility (Table 6). 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. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. Bone Joint J. The I-bars represent the corresponding 95% CI. An official website of the United States government. 17. Questions/purposes: VDK is a continuous series of pathological changes from the lightest to the most severe degrees. 3D femoral neck anteversion measurements based on the posterior femoral plane in ORTHODOC system. 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]. In these situations, a surgical procedure known as a. may be used. This surgery includes cutting and realigning the femur. [44] (Table 4). What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. Hesper T, Bixby SD, Maranho DA, Miller P, Kim YJ, Novais EN. 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. River Terrace (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). HHS Vulnerability Disclosure, Help The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. your express consent. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning for X-ray imaging may not reveal a rotation in the femoral neck. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Oduwole KO, de SA D, Kay J, et al. Loder RT, Aronson DD, Greenfield ML. [30], a recent study reported a prevalence of femoral retroversion (< 0) of 5% and a mean femoral version of 19 14 in a cohort of 538 hips with femoroacetabular impingement, developmental dysplasia of the hip, and Perthes disease [22]. Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. 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. 2019;43:2375-2382. I've recently turned 18 and I want to share my experience of femoral retroversion. and Tomczak et al. 2015;97:537-543. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. The .gov means its official. 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. 25. BMC Health Serv Res. Cartilage is a semi-rigid but flexible avascular connective tissue found at various sites within the body. Wylie JD, Beckmann JT, Maak TG, Aoki SK. Tomczak et al.s [44] method uses the center of the base of the greater trochanter as a landmark. Increasing femoral version angles with more-distal landmarks were observed in SCFE hips with and without previous in situ pinning alike (Table 5). All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. By contrast, Stanitski et al. [30]) when including the femoral heads center as a reference to account for displacement of the epiphysis (Fig. Fabricant PD, Fields KG, Taylor SA, Magennis E, Bedi A, Kelly BT. The torsional deformity is corrected by re-establishing the normal rotation between the hip and the knee. [19] and Tomczak et al. Bone Joint J. 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. And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. 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. Femoral anteversion is an inward twisting of the thigh bone (femur). One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. 2019;477:1073-1083. Berryman F, Pynsent P, McBryde C. A semi-automated method for measuring femoral shape to derive version and its comparison with existing methods. Femoral Retroversion. A Type I error rate of 5% was used. 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). It also appears to be related to the position of the baby as it grows in the womb. Femoral Retroversion. Second, we did not compare femoral version between different severity grades of SCFE because most patients had a severe slip. 3. Femoral version is a relevant measurement that affects hip range of motion and pathology. [19], Reikers et al. AJR Am J Roentgenol. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. The hip joint and psoas muscle lie directly deep to the femoral . 2015;31:247-253. This work was performed at the Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA. Femoral retroversion is a condition in which the femoral neck is rotated backward on the femoral shaft. 2013;37:2331-2336. 2). Symptoms, Causes, Treatment for Out-Toeing, the common name used for a condition known as femoral retroversion. Seventy-two percent of the patients in our cohort were overweight or obese. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. 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. Osteotomy to correct the alignment is rarely needed. Femoral anteversion. 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. Ethical approval for this study was obtained from the institutional review board of Boston Childrens Hospital (protocol number IRB-P00018761). 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). The first symptom of femoral retroversion is usually a visual recognition of the rotated femur. What is femoral anteversion? Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. 47. Wolters Kluwer Health Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. 19. First, we included patients who had previous in situ fixation and presented with a symptomatic SCFE deformity as well as patients who had not undergone any surgical treatment for SCFE. J Bone Joint Surg Am. Femoral anteversion can occur in one or both legs. 2013;95:e341-348. Hip/Femoral Anteversion: Causes, Symptoms, Treatment There are 2 types of femoral version: Femoral Anteversion; Femoral Retroversion AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. Semin Musculoskelet Radiol. Acta Orthop Scand. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. 2018;38(suppl 1):S5-S12. Baraka MM, Hefny HM, Thakeb MF, et al. Imhauser G. Pathogenesis and therapy of hip dislocation in youth [in German]. It also appears to be related to the position of the baby as it grows in the womb. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. Arthroscopy. 2020;14:190-200. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. and Murphy et al. Thus, this should not jeopardize the results of our study to a relevant degree. Clin Orthop Relat Res. Am J Sports Med. However, Koerner et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. J Bone Joint Surg Am. The prevalence of femoral retroversion was high in patients with SCFE, and even higher when retroversion was defined and diagnosed using proximal anatomic landmarks. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. 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 retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Am J Sports Med. 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%. Measuring the femoral neck version alone underestimates the asymmetric decrease in femoral version caused by displacement of the femoral epiphysis. However, severe cases require surgical correction. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. Data is temporarily unavailable. Some abnormalities may resolve spontaneously. After applying prespecified inclusion and exclusion criteria, we included 79 patients. Depending on the measurement method, femoral version angles vary considerably in hips with high femoral anteversion [37]. 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. Clin Orthop Relat Res. [35] uses the center of the femoral neck as a reference at the level where both cortices run parallel. 32. 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). References 1 article features images from this case After applying prespecified inclusion and exclusion criteria, we included 79 patients. The mean age at the time of CT was 15 4 years. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. [35] (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. 2017;11:93-98. 2013;95:851-854. 23. During the period in question, the general indication for obtaining a CT scan was to define the surgical strategy based on the assessment of deformity severity in patients with newly diagnosed SCFE or with previous in situ fixation. 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. We found that femoral neck version is asymmetrically decreased by -8 in unilateral hips with SCFE compared with contralateral hips. . 14. Disclaimer, National Library of Medicine 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. Bali K, Railton P, Kiefer GN, Powell JN. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. However, in excessive cases, surgery may be needed to correct the rotation. Clin Orthop Relat Res. 2013;27:308-311. Femoral anteversion causes a child's knees and feet to turn inward and have a "pigeon-toed" appearance. Arthroscopic treatment of mild to moderate deformity after slipped capital femoral epiphysis: intra-operative findings and functional outcomes. 479(5):960-961, May 2021. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? At times, pure femoral retroversion may be the only source of hip impingement. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. Millis MB. 2020;30:5281-5297. The prevalence of femoral retroversion was high in our study and ranged from 47% to 91%, depending on the applied measurement method (Table 3). This is also called in-toeing. Akiyama M, Nakashima Y, Kitano T, et al. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. He may also order an. The patient is a 19-year-old female who was born with a dislocated right hip. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. 6. Accessibility Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. Video case study Femoral retroversion is also often called hip 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. Background: 8600 Rockville Pike Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. 3). 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. Bone Joint J. See this image and copyright information in PMC. [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. 41. Clin Orthop Relat Res. Femoral retroversion is often a congenital condition, meaning children are born with it. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. 27. Bali NS, Harrison JO, Bache CE. This yielded a mean difference of -19 7 (95% CI -21 to -18; p < 0.001) between the methods of Lee et al. and Murphy et al.). Surgical dislocation in the management of pediatric and adolescent hip deformity. Rebello G, Spencer S, Millis MB, Kim Y-J. Subcapital osteotomy of the femoral neck for patients with healed slipped capital femoral epiphysis. Mechanical risk factors for SCFE include rapid growth spurts, femoral retroversion, and femoral neck shaft angle. Measurement of femoral version has been recommended in patients eligible for hip preservation surgery [27, 38] because of the high prevalence of abnormal femoral version in patients with hip pain [21, 22] and its effect on ROM [8, 20] and the outcome of surgery for femoroacetabular impingement [11, 12]. 2. 18. New York, NY 10021 However, among the remaining measurement methods, it is not possible to recommend one measurement method over another based on our findings. A 10-year minimum followup study. Please enable it to take advantage of the complete set of features! The method of Murphy et al. It has been reported that some degree of remodeling of the femoral head-neck junction can be expected after fixation of the epiphysis over time [1, 9]. The remaining four measurement methods use the femoral heads center as the most proximal reference. 7. In severe cases, however, surgery may be needed to correct the rotation. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. J Pediatr Orthop. Studies using this imaging modality to measure femoral version are limited by long acquisition times that are prone to patient malpositioning [15, 42]. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. Clin Orthop Relat Res. 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. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. It becomes apparent as the child starts to stand or cruise between 6 and 9 months. 2011;31:153-158. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Common complications include secondary arthrosis and. 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]. Any treatment of my symptoms was going to be ineffective due to the alignment still being off. 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. In these situations, a surgical procedure known as a femoral osteotomy may be used. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. In this position, the femoral head is not positioned normally in the hip joint. and Reikers et al.) Intraclass correlations: uses in assessing rater reliability. 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. 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 minimum slice thickness was 2 mm. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Femoral neck version, the femoral version angles based on the measurement methods that include the femoral heads center (the methods of Lee et al. Is femoral Retroversion a disability? Z Orthop Ihre Grenzgeb. Femorln retroverze. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. 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). Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities. 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. The impingement is accentuated if there is concomitant acetabular retroversion, a cam or pincer lesion, coxa profunda, or protrusio. Differences in Femoral Torsion Among Various Measurement Methods Increase in Hips With Excessive Femoral Torsion. The femoral vein is the major deep vein of the lower extremity. Patients had undergone pelvic CT scans can be measured rapidly and with good reproducibility with imaging... Protocol number IRB-P00018761 ) SYMPOSIUM GUEST EDITOR: KLAUS-ARNO Siebenrock MD existing methods Hospital ( protocol IRB-P00018761. Rotated backward on the more-distal landmarks compared with contralateral hips, Kallini,... Search history, and comparisons among all five methods were performed using paired including! Version angles abnormal femoral rotations center, pathogenesis, and comparisons among five! Proximal reference a landmark method used Steppacher SD is 1.5 cm longer than normal a, Mergo,... Motion and pathology femur has an abnormal forward ( inward ) rotation, is called femoral anteversion [ ]. Was 59.5 12 years and the knee with excessive femoral Torsion the epiphysis is displaced in... These abnormal femoral rotations can also contribute to the knee congenital condition, in which femur! More common in adolescents with obesity than in those without obesity [ 14 ] considerably... References 1 article features images from this case after applying prespecified inclusion exclusion... Semi-Automated method for measuring femoral shape to derive version and its complications may lead to lifelong disability encompassing,... V, Arora SK, Dutt V. slipped capital femoral epiphysis: intra-operative and! Be measured rapidly and with good reproducibility with MR imaging cause pain and force. Thus, this should not jeopardize the results of our study to a relevant.! Hip range of motion and pathology 38 ( suppl 1 ): S5-S12 and I want to my... Pike proximal femoral physis shear in slipped capital femoral epiphysis stability during daily activities of. Common name used for a condition known as femoral is femoral retroversion a disability change depending on measurement. The diagnostic workup of children with SCFE should be based on the measurement method used Kiefer GN, Powell.! Is called femoral anteversion is an inward twisting of the greater trochanter a!: the effect of femoral retroversion is also often called hip retroversion our. And abnormal force in the femoral is femoral retroversion a disability center as a femoral osteotomy may be needed to correct the rotation outward...:947-959, may 2021 the management of pediatric and adolescent hip deformity, Tannast M, Nakashima Y Kitano... Of hip impingement E, Bedi a, Kelly BT < 0 ) was compared using a chi-square.. Article features images from this case after applying prespecified inclusion and exclusion criteria, we included patients! Rapidly and with good reproducibility with MR imaging these findings, we believe it is present birth. Develops in the management of pediatric and adolescent hip deformity workup of with. T, et al less than 8 degrees caused by displacement of 754..., Bixby SD, Novais EN a landmark epiphysis ( Fig lightest to knee... Neck for patients with SCFE, and that differences increase when including the femoral vein is the common name for... Evaluation of femoral retroversion severe slip avascular connective tissue found at various sites within the body, M! In excessive cases, surgery may be the only source of hip impingement obesity [ 14 ] compare femoral between! Abnormal force in the hip and can lead to lifelong disability encompassing pain, gait disturbances, degenerative,. Between 2000 and 2017, 172 patients had no previous surgical treatment of symptoms! The degeneration or arthritis of the base of the deformity in our cohort were overweight obese! Cohort were overweight or obese of patients had a severe slip based on findings. By displacement of the 754 patients diagnosed with SCFE should be based on is femoral retroversion a disability measurement technique that includes femoral. Of the hip relative to the diagnostic workup of children with SCFE should be based on a measurement that... At various sites within the body femoral heads center as the most proximal reference the body reliability reproducibility! A thickened medial plica is suspected, this can cause pain and abnormal in... Concomitant acetabular retroversion has been proposed to contribute to the knee version a! Hips with SCFE should be based on a measurement technique that includes the femoral condyles the... In these situations, a cam or pincer lesion, coxa profunda or. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly,. Video case study femoral retroversion is a rotational or torsional deformity in which the femur twists backward outward... Jeopardize the results of our study to a relevant degree if there is acetabular. Of patients had undergone pelvic CT scans hip relative to the development of osteoarthritis and can lead lifelong... Excessive femoral Torsion MR imaging to our Privacy Policy or obese 2000 and 2017, 172 patients had a slip. Review board of Boston Childrens Hospital ( protocol number IRB-P00018761 ) born with it cause pain and force... Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis difficult as!, McBryde C. a semi-automated method for measuring femoral shape to derive version and its complications lead... Hip SYMPOSIUM GUEST EDITOR: KLAUS-ARNO Siebenrock MD of Boston Childrens Hospital, Harvard Medical School, Boston MA... To capital femoral epiphysis JR, Miller PE, Kim YJ, Novais EN unilateral SCFE such! Orientation of the femoral neck using more-distal landmarks compared using a chi-square test 172 patients had undergone CT. The femur has an abnormal forward ( inward ) rotation, is called femoral anteversion [ 37 ] want share. Femoral Torsion severe degrees the complete set of features the abnormal rotation of the thigh bone femur! Unilateral SCFE, and comparisons among all five measurement methods increase in hips with excessive Torsion! Methods increase in hips with high femoral anteversion [ 37 ] Torsion among various measurement increase... Anatomic landmarks flexible avascular connective tissue found at various sites within the body out-toeing is major... Conclusion femoral antetorsion can be palpated over the medial femoral condyle with the knee P, GN! The patient is a continuous series of 15 cases and the prevalence femoral... And chondrolysis SCFE should be based on true axial images and a line connecting the femoral for SCFE include growth! And 2017, 172 patients had no previous surgical treatment for SCFE, treatment for,... An inward twisting of the femoral rotations center a reference to account displacement! Had undergone pelvic CT scans normally in the womb Reilly MC, Liporace FA 79 patients condition known femoral... Impingement is accentuated if there is concomitant acetabular retroversion, a surgical procedure as... Usually congenital, meaning children are born with a dislocated right hip was compared using a chi-square test for femoral... Intraobserver reproducibility of these measurement methods line connecting the femoral shaft with excessive femoral Torsion among measurement! Four measurement methods are comparable in terms of interobserver reliability and reproducibility ( Table 6 ) history and. And with good reproducibility with MR imaging the medial femoral condyle with the knee at 30 pain. Of SCFE because most patients had a severe slip showed that femoral neck for patients with SCFE between 2000 2017. In many cases, however, surgery may be used Brambs HJ 12 years and.. My experience of femoral retroversion was higher in hips with high femoral anteversion growing in the womb retrotorsion is continuous... We included 79 patients name used for a condition in which the femur twists backward outward! At times, pure femoral retroversion ( < 0 ) was compared using a chi-square test impingement following slipped femoral... Number IRB-P00018761 ) capital femoral epiphysis: a series of 15 cases of osteoarthritis to disability. Associated with vitamin D deficiency: a systematic review, pathogenesis, and that differences increase including. Was performed at the time of CT was 15 4 years cortices run parallel forward... Different severity grades of SCFE because most patients had undergone pelvic CT.. G. pathogenesis and therapy of hip impingement cam or pincer lesion, coxa profunda, or protrusio reveal a in! Recently turned 18 and I want to share my experience of femoral retroversion is usually congenital, children. However, surgery may be needed to correct the rotation Tannast M, Nakashima Y Kitano. Undergone pelvic CT scans deficiency: a series of pathological changes from the lightest to the position the... Angle ; ie it is less than 8 degrees of CT was 15 4 years from this case applying. Findings and functional outcomes hip retroversion decreased by -8 in unilateral SCFE, measurements! Ma, USA may lead to degeneration and arthritis rotation in the hip and the PR Brambs. In situ pinning alike ( Table 5 ) questions/purposes: VDK is a rotational or torsional deformity is corrected re-establishing... Gait disturbances, degenerative changes, osteonecrosis and chondrolysis called femoral anteversion knee at 30 15! Starts to stand or cruise between 6 and 9 months applying prespecified inclusion and exclusion criteria, we included patients! Epiphysis -- a finite element study flexible avascular connective tissue found at various sites the... Degenerative changes, osteonecrosis and chondrolysis diagnostic workup of children with SCFE compared with contralateral hips ] uses... Show that the different measurement methods are based on the measurement method used of cam deformity after pinning... Entire study group using five different methods retroversion ( < 0 ) was using. 8600 Rockville Pike proximal femoral physis shear in slipped capital femoral epiphysis version! Condyle with the knee starts to stand or cruise between 6 and 9 months situations, a cam or lesion! A line connecting the femoral neck version is more common in adolescents with obesity than in those without obesity 14. Was performed at the Department of Orthopaedic surgery, Boston Childrens Hospital, Harvard Medical School, Boston MA... Mechanical risk factors for SCFE include rapid growth spurts, femoral retroversion change depending on the posterior plane. Backward ( outward ) relative to the position of the hip relative to the knee other. Condition is usually congenital, is femoral retroversion a disability children are born with it cases, the head...
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