Femoral Version Abnormalities Significantly Outweigh Effect of Cam Impingement on Hip Internal Rotation.

Published on Feb 7, 2018in Journal of Bone and Joint Surgery, American Volume5.284
· DOI :10.2106/JBJS.17.00376
Matthew J. Kraeutler30
Estimated H-index: 30
,
Vivek Chadayammuri15
Estimated H-index: 15
(UConn: University of Connecticut)
+ 1 AuthorsOmer Mei-Dan26
Estimated H-index: 26
(University of Colorado Denver)
Sources
Abstract
BACKGROUND: The purpose of this study was to investigate the effects of femoral version, cam-type femoroacetabular impingement (FAI), and the combination of the 2 on the passive hip range of motion (ROM). METHODS: We prospectively analyzed a consecutive cohort of 220 patients (440 hips) who presented with unilateral or bilateral hip pain. The passive hip ROM was measured bilaterally with the patient in prone, supine, and lateral positions. Femoral version was measured and the presence of cam-type deformity was determined on preoperative computed tomography (CT) scans. Diagnostic findings of cam-type FAI included an alpha angle of >50° on CT radial sequences of the head-neck junction and a femoral head-neck offset ratio of <0.18 on both radiographs and CT. RESULTS: Multivariate linear regression analysis confirmed that femoral version, as compared with the presence of a cam lesion, was a stronger independent predictor of internal rotation ROM. Conversely, the presence of a cam lesion resulted in a significant decrease in the passive hip flexion ROM (p < 0.001) with no additional effects due to the degree of femoral version. The passive hip internal rotation ROM in neutral flexion/extension and with the hip in 90° of flexion were maximized in patients with femoral anteversion and decreased significantly with each incremental decrease in femoral version (p < 0.001). CONCLUSIONS: Abnormalities in femoral version significantly outweigh the effect of cam-type impingement on the passive hip internal rotation ROM. In contrast, the presence of a cam lesion significantly decreases the hip flexion ROM, irrespective of the degree of femoral version. These findings help to inform surgical decision-making for patients with cam-type FAI or femoral version abnormalities. CLINICAL RELEVANCE: It is common clinical practice to ascribe loss of hip internal rotation to the presence of a cam lesion and to assume that arthroscopic femoral osteoplasty will substantially improve internal rotation postoperatively. Our study shows that the cam lesion is more intimately tied to hip flexion than to hip internal rotation. This result directly impacts the clinical assessment of a patient presenting with radiographic findings of FAI.
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#1Steven F. DeFroda (Rush University Medical Center)H-Index: 2
#2Thomas D. Alter (Rush University Medical Center)H-Index: 4
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Background:The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied.Purpose:To...
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The goal of this study is to report the short-term outcomes of concomitant hip arthroscopy and femoral derotational osteotomy (FRO) to treat femoral malrotation and intra-articular pathology. Data were retrospectively reviewed for patients undergoing concomitant hip arthroscopy and FRO between March 2013 and January 2017. Patients were included if they had a minimum of 1 year of follow-up for modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subsc...
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#1Emily A. Parker (UIHC: University of Iowa Hospitals and Clinics)
#2Alex M. Meyer (UIHC: University of Iowa Hospitals and Clinics)
Last. Robert W. Westermann (UIHC: University of Iowa Hospitals and Clinics)H-Index: 27
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Purpose null To perform a systematic review and meta-analysis of literature and to evaluate the relationship between abnormal femoral version and the development of hip osteoarthritis (OA). null null null Methods null A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluating Level I and II studies. Included studies had to provide granular femoral version (FV) information. The severity of OA was ranked on the Kel...
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#1Nicholas J. Murphy (Kolling Institute of Medical Research)H-Index: 3
#2Laura E. Diamond (Griffith University)H-Index: 14
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#2Abioye Oshodi (Roy J. and Lucille A. Carver College of Medicine)
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Abstract null null Background null To evaluate the relationship between femoral version (FV) and alpha angle (AA) in a large osteological collection of human femora. null null null Methods null The University of Iowa-Stanford osteological collection was used to evaluate the research aims. To measure FV and AA, axial photographs of the proximal femora were taken referenced from the posterior condylar axis. FV and AA measurements were obtained using ImageJ software (National Institutes of Health, ...
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This study evaluated the accuracy of synthetic computed tomography (sCT), as compared to CT, for the 3D assessment of the hip morphology. Thirty male patients with asymptomatic hips, referred for magnetic resonance imaging (MRI) and CT, were included in this retrospective study. Synthetic CT images were generated from 3D radiofrequency-spoiled T1-weighted multi-echo gradient-echo MR images using a commercially available deep learning-enabled software and were compared with CT images through mean...
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#1Kyle N. Kunze (Rush University Medical Center)H-Index: 15
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#1Andrew L. Schaver (UI: University of Iowa)
#2Kushtrim Grezda (UI: University of Iowa)
Last. Robert W. Westermann (UI: University of Iowa)H-Index: 27
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#1Zhencun CaiH-Index: 1
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BACKGROUND Accurate femoral neck anteversion angle (FNA) measurement is of great significance in the diagnosis and treatment of developmental dysplasia of the hip (DDH) in children. The FNA measurement still remains a controversy. We aimed to verify the accuracy of our CT method by 3D printing technology and to evaluate its clinical value. METHODS Sixty-eight children with unilateral DDH were enrolled, and their FNA was measured using 2D-CT and 3D-CT, respectively, by three observers. This proce...
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Femoral version is extremely variable between patients presenting with femoroacetabular impingement (FAI). Careful and routine measurement of femoral anteversion is essential in comprehensive preoperative planning. In general, low degrees of femoral version can lead to anterior impingement (especially on the subspine and distal medial femoral neck). High degrees of anteversion can be seen in the setting of acetabular dysplasia and can lead to anterior hip instability and or posterior impingement...
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