Femoral Deformities: Varus, Valgus, Retroversion, and Anteversion

Buly, Robert L.

doi:10.1007/978-1-4614-6965-0_52

Cited by 1 publication

(3 citation statements)

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“…However, these studies did not report outcomes separately in severe levels of retroversion, where isolated arthroscopic treatment is ineffective 34,35 . Overall, most studies suggest that hip arthroscopy is generally effective in retroverted femora, with the caveat that patients with more extreme isolated femoral retroversion (>10°) may benefit from a concomitant femoral derotational procedure 18,36 .…”

Section: Discussionmentioning

confidence: 99%

“…Another study investigated high femoral anteversion in patients who underwent arthroscopic psoas lengthening 22 . It is thought that the psoas muscle-tendon unit stabilizes the hip due to its anteromedial position 25,36 . This biomechanical advantage is lost after psoas lengthening and predisposes the joint to instability.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our review does not provide information regarding an amount of rotation to use as a cutoff to facilitate decision-making between rotational osteotomy (femoral or periacetabular) and hip arthroscopy in the setting of torsional deformity. Some authors have elucidated the concept of combined femoral and acetabular anteversion (McKibbin Index) in an effort to guide the choice between hip arthroscopy and rotational osteotomies, with a sum of 15° to 60° being amenable to isolated arthroscopy and values outside this range being favorable for femoral or periacetabular osteotomies 10,36,44,45 . Despite data limitations, we believe that this systematic review summarizes the best existing knowledge on the effect of rotational abnormalities in hip arthroscopy outcomes, helping to identify gaps in our current understanding and generating new hypotheses for research.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Femoral and Acetabular Version on Outcomes Following Hip Arthroscopy

Wang

Cohen

Kay

et al. 2021

Journal of Bone and Joint Surgery

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Background: Torsional hip deformities are common among patients undergoing hip arthroscopy. However, recent studies have suggested conflicting outcomes following arthroscopy in the setting of abnormal hip version. The purpose of this study was to systematically evaluate the literature and determine the impact of femoral and acetabular version on patient-reported outcomes following primary arthroscopic hip surgery.Methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies investigating femoral and acetabular version in primary hip arthroscopy with clinical outcomes were identified, and data were extracted in duplicate.Results: Overall, 11 studies met inclusion criteria and comprised 1,297 hips (726 femora and 571 acetabulae), with a mean patient age of 29.2 years (range, 14 to 74.7 years). In patients with acetabular retroversion, there was no significant difference, when compared with the normal acetabular version group, in the modified Harris hip score (mHHS), the Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) pain scores postoperatively. Among patients with femoral retroversion, in 2 of 3 studies, the authors reported no difference in mHHS postoperatively compared with patients with normal femoral version. In patients with high femoral anteversion, in 2 of 3 studies, the authors reported a significant difference in postoperative mHHS favoring patients with normal femoral version. Studies examining high femoral anteversion included patients with borderline hip dysplasia and patients who underwent concurrent psoas-lengthening procedures.Conclusions: Although the definition of the normal version of the hip varied within the literature, hip arthroscopy in patients with acetabular retroversion resulted in no difference in functional outcomes compared with patients with normal version. Postoperative functional outcomes in patients with femoral retroversion and high femoral anteversion were mixed, although the procedure was possibly less effective in high femoral anteversion combined with specific clinical scenarios. Further prospective studies based on standardized definitions and version analysis techniques would be useful in identifying the precise surgical indications for safe arthroscopic surgical procedures in patients with version abnormalities of the femur and acetabulum, particularly those with high femoral anteversion and retroversion.

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