Femoral Version May Impact Hip Arthroscopy Outcomes in Select Patient Populations: A Systematic Review

Sinkler, Margaret A.; Magister, Steven; Su, Charles A.; Salata, Michael J.

doi:10.1016/j.arthro.2022.06.026

Cited by 13 publications

(5 citation statements)

References 56 publications

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“…Wang et al 55 published a systematic review of 5 studies evaluating the role of femoral torsion, similarly finding that torsion did not affect outcomes. In a more inclusive systematic review 1 year later, Sinkler et al 50 also concluded that femoral torsion likely had no effect on outcomes and found mixed results regarding the reoperation rate.…”

Section: Discussionmentioning

confidence: 99%

“…Different methods have been found to produce differing amounts of torsion. 50,55 Even the terms utilized are inconsistent —femoral torsion has been described as measuring the entirety of the femur, whereas femoral version refers only to the proximal segment—but not all studies use these definitions. 29 Despite challenges with standardization, the preponderance of evidence in the literature and the results of the present midterm study suggest that femoral torsion, in isolation, does not affect outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…18,41,45 Femoral torsion is a morphologic parameter that has been posited to confer an influence on postoperative outcomes. 29,31,50,55 In the context of hip biomechanics, femoral antetorsion results in an in-toeing gate, requiring a compensatory external rotation of the hip to achieve a neutral foot orientation, with the contrary applying to femoral retrotorsion (ie, out-toeing gate; obligate internal rotation). 7,27 While hip biomechanical abnormalities in patients with FAIS are often attributed to cam morphology, femoral torsion may be a stronger predictor of hip internal rotation range of motion.…”

mentioning

confidence: 99%

“…29,31 Two recent systematic reviews highlight the variability in the literature and the infrequency with which femoral torsion is reported. 50,55 The lack of consensus in the literature may be explained, in part, by the variability with which femoral torsion is quantified, with measurements performed on computed tomography (CT) and magnetic resonance imaging (MRI), with use of true axial and oblique axial sequences, 2 and with wide variation in measurement methodology. 25 The purpose of this study was to quantify femoral torsion using CT imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy.…”

mentioning

confidence: 99%

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Effect of Differing Orientation and Magnitude of Femoral Torsion on Outcomes and Achievement of the MCID and PASS at 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

et al. 2023

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Background: Femoral torsion measurements and outcomes are variable throughout the literature and have focused on short-term follow-up. However, there is a paucity of literature investigating clinically meaningful outcomes at midterm follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To quantify femoral version using computed tomography imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and November 2017 were identified. Patients were included if they had 5-year follow-up with completion of ≥1 patient-reported outcome (PRO) scores and excluded if they had Tönnis grade >1, revision hip surgery, a concomitant hip procedure, a developmental disorder, or a lateral center-edge angle <20°. Torsion groups were defined as severe retrotorsion (<0°), moderate retrotorsion (0.1°-5°), normal torsion (5.1°-20°), moderate antetorsion (20.1°-25°), and severe antetorsion (>25.1°) based on computed tomography measurements. Patient characteristics were analyzed among the torsion cohorts, as were preoperative and 5-year PROs: Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool, visual analog scale for pain, and visual analog scale for satisfaction. Achievement rates of cohort-specific thresholds for the minimal clinically important difference and Patient Acceptable Symptom State were calculated and compared among cohorts. Results: A total of 362 patients (244 female, 118 male; mean ± SD age, 33.1 ± 11.5 years; body mass index, 26.9 ± 17.8) met inclusion/exclusion criteria and were analyzed at a final mean follow-up of 64.3 ± 9.4 months (range, 53.5-115.5 months). Mean femoral torsion was 12.8°± 9.2°. The number of patients within each group was 20 for severe retrotorsion (torsion, −6.3°± 4.9°), 45 for moderate retrotorsion (2.7°± 1.3°), 219 for normal torsion (12.2°± 4.1°), 39 for moderate antetorsion (21.9°± 1.3°), and 39 for severe antetorsion (29.0°± 4.2°). No significant differences in age, body mass index, sex, smoking status, workers’ compensation, psychiatric history, back pain, or physical activity were found among the torsional groups. All groups demonstrated significant improvements at 5 years postoperatively ( P < .01 for all). All torsion subgroups demonstrated similar pre- to postoperative changes in PROs ( P≥ .515) and PRO values at 5-year follow-up ( P≥ .098). There were no significant differences in the achievement of the minimal clinically important difference ( P≥ .422) or Patient Acceptable Symptom State ( P≥ .161) for any of the PROs among the torsion groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study’s cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Effect of Differing Orientation and Magnitude of Femoral Torsion on Outcomes and Achievement of the MCID and PASS at 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

et al. 2023

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“…Although a recent meta-analysis found that subsequent procedures after hip arthroscopy were more frequent in patients with femoral retroversion or excessive femoral anteversion with borderline dysplasia [8], we need studies that consider the femoral version and morphological features when assessing the symptomatic state and thresholds for acetabular indices in addition to spinopelvic parameters.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

CORR Insights®: Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study

Tarwala

2023

Clin Orthop Relat Res

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Computed tomography‐based automated 3D measurement of femoral version: Validation against standard 2D measurements in symptomatic patients

Schmaranzer,

Movahhedi,

Singh

et al. 2024

Journal Orthopaedic Research

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To validate 3D methods for femoral version measurement, we asked: (1) Can a fully automated segmentation of the entire femur and 3D measurement of femoral version using a neck based method and a head‐shaft based method be performed? (2) How do automatic 3D‐based computed tomography (CT) measurements of femoral version compare to the most commonly used 2D‐based measurements utilizing four different landmarks? Retrospective study (May 2017 to June 2018) evaluating 45 symptomatic patients (57 hips, mean age 18.7 ± 5.1 years) undergoing pelvic and femoral CT. Femoral version was assessed using four previously described methods (Lee, Reikeras, Tomczak, and Murphy). Fully‐automated segmentation yielded 3D femur models used to measure femoral version via femoral neck‐ and head‐shaft approaches. Mean femoral version with 95% confidence intervals, and intraclass correlation coefficients were calculated, and Bland‐Altman analysis was performed. Automatic 3D segmentation was highly accurate, with mean dice coefficients of 0.98 ± 0.03 and 0.97 ± 0.02 for femur/pelvis, respectively. Mean difference between 3D head‐shaft‐ (27.4 ± 16.6°) and 3D neck methods (12.9 ± 13.7°) was 14.5 ± 10.7° (p < 0.001). The 3D neck method was closer to the proximal Lee (−2.4 ± 5.9°, −4.4 to 0.5°, p = 0.009) and Reikeras (2 ± 5.6°, 95% CI: 0.2 to 3.8°, p = 0.03) methods. The 3D head‐shaft method was closer to the distal Tomczak (−1.3 ± 7.5°, 95% CI: −3.8 to 1.1°, p = 0.57) and Murphy (1.5 ± 5.4°, −0.3 to 3.3°, p = 0.12) methods. Automatic 3D neck‐based‐/head‐shaft methods yielded femoral version angles comparable to the proximal/distal 2D‐based methods, when applying fully‐automated segmentations.

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Femoral Version May Impact Hip Arthroscopy Outcomes in Select Patient Populations: A Systematic Review

Cited by 13 publications

References 56 publications

Effect of Differing Orientation and Magnitude of Femoral Torsion on Outcomes and Achievement of the MCID and PASS at 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Effect of Differing Orientation and Magnitude of Femoral Torsion on Outcomes and Achievement of the MCID and PASS at 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

CORR Insights®: Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study

Computed tomography‐based automated 3D measurement of femoral version: Validation against standard 2D measurements in symptomatic patients

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