Increased femoral anteversion-related biomechanical abnormalities: lower extremity function, falling frequencies, and fatigue

Leblebici, Gokce; Akalan, Ekin; Apti, Adnan; Kuchimov, Shavkat; Kurt, A.; Onerge, K.; Temelli, Yener; Miller, Freeman

doi:10.1016/j.gaitpost.2019.03.027

Cited by 15 publications

(10 citation statements)

References 28 publications

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“…Although increased femoral anteversion is often considered a primarily cosmetic problem, it can also be associated with orthopedic and functional problems in pediatric and adolescent patients, who may eventually require surgical intervention. Increased femoral torsion was reported to lead to functional problems, especially concerning high falling frequencies ( Leblebici et al, 2019 ; Mackay et al, 2021 ) and altered lower-limb kinematics during gait, such as in-toeing and increased hip internal rotation ( Bruderer-Hofstetter et al, 2015 ; Passmore et al, 2018 ; Alexander et al, 2019 ; Mackay et al, 2021 ). Since femoral anteversion measured by computed tomography (CT) scans correlates weakly with hip internal rotation during walking, a complete three-dimensional (3D) gait analysis was recommended when planning a surgical correction of torsional deformities ( Radler et al, 2010 ; Gaston et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients

Alexander

Brunner

Cip³

et al. 2022

Front. Bioeng. Biotechnol.

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Orthopedic complications were previously reported for patients with increased femoral anteversion. A more comprehensive analysis of the influence of increased femoral anteversion on joint loading in these patients is required to better understand the pathology and its clinical management. Therefore, the aim was to investigate lower-limb kinematics, joint moments and forces during gait in adolescent patients with increased, isolated femoral anteversion compared to typically developing controls. Secondly, relationships between the joint loads experienced by the patients and different morphological and kinematic features were investigated. Patients with increased femoral anteversion (n = 42, 12.8 ± 1.9 years, femoral anteversion: 39.6 ± 6.9°) were compared to typically developing controls (n = 9, 12.0 ± 3.0 years, femoral anteversion: 18.7 ± 4.1°). Hip and knee joint kinematics and kinetics were calculated using subject-specific musculoskeletal models. Differences between patients and controls in the investigated outcome variables (joint kinematics, moments, and forces) were evaluated through statistical parametric mapping with Hotelling T2 and t-tests (α = 0.05). Canonical correlation analyses (CCAs) and regression analyses were used to evaluate within the patients’ cohort the effect of different morphological and kinematic predictors on the outcome variables. Predicted compressive proximo-distal loads in both hip and knee joints were significantly reduced in patients compared to controls. A gait pattern characterized by increased knee flexion during terminal stance (KneeFlextSt) was significantly correlated with hip and knee forces, as well as with the resultant force exerted by the quadriceps on the patella. On the other hand, hip internal rotation and in-toeing, did not affect the loads in the joints. Based on the finding of the CCAs and linear regression analyses, patients were further divided into two subgroups based KneeFlextSt. Patients with excessive KneeFlextSt presented a significantly higher femoral anteversion than those with normal KneeFlextSt. Patients with excessive KneeFlextSt presented significantly larger quadriceps forces on the patella and a larger posteriorly-oriented shear force at the knee, compared to patients with normal KneeFlextSt, but both patients’ subgroups presented only limited differences in terms of joint loading compared to controls. This study showed that an altered femoral morphology does not necessarily lead to an increased risk of joint overloading, but instead patient-specific kinematics should be considered.

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Section: Introductionmentioning

confidence: 99%

Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients

Alexander

Brunner

Cip³

et al. 2022

Front. Bioeng. Biotechnol.

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“…19 However, significant functional morbidity for children includes tripping and progressing into adolescence with limited endurance and hip pain with increased activity. 2,20 A major physical finding in patients with torsional abnormalities when compared with typically developing children is the degree of hip rotation. 21 Preoperatively, both our groups of patients had widely different internal and external hip rotation, as compared with the control group with nearly equal and opposite deformities.…”

Section: Discussionmentioning

confidence: 99%

“…It is accepted that there is a wide range of “normal” rotational alignment in children, as most torsional deformities spontaneously self-correct over time 1. Current normal values for rotational profiles have relied on large cross-sectional studies conducted on typically developing healthy children 2,3. These normative values have been statistically defined using the ±2 SD range, and there is no consensus in the literature for the amount of rotational deformity defined as “malalignment.”3,4 However, torsional deformity with functional disability and/or pain is an established indication requiring surgical correction 5…”

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confidence: 99%

“…Idiopathic torsional deformities (ITD) can be disabling during adolescence and contribute to knee pain, patellofemoral instability, and hip impingement. 1,2 For example, IFTD may result in abnormal patellofemoral tracking and cause knee pain. 6 Meanwhile, EFTD can lead to femoroacetabular impingement (FAI) and subsequent damage to the labrum and articular cartilage.…”

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confidence: 99%

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3D Gait Analysis and Patient-reported Outcomes of Femoral Osteotomies for Torsional Deformity

Hamid

Bauer

2022

Journal of Pediatric Orthopaedics

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Background: Idiopathic torsional deformities causing pain and/or functional difficulty is an indication for a femoral derotational osteotomy (FDRO). Past studies have focused entirely on children with internal femoral torsional deformity (IFTD). This study aims to compare gait and outcomes between children with IFTD and those with external femoral torsional deformity (EFTD) after a FDRO. Methods: A retrospective review of all patients who underwent an FDRO between 1997 and 2020 at our institution. Data on typically developing (TD) children with no torsional deformity was used as a control group. We analyzed preoperative and postoperative standardized physical examination, 3-dimensional gait analysis, and Pediatric Outcomes Data Collection Instrument questionnaires. Results: There were 54 patients in total (IFTD = 37, EFTD = 17) and 20 patients in the control group. The EFTD cohort was older (IFTD = 11.7, EFTD = 14.7, P < 0.05) and had a higher body mass index both preoperatively (IFTD = 21.1 kg/m 2 , EFTD = 32.1 kg/m 2 , P < 0.05) and postoperatively (IFTD = 20.2 kg/m 2 , EFTD = 34.1 kg/m 2 , P < 0.05). Preoperatively, 3-dimensional gait analysis elicited mean hip rotation in stance was more internal for IFTD cohort (10.8 degrees) and external for the EFTD cohort (−17.8 degrees) in comparison to the TD (2.4 degrees, P < 0.001). Postoperatively, dynamic mean hip rotation during stance was −1.4 degrees for IFTD, whereas for EFTD, it was −5.4 degrees, which was different to the TD (P < 0.05). The IFTD group's Pediatric Outcomes Data Collection Instrument improved for transfer/basic mobility, sports/ physical function, global functioning, and satisfaction with symptoms (P < 0.05). The EFTD group that only reported an improvement with the satisfaction with symptoms after surgery (P < 0.05). Conclusions: Adolescents with surgically corrected IFTD show more improvement in gait and in patient-reported outcomes than those with surgically corrected EFTD. Children with EFTD persist in external rotation and have less satisfactory patientreported outcomes after a FDRO in comparison those with IFTD.

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“…These patients have statistically significant increase in fall frequency ( P =0.02), which is especially noted during running and fast walking. 23 The consequences of this are that these patients are likely more prone to injuries, especially during highly mobile sports that include running. 3D gait analysis has highlighted the notion that abnormal hip torsion may not just be a cosmetic issue as it causes alterations in all lower limb joints, thus leading to gait issues.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Lower Extremity Rotational Malalignment on Pediatric Patient-reported Outcomes Measurement and Information System (PROMIS) Scores

Chandrananth

Hannan

Bouton

et al. 2022

Journal of Pediatric Orthopaedics

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Background: There is sparse literature demonstrating the relationship between lower limb pediatric idiopathic rotational malalignment (IRM) and patient-reported outcomes measurement information system (PROMIS) scores. Our goal is to determine and quantify the amount that IRM deformities, as measured with the 3D gait analysis, affect childrens’ pain interference, mobility, and peer relationship PROMIS domains. Secondary outcomes include investigating the potential relationships between IRM and various subgroups (Pediatric Outcomes Data Collection Instrument (PODCI), gender, Body Mass Index (BMI), femur Versus tibia). We also examine whether the PROMIS domains correlate with PODCI in this population. Methods: This study was a retrospective cohort, single institution, and consecutively recruited cases series. We identified 47 children over a 3-year period who were evaluated at the motion analysis center at our tertiary care hospital, with increased torsion of the femur or tibia. After exclusions, 25 children with IRM, documented PROMIS data and gait analysis were considered. Results: Femoral malrotation had a significant relationship with female gender ( P =0.001) and increased BMI ( P <0.001). Femoral malrotation had a correlation with PROMIS pain interference ( P =0.016), whereas tibial rotation did not achieve significance ( P =0.084). In the ANOVA regression analysis, there was a strong prediction of the PROMIS mobility domain when both malrotation and pain interference were present ( P =0.007). There were Pearson Correlations of PROMIS and PODCI domains for Mobility Versus Sports ( P =0.007) and Pain Interference Versus Comfort/Pain ( P =0.004), respectively. Conclusion: The evident relationship between lower limb rotational malalignment and PROMIS scores signifies the likelihood for gait and pain disturbance. This in turn could show us that children are likely to be more debilitated and thus may benefit from timely correction. We aim to conduct this as a multicentre trial to confirm our findings. Level of Evidence: Level IV.

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Increased femoral anteversion-related biomechanical abnormalities: lower extremity function, falling frequencies, and fatigue

Cited by 15 publications

References 28 publications

Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients

Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients

3D Gait Analysis and Patient-reported Outcomes of Femoral Osteotomies for Torsional Deformity

The Effects of Lower Extremity Rotational Malalignment on Pediatric Patient-reported Outcomes Measurement and Information System (PROMIS) Scores

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