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

Abstract

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.

How frequent is absolute femoral retroversion in symptomatic patients with cam- and pincer-type femoroacetabular impingement?

“…13 Variations in FV are becoming increasingly recognized as contributing factors to the development of hip pain in patients with FAI. 14 However, two recent systematic reviews investigated the influence of FV for the outcome of hip arthroscopy, 15,16 and they reported that patients with normal FV and patients with femoral retroversion (FV < 5°) exhibited similar outcome scores, and similar failure rates at short-term follow-up. 15 Another recent systematic review reported a frequency of abnormal FV of 51% in patients with symptomatic FAI.…”

A systematic approach to CT evaluation of non-arthritic hip pain

“…The impact of the femoral version on hip function and pathology has become increasingly recognized in the past decade (10,11). A recent cross-sectional study of 538 symptomatic hips suggested an incidence of severe femoral version abnormalities in 17% of patients (10) planning of a femoral rotational osteotomy, the authors concluded that these metrics can help position the greater trochanter appropriately in the axial plane, resulting in normal functional antetorsion (51).…”

“…The impact of the femoral version on hip function and pathology has become increasingly recognized in the past decade ( 10 , 11 ). A recent cross-sectional study of 538 symptomatic hips suggested an incidence of severe femoral version abnormalities in 17% of patients ( 10 ).…”

“…However, osseous morphologic features, which MRI is unable to highlight, have been recently recognized as factors that can affect the clinical outcomes of patients with hip pain. These factors include extra-articular impingement, version and torsional morphologies of the acetabulum and/or femur, and subtle coverage abnormalities of the femoral head ( 6 , 7 , 8 , 9 , 10 , 11 , 12 ). These structural variables highlight the importance of using CT imaging to thoroughly evaluate the 3D bony anatomy of the femur and pelvis, and routine utilization of CT has been endorsed by experts in the field of hip preservation ( 13 ).…”