Femoral version: Comparison among advanced imaging methods

Fuller, Corey B.; Farnsworth, Christine L.; Bomar, James D.; Jeffords, Megan E.; Murphy, Joshua; Edmonds, Eric W.; Pennock, Andrew T.; Wenger, Dennis R.; Upasani, Vidyadhar V.

doi:10.1002/jor.23785

Cited by 32 publications

(27 citation statements)

References 14 publications

(27 reference statements)

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“…115,125 Biplanar radiographs with 3D modeling are being increasingly used for torsional assessment and constitute a low-dose alternative to CT with comparable results. 124 The 3D-based measurements were reported to be reproducible and independent of femur positioning, overcoming major reproducibility issues encountered with 2D methods. 126 Various measurement methods are reported in the literature for assessing this angle.…”

Section: Femoral Torsionmentioning

confidence: 99%

“…115,121 Initially, femoral torsion was measured on radiographs, 31 but CT and MRI are currently the preferred modalities to determine this parameter. 124 Although a globally accepted measurement method remains to be ascertained, adequate anatomical measurements of femoral torsion can be performed on CT and MRI systematically using strict axial slices. 115,125 Biplanar radiographs with 3D modeling are being increasingly used for torsional assessment and constitute a low-dose alternative to CT with comparable results.…”

Section: Femoral Torsionmentioning

confidence: 99%

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Imaging Methodology for Hip Preservation: Techniques, Parameters, and Thresholds

Mascarenhas

Ayeni

Egund

et al. 2019

Semin Musculoskelet Radiol

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The concept of hip impingement and hip-preserving surgery has been appreciated in more detail since 2001 when a new surgical approach was reported and a hypothesis linking femoroacetabular impingement (FAI) with osteoarthritis was presented. Paralleling the introduction of hip arthroscopy, these events led to an increasing interest in the hip, and the number of publications has risen rapidly over the past 15 years, despite limited evidence levels and inconsistent methodology. Accordingly, etiology, diagnosis, prognosis, and the effects of treatment for FAI are still elusive due to a number of uncertainties and a lack of clear diagnostic criteria.Future research must focus on developing high-quality scientific studies, so thorough and reproducible methodology is needed. This review provides researchers, radiologists, and clinicians with a comprehensive approach to hip imaging with a focus on strategies to help guide the clinical diagnosis. Using evidence from current literature and knowledge from experienced clinicians, some of the imaging methodology challenges are deciphered.

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Section: Femoral Torsionmentioning

confidence: 99%

Section: Femoral Torsionmentioning

confidence: 99%

Imaging Methodology for Hip Preservation: Techniques, Parameters, and Thresholds

Mascarenhas

Ayeni

Egund

et al. 2019

Semin Musculoskelet Radiol

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show abstract

“…The magnetic resonance imagingebased version measurements used by Lall et al are acceptable, but the gold standard for measuring version is based on a 3dimensional computed tomography model. 9 Besides, these excellent outcomes from experienced surgeons at a dedicated hip arthroscopy center may not be generalizable to community practice. Despite these shortcomings, this study does prove that patients with femoral retroversion can benefit from comprehensive hip arthroscopic treatment.…”

Section: See Related Article On Page 3035mentioning

confidence: 99%

Editorial Commentary: Myth Buster—Is Femoral Retroversion a Contraindication to Hip Arthroscopy in Femoroacetabular Impingement?

Kalore¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hip arthroscopy can effectively address cam and pincer impingement by reshaping bone prominences or bone edges. However, hip arthroscopy cannot be used to correct severe bone torsion abnormalities such as acetabular or femoral retroversion. As a result, some surgeons contraindicate hip arthroscopy in patients with femoral retroversion absent correction of the torsion abnormalities. However, recent research has suggested that hip arthroscopy absent osteotomy, with a focus on labral preservation and thorough correction of underlying cam and pincer bony abnormalities, achieves positive outcomes. Still, although femoral retroversion should not be considered a contraindication for hip arthroscopy, patients should be carefully counseled about residual symptoms.

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“…All 3D models were imported into custom MATLAB (Mathworks, Natick, MA, USA) software for femoral torsion and pin angle calculations. Femoral torsion was automatically calculated using a custom a MATLAB program, thus eliminating human measurement error [13]. Femur models were reoriented based on the mechanical axis (MA) and the anatomical axis (AA).…”

Section: Femoral Torsion Measurement Techniquementioning

confidence: 99%

Femoral derotational osteotomy level does not effect resulting torsion

et al. 2020

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Purpose: The purpose of this study was to assess the effect on femoral torsion by rotational osteotomies at three different levels as measured in 3D using both the mechanical and the anatomic axes. Methods: Ten cadaveric lower extremities underwent femoral osteotomies perpendicular to the anatomic axis (AA) at three levels: subtrochanteric, mid-diaphyseal and supracondylar. Parallel pins were placed, one in each femur segment. Computed tomography (CT) was acquired in post-osteotomies neutral position, then post-external rotation of the femur at each osteotomy level. Femurs were returned to neutral rotation between imaging exams. Using 3D CT reconstructions, custom software calculated femoral torsion (angle between the femoral neck axis and the posterior condylar axis in the transverse plane) and pin angle between segments, reoriented to both the mechanical axis (MA) and the AA. Pin angle and torsion change were compared for the three osteotomy locations (regression analysis and ANOVA performed). Results: Two specimens were omitted (inadequate imaging); the remaining eight donors were 55-90 years old (mean: 64 ± 15 years), CT confirmed no bony defects. All three levels of osteotomy demonstrated significant correlations between the amount of rotation at the osteotomy (pin angle change) and the resulting change in femoral torsion (R square range 0.658-0.847). No significant differences were found between osteotomy level in torsion (MA:p = 0.285, AA:p = 0.156) or in pin angle (MA:p = 0.756, AA:p = 0.753). Conclusions: Performing a corrective rotational osteotomy orthogonal to the AA achieves the desired effect on MA regardless of location. This suggests that a surgeon's osteotomy level choice may be based on other risks/benefits of the various techniques.

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Femoral version: Comparison among advanced imaging methods

Cited by 32 publications

References 14 publications

Imaging Methodology for Hip Preservation: Techniques, Parameters, and Thresholds

Imaging Methodology for Hip Preservation: Techniques, Parameters, and Thresholds

Editorial Commentary: Myth Buster—Is Femoral Retroversion a Contraindication to Hip Arthroscopy in Femoroacetabular Impingement?

Femoral derotational osteotomy level does not effect resulting torsion

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