Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities

Abstract

Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. Results A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (10–25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. Conclusion Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. Level of evidence IV.

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

“…The reported frequency of patients with abnormal FV in FAI ranged from 13% 49 to 24% 50 for FV < 5°, and from 15% 50 to 34% 4 for FV > 20°. In comparison to a recent systematic review reporting abnormal FV of up to 51%, 17 a lower prevalence of patients with abnormal FV (45%; Table II ) was found. The reason for this discrepancy could be a selection bias of patients evaluated in an university hospital, or different measurement methods used in other studies.…”

“…15 Another recent systematic review reported a frequency of abnormal FV of 51% in patients with symptomatic FAI. 17 In all the evaluated studies, they found a mean FV in the normal range (10° to 25°). For patients with cam-type FAI, they reported a frequency of femoral retroversion (FV < 10°) of up to 42%.…”

“…For patients with cam-type FAI, they reported a frequency of femoral retroversion (FV < 10°) of up to 42%. 17 However, different measurement methods of FV exist, 18 and different definitions of femoral retroversion add confusion. 10,11 So far, the frequency of severe or absolute femoral retroversion (FV < 0°) of patients with cam-type FAI is unclear.…”

“…For patients with cam-type FAI, they reported a frequency of femoral retroversion (FV < 10°) of up to 42%. 17 However, different measurement methods of FV exist, 18 and different definitions of femoral retroversion add confusion. 10 , 11 …”

Back to the Future with Osteotomies around the Hip

“…The fact that reduced femoral antetorsion causes an early anterior conflict upon internal rotation of the hip has raised the significance of appreciating torsional correction in cases where cam and pincer correction alone would result in an inadequate restoration of internal rotation [ 6 ]. On the other hand, high femoral antetorsion has been described as being associated with posterior impingement and, in particular, extra-articular impingement between the femur and the ischium [ 7 ].…”