Till D Lerch1, Florian Schmaranzer2,3, Markus S Hanke2, Christiane Leibold2, Simon D Steppacher2, Klaus A Siebenrock2, Moritz Tannast2,4. 1. Universitätsklinik für orthopädische Chirurgie und Traumatologie, Inselspital, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz. till.lerch@insel.ch. 2. Universitätsklinik für orthopädische Chirurgie und Traumatologie, Inselspital, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz. 3. Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universität Bern, Bern, Schweiz. 4. Klinik für Orthopädische Chirurgie und Traumatologie, HFR Freiburg - Kantonsspital, Universität Freiburg, Chemin des Pensionnats 2-6, 1708, Freiburg, Schweiz.
Abstract
BACKGROUND: Torsional deformities of the femur include femoral retrotorsion and increased femoral torsion, which are possible causes for hip pain and osteoarthritis. For patients with femoroacetabular impingement (FAI), torsional deformities of the femur represent an additional cause of FAI in addition to cam and pincer-type FAI. OBJECTIVES: The aim of this article is to provide an overview of measurement techniques and normal values of femoral torsion. The clinical presentation, possible combinations and surgical therapy of patients with torsional deformities of the femur will be discussed. METHODS: For measurement of femoral torsion, CT or MRI represent the method of choice. The various definitions should be taken into account, because they can lead to differing values and misdiagnosis. This is the case especially for patients with high femoral torsion. Dynamic 3D impingement simulation using 3D-CT can help to differentiate between intra und extra-articular FAI. RESULTS AND DISCUSSION: Femoral retrotorsion (< 5°) can lead to anterior intra- and extraarticular (subspine) FAI, between the anterior iliac inferior spine (AIIS) and the proximal femur. Increased femoral torsion (> 35°) can lead to posterior intra- and extra-articular ischiofemoral FAI, between the lesser/greater trochanter and the ischial tuberosity. During clinical examination, a patient with femoral retrotorsion exhibits loss of internal rotation and a positive anterior impingement test. Hips with increased femoral torsion show high internal rotation if examined in prone position and have a positive FABER and posterior impingement test. During surgical therapy for patients with torsional deformities, intra and extra-articular causes for FAI in addition to cam and pincer-deformities should be considered. In addition to hip arthroscopy and surgical hip dislocation, also femoral rotational or derotational osteotomies should be evaluated during surgical planning of these patients.
BACKGROUND: Torsional deformities of the femur include femoral retrotorsion and increased femoral torsion, which are possible causes for hip pain and osteoarthritis. For patients with femoroacetabular impingement (FAI), torsional deformities of the femur represent an additional cause of FAI in addition to cam and pincer-type FAI. OBJECTIVES: The aim of this article is to provide an overview of measurement techniques and normal values of femoral torsion. The clinical presentation, possible combinations and surgical therapy of patients with torsional deformities of the femur will be discussed. METHODS: For measurement of femoral torsion, CT or MRI represent the method of choice. The various definitions should be taken into account, because they can lead to differing values and misdiagnosis. This is the case especially for patients with high femoral torsion. Dynamic 3D impingement simulation using 3D-CT can help to differentiate between intra und extra-articular FAI. RESULTS AND DISCUSSION: Femoral retrotorsion (< 5°) can lead to anterior intra- and extraarticular (subspine) FAI, between the anterior iliac inferior spine (AIIS) and the proximal femur. Increased femoral torsion (> 35°) can lead to posterior intra- and extra-articular ischiofemoral FAI, between the lesser/greater trochanter and the ischial tuberosity. During clinical examination, a patient with femoral retrotorsion exhibits loss of internal rotation and a positive anterior impingement test. Hips with increased femoral torsion show high internal rotation if examined in prone position and have a positive FABER and posterior impingement test. During surgical therapy for patients with torsional deformities, intra and extra-articular causes for FAI in addition to cam and pincer-deformities should be considered. In addition to hip arthroscopy and surgical hip dislocation, also femoral rotational or derotational osteotomies should be evaluated during surgical planning of these patients.
Entities:
Keywords:
Femoral torsion; Hip joint; Imaging, three-dimensional; Osteoarthritis; Reference values
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