[Torsional deformities of the femur in patients with femoroacetabular impingement : Dynamic 3D impingement simulation can be helpful for the planning of surgical hip dislocation and hip arthroscopy].

Lerch, Till D.; Schmaranzer, Florian; Hanke, Markus S.; Leibold, Christiane; Steppacher, Simon D.; Siebenrock, Klaus A.; Tannast, Moritz (2020). [Torsional deformities of the femur in patients with femoroacetabular impingement : Dynamic 3D impingement simulation can be helpful for the planning of surgical hip dislocation and hip arthroscopy]. Der Orthopäde, 49(6), pp. 471-481. Springer 10.1007/s00132-019-03847-x

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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.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Lerch, Till; Schmaranzer, Florian; Hanke, Markus; Leibold, Christiane Sylvia; Steppacher, Simon Damian; Siebenrock, Klaus-Arno and Tannast, Moritz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1433-0431

Publisher:

Springer

Language:

German

Submitter:

Kathrin Aeschlimann

Date Deposited:

28 Jan 2020 09:16

Last Modified:

09 Jun 2020 12:03

Publisher DOI:

10.1007/s00132-019-03847-x

PubMed ID:

31853580

Uncontrolled Keywords:

Femoral torsion Hip joint Imaging, three-dimensional Osteoarthritis Reference values

BORIS DOI:

10.7892/boris.138140

URI:

https://boris.unibe.ch/id/eprint/138140

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