Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
Department of Radiology, Sonnenhof Clinic, Bern, Switzerland.
Am J Sports Med. 2018 Jan;46(1):122-134. doi: 10.1177/0363546517726983. Epub 2017 Sep 22.
Variations in femoral and acetabular version are becoming increasingly recognized as contributing factors to the development of hip pain in patients with femoroacetabular impingement (FAI) and hip dysplasia. It is still unknown what the true prevalence of these rotational abnormalities is in this patient population.
To determine (1) the prevalence of femoral version abnormalities in symptomatic hips with FAI and hip dysplasia, (2) the prevalence of combined abnormalities of femoral and acetabular version in these patients, and (3) which specific hip morphologies are associated with abnormalities of femoral version.
Cross-sectional study; Level of evidence, 3.
A total of 462 symptomatic patients (538 hips) were included who had hip pain attributed to FAI or hip dysplasia and who presented to our tertiary referral center for hip preservation surgery between 2011 and 2015. We retrospectively examined femoral and acetabular version among 11 subgroups with predefined hip morphologies and compared findings with a control group. The allocation to each subgroup was based on morphologic reference values for femoral head coverage, lateral center edge angle, alpha angle, and neck-shaft angle calculated on plain radiographs.
Of the 538 hips included, 52% were found to have abnormal femoral version; severe abnormalities were found in 17%. Severely decreased femoral version (<0°) was found in 5%; moderately decreased femoral version (0°-10°), in 17%; moderately increased femoral version (26°-35°), in 18%; and severely increased femoral version (>35°), in 12%. The most frequent abnormal combination was increased femoral version combined with normal acetabular version (22%). We found significantly lower mean femoral version for the cam-type FAI group (15°) and significantly higher mean femoral version for the Perthes hips (32°; ie, Legg-Calvé-Perthes disease) as compared with the control group (22°). The mean femoral version of the study group was 19°; for male patients, 15°; and for female patients, 22°.
Abnormalities in femoral version are highly prevalent in patients with hip pain who are eligible for hip preservation surgery, and severe abnormalities are prevalent in 1 of 6 patients (17%). Based on these results, the evaluation of young patients with hip pain should always include an assessment of femoral version and acetabular version to best decide what treatment approach should be undertaken to optimize outcomes.
股骨和髋臼的旋转变化越来越被认为是引起股骨髋臼撞击症（FAI）和髋关节发育不良患者髋关节疼痛的因素。目前尚不清楚在这一患者群体中，这些旋转异常的真实患病率是多少。
确定（1）有 FAI 和髋关节发育不良症状的髋关节中股骨版本异常的发生率，（2）这些患者中股骨和髋臼版本联合异常的发生率，以及（3）哪些特定的髋关节形态与股骨版本异常相关。
横断面研究；证据水平，3 级。
共有 462 名有髋关节疼痛症状的患者（538 髋）纳入本研究，这些患者的髋关节疼痛归因于 FAI 或髋关节发育不良，并于 2011 年至 2015 年期间在我们的三级转诊中心接受髋关节保留手术。我们回顾性地检查了 11 个预定义髋关节形态亚组的股骨和髋臼版本，并将结果与对照组进行比较。每个亚组的分配是基于在骨盆正位片上计算的股骨头覆盖、外侧中心边缘角、α角和颈干角的形态参考值。
在纳入的 538 髋中，52%的髋关节存在股骨版本异常；严重异常占 17%。严重股骨版本降低（<0°）占 5%；中度股骨版本降低（0°-10°）占 17%；中度股骨版本增加（26°-35°）占 18%；严重股骨版本增加（>35°）占 12%。最常见的异常组合是股骨版本增加伴髋臼版本正常（22%）。与对照组（22°）相比，凸轮型 FAI 组的平均股骨版本明显较低（15°），而 Perthes 髋关节的平均股骨版本明显较高（32°；即，Legg-Calvé-Perthes 病）。研究组的平均股骨版本为 19°；男性患者为 15°；女性患者为 22°。
在有髋关节疼痛症状且适合髋关节保留手术的患者中，股骨版本异常非常常见，1/6 的患者（17%）存在严重异常。基于这些结果，对于有髋关节疼痛的年轻患者，评估时应始终包括股骨版本和髋臼版本的评估，以最佳决定应采取何种治疗方法来优化治疗效果。
