Femoral Antetorsion: Comparing Asymptomatic Volunteers and Patients with Femoroacetabular Impingement

Published Online:May 1 2012https://doi.org/10.1148/radiol.12111903

Abstract

Patients with pincer-type femoroacetabular impingement (FAI) had a significantly larger femoral antetorsion than patients with cam-type FAI, although there was a wide range of values in both volunteers and patients with FAI.

Purpose

To assess the range of femoral antetorsion with magnetic resonance (MR) imaging in asymptomatic volunteers and patients with different subtypes of femoroacetabular impingement (FAI) because abnormal femoral antetorsion might be a contributing factor in the development of FAI.

Materials and Methods

This study was institutional review board approved; all individuals provided signed informed consent. Sixty-three asymptomatic volunteers and 63 patients with symptomatic FAI between age 20 and 50 years were matched for age and sex. They underwent standard MR imaging with two additional rapid transverse sequences over the proximal and distal femur for antetorsion measurement. Twenty volunteers underwent a second MR imaging examination in the same leg. Two readers independently measured femoral antetorsion. The time for the additional sequences was tabulated. Interobserver agreement was calculated; differences in antetorsion were assessed by using analysis of variance and the unpaired t test.

Results

Femoral antetorsion can be assessed with MR imaging in about 80 seconds, with high interobserver agreement (intraclass correlation coefficient [ICC] = 0.967) and high agreement between different MR examinations (ICC = 0.966). Women had a significantly larger antetorsion than men (P < .001 for both readers), and antetorsion of the left femur was significantly larger than that of the right femur (P = .01 for reader 1, P = .02 for reader 2). Overall, antetorsion was similar in volunteers and in patients for reader 1 (12.7° ± 10.0 [standard deviation] vs 12.6° ± 9.8, respectively; P = .9) and reader 2 (12.8° ± 10.1 vs 13.5° ± 9.8, respectively; P = .7). Femoral antetorsion was significantly higher in patients with pincer-type FAI than in those with cam-type FAI for reader 1 (18.3° ± 9.8 vs 10.0° ± 9.1, P = .02) and reader 2 (18.7° ± 10.5 vs 11.6° ± 8.8, P = .04).

Conclusion

Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. Patients with pincer-type FAI had a significantly larger femoral antetorsion than patients with cam-type FAI.

References

1 Wagner S, Hofstetter W, Chiquet M, et al.. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage 2003;11(7):508–518. Crossref, Medline, Google Scholar
2 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003;(417):112–120. Medline, Google Scholar
3 Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 2006;240(3):778–785. Link, Google Scholar
4 Allen D, Beaulé PE, Ramadan O, Doucette S. Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement. J Bone Joint Surg Br 2009;91(5):589–594. Crossref, Medline, Google Scholar
5 Werner CM, Copeland CE, Ruckstuhl T, et al.. Radiographic markers of acetabular retroversion: correlation of the cross-over sign, ischial spine sign and posterior wall sign. Acta Orthop Belg 2010;76(2):166–173. Medline, Google Scholar
6 Jamali AA, Mladenov K, Meyer DC, et al.. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res 2007;25(6):758–765. Crossref, Medline, Google Scholar
7 Tönnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop 1991;11(4):419–431. Crossref, Medline, Google Scholar
8 Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 1999;81(12):1747–1770. Crossref, Medline, Google Scholar
9 Huber H, Haefeli M, Dierauer S, Ramseier LE. Treatment of reduced femoral antetorsion by subtrochanteric rotational osteotomy. Acta Orthop Belg 2009;75(4):490–496. Medline, Google Scholar
10 Schneider B, Laubenberger J, Jemlich S, Groene K, Weber HM, Langer M. Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol 1997;70(834):575–579. Crossref, Medline, Google Scholar
11 Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. AJR Am J Roentgenol 1997;168(3):791–794. Crossref, Medline, Google Scholar
12 Domayer SE, Ziebarth K, Chan J, Bixby S, Mamisch TC, Kim YJ. Femoroacetabular cam-type impingement: diagnostic sensitivity and specificity of radiographic views compared to radial MRI. Eur J Radiol 2011;80(3):805–810. Crossref, Medline, Google Scholar
13 Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br 1999;81(2):281–288. Crossref, Medline, Google Scholar
14 Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res 2008;466(3):677–683. Crossref, Medline, Google Scholar
15 Ruelle M, Dubois JL. The protrusive malformation and its arthrosic complication. I. Radiological and clinical symptoms: etiopathogenesis [in French]. Rev Rhum Mal Osteoartic 1962;29:476–489. Medline, Google Scholar
16 Ecker TM, Tannast M, Puls M, Siebenrock KA, Murphy SB. Pathomorphologic alterations predict presence or absence of hip osteoarthrosis. Clin Orthop Relat Res 2007;465:46–52. Crossref, Medline, Google Scholar
17 Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002;84(4):556–560. Crossref, Medline, Google Scholar
18 Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res 2004;(429):178–181. Crossref, Medline, Google Scholar
19 Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res 2004;(429):170–177. Crossref, Medline, Google Scholar
20 Palmer WE. Femoroacetabular impingement: caution is warranted in making imaging-based assumptions and diagnoses. Radiology 2010;257(1):4–7. Link, Google Scholar
21 Anderson SE, Siebenrock KA, Tannast M. Femoroacetabular impingement: evidence of an established hip abnormality. Radiology 2010;257(1):8–13. Link, Google Scholar
22 Cobb J, Logishetty K, Davda K, Iranpour F. Cams and pincer impingement are distinct, not mixed: the acetabular pathomorphology of femoroacetabular impingement. Clin Orthop Relat Res 2010;468(8):2143–2151. Crossref, Medline, Google Scholar
23 Turgeon TR, Phillips W, Kantor SR, Santore RF. The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond. Clin Orthop Relat Res 2005;441:188–199. Crossref, Medline, Google Scholar
24 Haverkamp D, Marti RK. Intertrochanteric osteotomy combined with acetabular shelfplasty in young patients with severe deformity of the femoral head and secondary osteoarthritis: a long-term follow-up study. J Bone Joint Surg Br 2005;87(1):25–31. Crossref, Medline, Google Scholar
25 Millis MB, Kim YJ. Rationale of osteotomy and related procedures for hip preservation: a review. Clin Orthop Relat Res 2002;(405):108–121. Crossref, Medline, Google Scholar
26 Liu RW, Toogood P, Hart DE, Davy DT, Cooperman DR. The effect of varus and valgus osteotomies on femoral version. J Pediatr Orthop 2009;29(7):666–675. Crossref, Medline, Google Scholar
27 Ogata K, Goldsand EM. A simple biplanar method of measuring femoral anteversion and neck-shaft angle. J Bone Joint Surg Am 1979;61(6A):846–851. Crossref, Medline, Google Scholar
28 Kuo TY, Skedros JG, Bloebaum RD. Measurement of femoral anteversion by biplane radiography and computed tomography imaging: comparison with an anatomic reference. Invest Radiol 2003;38(4):221–229. Crossref, Medline, Google Scholar
29 Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Femoral anteversion. J Bone Joint Surg Am 1987;69(8):1169–1176. Crossref, Medline, Google Scholar
30 Dunlap K, Shands AR, Hollister LC, Gaul JS, Streit HA. A new method for determination of torsion of the femur. J Bone Joint Surg Am 1953;35-A(2):289–311. Crossref, Medline, Google Scholar
31 Fabry G, MacEwen GD, Shands AR. Torsion of the femur: a follow-up study in normal and abnormal conditions. J Bone Joint Surg Am 1973;55(8):1726–1738. Crossref, Medline, Google Scholar
32 Prasad R, Vettivel S, Isaac B, Jeyaseelan L, Chandi G. Angle of torsion of the femur and its correlates. Clin Anat 1996;9(2):109–117. Crossref, Medline, Google Scholar
33 Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res 2009;467(4):876–885. Crossref, Medline, Google Scholar
34 Schneider B, Laubenberger J, Wildner M, Exne V, Langer M. NMR tomographic measurement of femoral ante-torsion and tibial torsion [in German]. Rofo 1995;162(3):229–231. Crossref, Medline, Google Scholar
35 Walker JM, Goldsmith CH. Morphometric study of the fetal development of the human hip joint: significance for congenital hip disease. Yale J Biol Med 1981;54(6):411–437. Medline, Google Scholar
36 Ito K, Minka MA, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 2001;83(2):171–176. Crossref, Medline, Google Scholar
37 Philippon MJ, Ejnisman L, Pennock AT, et al.. Does femoral anteversion play a role in the pathomechanics and subsequent surgical treatment of femoroacetabular impingement? Arthroscopy 2011;27(5 suppl):e53. Crossref, Google Scholar

Article History

Received September 5, 2011; revision requested October 27; revision received November 7; accepted November 22; final version accepted December 8.
Published online: May 2012
Published in print: May 2012

Vol. 263, No. 2

Abbreviations

Abbreviations:
FAI	femoroacetabular impingement
ICC	intraclass correlation coefficient

Metrics

Altmetric Score

PDF download