Editorial Commentary: A Simple Twist of Fate: The Ramifications of Abnormal Femoral Version

Femoral Version May Impact Hip Arthroscopy Outcomes in Select Patient Populations: A Systematic Review

PURPOSE

To provide further clarity regarding the management of patients with abnormal femoral version in the setting of hip arthroscopy and will discuss the definition of femoral version, the diagnostic and clinical evaluation of abnormal femoral version, and several described measurement techniques.

METHODS

A systematic review was conducted in literature published before August 2021 that measured femoral version and reported patient-reported outcomes measures or rates of subsequent procedures following hip arthroscopy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and the electronic databases, PubMed, OvidMedLine, Scopus, and Web of Science were searched. Two blinded reviews screened and evaluated data quality using the Newcastle-Ottawa Scale.

RESULTS

Eighteen studies were included with 11 studies reporting patient outcomes and 7 studies reporting rates of subsequent procedures. The most commonly used definition of femoral version was 5° to 20° of femoral anteversion. Computed tomography scan was the most commonly used imaging modality. The majority of studies (7 of 11) demonstrated that femoral version does not have an impact on patient-reported outcomes measures and is not predictive of clinically meaningful improvement scores. However, in select studies, patients with femoral retroversion were found to experience slightly inferior outcomes following hip arthroscopy for femoroacetabular impingement. While femoral retroversion may be a risk factor for subsequent procedures, 3 of 7 studies refute this claim. Although in patients with borderline hip dysplasia, excessive femoral anteversion led to greater rates of subsequent hip procedures.

CONCLUSIONS

While the majority of studies show that femoral version does not have an impact on patient-reported outcomes following hip arthroscopy, those with femoral retroversion and with excessive anteversion with coexisting borderline hip dysplasia need to be educated on their increased risk of subsequent operation. Ultimately, this review suggests that clinical improvement can likely be achieved regardless of femoral version.

LEVEL OF EVIDENCE

IV; systematic review of Level I-IV studies.

Editorial Commentary: Excessive Femoral Retroversion and Increased Femoral Anteversion Has a Negative Effect on Hip Arthroscopy Outcomes: Symptomatic Extremes of Version Require an Osteotomy

With the rise in the prevalence of hip arthroscopy, patient selection and proper surgical execution are key to achieving excellent outcomes. As our understanding of femoral acetabular impingement grows, so does our surgical indications to achieve excellent surgical outcomes. Some impingement pathologies are amenable to arthroscopy alone and those with excessive version, dysplasia, Perthese, protrusio, and coxa-vara, or valga require an isolated or combined osteotomy. The version of the femur is known to be a significant source of impingement, and its impact on arthroscopic surgical outcomes has long been assumed to be inconsequential. Those that perform open and arthroscopic hip surgery understand this to be untrue, and arthroscopy alone cannot solve all of our impingement problems.