Hip pain femoral retroversion
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Slipped capital femoral epiphysis- the primary situation where there is hip pain and femoral retroversion- is recognized as a possibly devastating hip problem.
The disorder is due to abnormal separation of the proximal femoral epiphysis through the growth plate with anterior movement of the femoral neck relative to the epiphysis.
The complications of this disease are avascular necrosis and cartilage damage. Early diagnosis and prompt treatment are mandatory.
The average age at presentation is 12 for boys and 13.5 for girls. There is a strong association with obesity
Evidence indicates that endocrine factors play a strong role as well.
A patient with this condition is typically an overweight adolescent who presents with a limp and history of hip or groin pain.
Symptoms are frequently referred to the medial thigh or knee. Physical exam will reveal limitation of hip motion in internal rotation and abduction. X-rays confirm the diagnosis.
Slipped capital femoral epiphysis (SCFE)has been classified by the duration of symptoms. An acute SCFE presents after fewer than three weeks of symptoms. These account for about 10% of patients. A chronic slip, which accounts for the majority of patients, presents with weeks to months of mild to moderate symptoms.
Most surgeons today agree that the best outcomes are obtained by using careful screw fixation.
In a paper by Gelberman and colleagues (Gelberman RH. Cohen MS. Shaw BA. Kasser JR. Griffin PP. Wilkinson RH. The association of femoral retroversion with slipped capital femoral epiphysis. Journal of Bone & Joint Surgery - American Volume. 68(7):1000-7, 1986 Sep.), it was demonstrated in a study of twenty-five patients who had a unilateral or bilateral slip of the capital femoral epiphysis, that a decreased angle of femoral anteversion appears to be specifically associated with the development of slipped capital femoral epiphysis. The mechanical forces that act across the proximal femoral physis may be altered by this rotational abnormality, and this may lead to an increased shear stress that ultimately causes failure of the growth plate.
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