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Anatomic Analysis of Site-Specific Femoral Version and Cam Deformity in 1058 Cadaveric Hips
Margaret A Sinkler1, Steven J Magister1, Luc M Fortier1
1Drusinsky Sports Medicine Institute, University Hospitals, Cleveland, Ohio, USA.
Background:
Femoral version (FV) is an anatomic parameter that has recently received increased attention in its role in multiple hip pathologies, including femoroacetabular impingement (FAI) and cam lesion development.
Purpose:
To evaluate site-specific femoral version and assess the relationship with the size and location of cam deformity in cadaveric specimens.
Study Design:
Descriptive laboratory study.
Methods:
A total of 1058 cadaveric femurs were selected from a historical osteologic collection. Each femur was assessed to determine the α angle, total FV, neck-based FV, and shaft-based FV. Cam morphology was defined as an α angle >60°. Pearson correlation and multiple regression analysis were performed to determine the relationship between site-specific FV location and α angle.
Results:
Of the cadaveric femurs, the mean ± SD α angle was 54°± 11°. There were 354 (33%) cam deformities. The mean ± SD was 11°± 12° for total FV among all specimens, 24°± 10° for the femoral shaft version, and -13°± 19° for the femoral neck version. On multivariate analysis, sex, race, femoral neck version, and femoral shaft version were independent predictors for α angle (P < .05). Each degree increase predicted an increase in α angle of 0.09° (P = .006) for the femoral neck version and 0.14° (P = .02) for the femoral shaft version.
Conclusion:
Our study reveals an anatomic relationship between site-specific FV and cam deformity; an increase in shaft FV and neck FV predicted an increased α angle. While the observed absolute value of this relationship is small, site-specific FV remains a previously unrecognized area of interest that could help explain differences previously reported in the literature regarding the multifactorial symptomology in FAI.
Clinical Relevance:
FV is classically reported as one value combining the femoral neck version and torsion of the femoral shaft. In addition to the identified relationship between site-specific FV and cam deformity, this study encourages clinicians to consider both contributing anatomic components of femoral version, especially when identifying the level of deformity before corrective femoral osteotomy in patients with FAI.
