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Femoral Version Measurements Vary Significantly Between Commonly Used Methods: Implications for Defining Diagnostic

Camille Vorimore¹, Kevin Smit¹, Kawan Rakhra¹

¹Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.

The American Journal of Sports Medicine

|May 12, 2026

Summary

This summary is machine-generated.

Femoral version measurement techniques vary significantly, impacting diagnostic accuracy. This study highlights the need for method-specific normal ranges and suggests 3D imaging offers a more detailed assessment for femoral version abnormalities.

Keywords:

3D measurements CT femoral version hip

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Area of Science:

Orthopedic surgery
Medical imaging analysis
Biomechanical assessment

Background:

Accurate femoral version measurement is crucial for diagnosing abnormalities and guiding surgical interventions.
Numerous measurement techniques exist, leading to potential discrepancies in clinical practice.

Purpose of the Study:

To compare differences between four 2D and 3D femoral version measurement techniques.
To assess how femoral version influences measurement discrepancies.
To evaluate an automated method's accuracy for femoral version determination.

Main Methods:

A cohort study of 100 patients undergoing hip preservation surgery.
Pelvic CT scans were used to measure femoral version with two 2D (Murphy, Reikeras) and two 3D (Sugano, Lee) techniques.
Measurements were taken relative to the posterior condylar axis (PCA) and transepicondylar axis (TEA), with interobserver reliability assessed.

Main Results:

All 2D methods showed excellent interobserver reliability (ICC: 0.93-0.97).
Mean femoral version varied widely, from 3.4° (Lee) to 23.2° (Murphy).
Strong correlations (R² > 0.8) were found for converting values between methods, with excellent agreement between manual 2D and automatic 3D methods.

Conclusions:

Significant variations in femoral version measurements exist across different techniques.
Method-specific normal ranges are essential due to differing mean values and reproducibility.
3D imaging provides a more detailed and practical assessment compared to 2D methods.