Long-Term Outcome of Idiopathic Increased Femoral Anteversion in 58 Untreated Individuals at a Mean Age of 46.2 Years.

BACKGROUND

Increased femoral anteversion is a common problem in children, but the condition usually normalizes spontaneously over time. There is limited knowledge of the long-term consequences of persistently increased anteversion. The purpose of this study was to analyse the long-term functional complaints of untreated adults with idiopathic increased anteversion compared with a control group.

METHODS

Study participants were recruited from our institutional register of increased femoral anteversion during the period 1975 to 2008. Inclusion criteria were anteversion angle ≥30 degrees and no other disorders affecting the lower limbs. Outcome measures were the HAGOS and KOOS questionnaires, radiographic signs of osteoarthritis, and clinical examination. A control group of 24 healthy individuals was examined with the same methods.

RESULTS

Fifty-eight patients (46 females) with a mean age of 46.2 years were included in the AV group. The mean anteversion angle was of 40.2 degrees in the anteversion group and 20.6 degrees in the controls. The mean external foot progression angle was 0.5 degrees in the anteversion group and 4.6 degrees in the controls ( P <0.001). The anteversion group scored significantly worse than the control group in 5 out of 6 HAGOS subscales: Pain ( P =0.032), Symptoms ( P =0.041), Sport/Rec ( P =0.001), PA ( P =0.036), and QOL ( P =0.001). The KOOS subscale Symptoms was the only subscale with a worse score in the AV group ( P =0.006). Only 1 patient in the anteversion group had hip osteoarthritis.

CONCLUSIONS

Untreated adults with idiopathic increased femoral AV at a mean age of 46 years experienced more hip pain and limitations in participation in physical activities and sports compared with healthy individuals, but the limitations were mostly small to moderate and would hardly influence the present strict indications for surgical correction in children.

LEVEL OF EVIDENCE: Level II-prospective comparative study.