Scholarlink

Background <p>Femoral version (FV) affects hip biomechanics and postoperative outcomes in developmental dysplasia of the hip (DDH) as well as femoroacetabular impingement (FAI). However, its assessment depends on advanced imaging modalities such as CT and MRI with limited clinical utility for cost-effective screening of FV. This study aimed to implement and test the diagnostic accuracy of the lesser trochanter index (LTI) as an indicator for increased femoral FV on pelvic radiographs in patients with symptomatic DDH and FAI.</p> Methods <p>This prospective, diagnostic cohort study included symptomatic patients with DDH (<i>n</i> = 194 patients) and FAI (<i>n</i> = 22 patients) undergoing hip preservation surgery. Patients underwent a standardized protocol of anteroposterior pelvic radiographs and magnetic resonance imaging (MRI) of the pelvis, hip and lower extremity. FV was measured in accordance to the Murphy method. The lesser trochanter morphology on pelvic radiographs was used to calculate the lesser trochanter index (LTI). It was predefined as positive to detect increased FV (&gt;25/30° Murphy) with a cut-off value of &gt; 1.5.</p> Results <p>A total of 409 hips in 216 patients were included. Patients with DDH were significant older (30.7 vs. 25.5, <i>p</i> = 0.008), were more frequently female (77.3% vs. 34.8, <i>p</i> &lt; 0.001) and had a significant higher femoral version compared to FAI (28 vs. 21.8, <i>p</i> = 0.013). The LTI &gt; 1.5 showed a high sensitivity (25°/30° FV − 90.9/93.1%), but a low specifity (25°/30° FV − 20.3/18.9%) to detect increased FV. The negative predictive value remained moderate (25°/30° FV − 65.5/81%), while the LTI has only a weak positive predictive value (25°/30° FV − 57.5/42.7%).</p> Conclusion <p>The LTI represents a clinical useful and widely available indicator of increased FV and can optimize the use of subsequent MRI and CT assessment. However, due to its moderate diagnostic accuracy, the LTI is more a rule- out test, than a diagnostic marker of increased FV and cannot replace advanced imaging modalities.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

The lesser trochanter index: detection of increased femoral version in patients with symptomatic hip disease

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月21日

查看全文
  • Klaudia Kaczmarek,
  • Andreas Nitsch,
  • Feras Kasabji,
  • Georgi I. Wassilew,
  • Jens Goronzy,
  • Maximilian Fischer

摘要

Background

Femoral version (FV) affects hip biomechanics and postoperative outcomes in developmental dysplasia of the hip (DDH) as well as femoroacetabular impingement (FAI). However, its assessment depends on advanced imaging modalities such as CT and MRI with limited clinical utility for cost-effective screening of FV. This study aimed to implement and test the diagnostic accuracy of the lesser trochanter index (LTI) as an indicator for increased femoral FV on pelvic radiographs in patients with symptomatic DDH and FAI.

Methods

This prospective, diagnostic cohort study included symptomatic patients with DDH (n = 194 patients) and FAI (n = 22 patients) undergoing hip preservation surgery. Patients underwent a standardized protocol of anteroposterior pelvic radiographs and magnetic resonance imaging (MRI) of the pelvis, hip and lower extremity. FV was measured in accordance to the Murphy method. The lesser trochanter morphology on pelvic radiographs was used to calculate the lesser trochanter index (LTI). It was predefined as positive to detect increased FV (>25/30° Murphy) with a cut-off value of > 1.5.

Results

A total of 409 hips in 216 patients were included. Patients with DDH were significant older (30.7 vs. 25.5, p = 0.008), were more frequently female (77.3% vs. 34.8, p < 0.001) and had a significant higher femoral version compared to FAI (28 vs. 21.8, p = 0.013). The LTI > 1.5 showed a high sensitivity (25°/30° FV − 90.9/93.1%), but a low specifity (25°/30° FV − 20.3/18.9%) to detect increased FV. The negative predictive value remained moderate (25°/30° FV − 65.5/81%), while the LTI has only a weak positive predictive value (25°/30° FV − 57.5/42.7%).

Conclusion

The LTI represents a clinical useful and widely available indicator of increased FV and can optimize the use of subsequent MRI and CT assessment. However, due to its moderate diagnostic accuracy, the LTI is more a rule- out test, than a diagnostic marker of increased FV and cannot replace advanced imaging modalities.