Do femoral version abnormalities play a role in hip function of patients with hip pain?

  • Viviane Bortoluzzi Frasson
    Corresponding author at: Physique – Physical Therapy Center, Rua Furriel Luiz Antônio Vargas, 250, 90470-130 Porto Alegre, RS, Brazil.
    Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada

    Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil

    Physique – Physical Therapy Centre, Porto Alegre, RS, Brazil
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  • Walter Herzog
    Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada

    McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada

    Health Centre, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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  • Kelly Johnston
    McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada

    Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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  • Yves Pauchard
    McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
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  • Marco Aurélio Vaz
    Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada

    Physique – Physical Therapy Centre, Porto Alegre, RS, Brazil

    Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Bruno Manfredini Baroni
    Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
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      • Hip internal rotation range of motion is maximized in anteverted hip patients.
      • Hip external rotation range of motion is maximized in retroverted hip patients.
      • Femoral version abnormalities affected hip muscle strength.
      • Rotation index is a strong femoral version predictor.
      • Femoral version should be considered in decision making of patients with hip pain.



      A high prevalence of femoral version abnormalities has been observed in hip pain patients, with impact on hip range of motion and muscle strength that should be elucidated.


      Cross-sectional study. Thirty-one patients with hip pain (16 men and 15 female) were subjected to Biplanar X-Rays to quantify femoral version using three-dimensional measurements. The 62 hips were divided into normal version (10–20°, n = 18), anteverted (>20°, n = 19), and retroverted (<10°, n = 25). Joint range of motion for flexion, internal rotation, and external rotation was assessed through digital goniometry. Maximal isometric hip strength (flexion, extension, internal rotation, external rotation at 0° and 30°, abduction, adduction) was evaluated through hand-held dynamometry. Hip rotation index was calculated as external rotation minus internal rotation.


      Anteverted hips had greater internal rotation, while retroverted hips had greater external rotation (p = 0.001). Anteverted hips were weaker than retroverted hips for external rotation at 30° (p < 0.001), abduction (p = 0.006) and adduction (p < 0.001), and weaker than normal version hips for extension (p = 0.018). All three groups had different rotation index: retroverted>normal>anteverted (p < 0.001). The ordinal logistic regression found higher values of rotation index with higher probability of being retroverted (common odds ratio = 1.20). There was a strong correlation between femoral version group and rotation index (rS = 0.76, p < 0.001). There was probability >70% of a hip being anteverted if the rotation index was <11°, and being retroverted if the index was >40°.


      Range of motion and muscle strength differed in hips with different femoral versions. The hip rotation index was a strong femoral version predictor.


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