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Sports Medicine

Femoral antiversion

01/16/2007

Question:

Hello, I also have been diagnosed with "Femoral antiversion". I went to an Orthopedic Surgeon Dr. Kenneth Krackow at Buffalo General Hospital due to the fact both of my knees were bothering me. I went to him 3 years ago, I am now 46 years old and he advised me that the "Cleveland Clinic" can operate and correct this. However, I cannot afford this, basically I used to run as well, and have a hard enought time getting up and or walking up and down stairs. My right knee is bone on bone basically and my left is almost the same. He told me that he can operate on my knees and hip, but it`s the femoral antiversion causing this and the femur bone would have to get corrected to help the knees and hip. What do you recommend I do, I am having a difficult time with stairs, I consider myself in pretty good shape and still rather young as I really do not want a knee or hip replacement at this age? I look forward to your response and help with this. Thank You and Happy New Year!

Answer:

This website provides medical information, but does not provide specific recommendations. You may wish to consult with an orthopedist who performs the type of "derotation" surgery you've been advised to consider, to assist in your decision making regarding how necessary is it for you to have your femoral anteversion surgically corrected. In the meantime, all nonsurgical options for controlling your symptoms and maximizing your function should also be explored, which, depending on the specifics of your situation, may include anti-inflammatory medications, non-anti-inflammatory analgesic (pain-killing) medications, such "supplements" as Glucosamine, bracing one or both knees, hand-held walking aids such as one - or two? - canes, vs. a 4-wheeled walker with a seat, knee and/or hip joint injections - steroid, as well as possibly "Synvisc," relevant stretching and strengthening exercises, possibly wedges placed in your shoes, and reconditioning exercise such as aquatic exercise or possibly using a stationary bike if tolerated.

Femoral anteversion refers to an inward rotation or twist of the femur (thigh bone) in relation to the femoral neck (which then ends in the femoral head, or the "ball" which fits into the hip socket). This "deformity" arises from the way the femur grows as the skeleton matures, and results in an inward turning of the knee(s) and/or feet (however, sometimes the tibia [shinbone] will grow externally rotated to compensate for this internal femoral rotation, resulting in the feet not necessarily pointing inward...). If a person with femoral anteversion tries to resist the tendency for their knee(s) to turn inward, this can then place abnormal stress upon the hip joint(s), as well as upon other structures (sacroiliac joint, lumbar spine, etc.).

You are correct in stating that knee and/or hip joint replacements at your age would ideally be postponed for as long as possible, but, if your functional levels are declining, pain levels are worsening, and/or joint deformity is progressing - despite having tried all nonsurgical treatment interventions - joint replacement would best be done sooner rather than later. Consider asking your orthopedist if the surgery to correct the femoral anteversion could be done at the same time as a joint replacement.

Happy New Year to you, also!

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University