The Journal of Bone & Joint Surgery

Introduction

Etiology of Altered Acetabular and Femoral Anteversion

Diagnosis of Decreased Anteversion

Clinical and Radiographic Study

Operative Treatment

Conclusions and Recommendations

References

Abel, M. F.; Sutherland, D. H.; Wenger, D. R.; and Mubarak, S. J.: Evaluation of CT scans and 3-D reformatted images for quantitative assessment of the hip. J. Pediat. Orthop.,14: 48-53, 1994.1448 1994

Anda, S.; Svenningsen, S.; Grontvedt, T.; and Benum, P.: Pelvic inclination and spatial orientation of the acetabulum. A radiographic, computed tomographic and clinical investigation. Acta Radiol.,31: 389-394, 1990.31389 1990 [PubMed]

Anda, S.: Evaluation of the Hip Joint by Computed Tomography and Ultrasonography. Dissertation, Universitat Trondheim, Tapir, 1991.

Anda, S.; Terjesen, T.; and Kvistad, K. A.: Computed tomography measurements of the acetabulum in adult dysplastic hips: which level is appropriate?. Skel. Radiol.,20: 267-271, 1991.20267 1991

Aranow S., and Zippel, H.: Untersuchung zur femoro-tibialen Torsion bei Patellainstabilitaten. Ein Beitrag zur Pathogenese rezidivierender und habitueller Patellaluxationen. Beitr. Orthop. Traumat.,37: 311-326, 1990.37311 1990

Bombelli, R.: Osteoarthritis of the Hip: Classification and Pathogenesis: The Role of Osteotomy as a Consequent Therapy. Ed. 2, pp. 67-88. New York, Springer, 1983.

Bråten, M.; Terjesen, T.; and Rossvoll, I.: Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients. J. Bone and Joint Surg.,75-B(5): 799-803, 1993.75-B(5)799 1993

Browning, W. H.; Rosenkrantz, H.; and Tarquinio, T.: Computed tomography in congenital hip dislocation. The role of acetabular anteversion. J. Bone and Joint Surg.,64-A: 27-31, Jan. 1982.64-A27 1982

Brückl, R.; Hepp, W. R.; and Tönnis, D.: Eine Abgrenzung normaler und dysplastischer Hüftgelenke durch den Hüftwert. Arch. Orthop. and Trauma Surg.,74: 13-32, 1972.7413 1972

Buckley, S. L.; Sponseller, P. D.; and Magid, D.: The acetabulum in congenital and neuromuscular hip instability. J. Pediat. Orthop.,11: 498-501, 1991.11498 1991

Busse, J.; Gasteiger, W.; and Tönnis, D.: Eine neue Methode zur röntgenologischen Beurteilung eines Hüftgelenkes—Der Hüftwert. Arch. Orthop. and Trauma Surg.,72: 1-9, 1972.721 1972

Busse, J.; Gasteiger, W.; and Tönnis, D.: Die Bedeutung des Hüftwertes für die Diagnose und Prognose deformierter Hüftgelenke. Arch. Orthop. and Trauma Surg.,72: 245-252, 1972.72245 1972

Chevrot, A.; Hazebroucq, V.; Vallée, C.; Godefroy, D.; Wybier, M.; Codert, E.; and Gires, F.: Un critère de validité de la mesure tomodensitométrique de l'antéversion du col fémoral. Rev. chir. orthop.,77: 370-373, 1991.77370 1991 [PubMed]

Conway, W. F.; Totty, W. G.; and McEnery, K. W.: CT and MR imaging of the hip. Radiology,198: 297-307, 1996.198297 1996 [PubMed]

Crane, L.: Femoral torsion and its relation to toeing-in and toeing-out. J. Bone and Joint Surg.,41-A: 421-428, April 1959.41-A421 1959

Detenbeck, L. C.; Coventry, M. B.; and Kelly, P. J.: Intertrochanteric osteotomy for degenerative arthritis of the hip. Clin. Orthop.,86: 73-78, 1972.8673 1972 [PubMed]

Dunlap, K.; Shands, A. R., Jr.; Hollister, L. C., Jr.; Gaul, J. S., Jr.; and Streit, H. A.: A new method for determination of torsion of the femur. J. Bone and Joint Surg.,35-A: 289-311, April 1953.35-A289 April 1953

Dunn, D. M.: Anteversion of the neck of the femur. A new method of measurement. J. Bone and Joint Surg.,34-B(2): 181-186, 1952.34-B(2)181 1952

Dunn, P. M.: The Influence of the Intrauterine Environment in the Causation of Congenital Postural Deformities, with Special Reference to Congenital Dislocation of the Hip. Thesis, University of Cambridge, Cambridge, England, 1969.

Dunn, P. M.: Perinatal observations on the etiology of congenital dislocation of the hip. Clin. Orthop.,119: 11-22, 1976.11911 1976 [PubMed]

Dürrschmidt, V.: Der negative azetabuloplastische Effekt der intertrochanteren Rotations-Varisations Osteotomie (IRVO). Zeitschr. Orthop.,120: 860-864, 1982.120860 1982

Eckhoff, D. G.; Montgomery, W. K.; Kilcoyne, R. F.; and Stamm, E. R.: Femoral morphometry and anterior knee pain. Clin. Orthop.,302: 64-68, 1994.30264 1994 [PubMed]

Eckhoff, D. G.: Femoral anteversion in arthritis of the knee [letter]. J. Pediat. Orthop.,15: 700, 1995.15700 1995

Fabry, G.; MacEwen, G. D.; and Shands, A. R., Jr.: Torsion of the femur. A follow-up study in normal and abnormal conditions. J. Bone and Joint Surg.,55-A: 1726-1738, Dec. 1973.55-A1726 1973

Galbraith, R. T.; Gelberman, R. H.; Hajek, P. C.; Baker, L. A.; Sartoris, D. J.; Rab, G. T.; Cohen, M. S.; and Griffin, P. P.: Obesity and decreased femoral anteversion in adolescence. J. Orthop. Res.,5: 523-528, 1987.5523 1987 [PubMed]

Ganz, R.; Klaue, K.; Vinh, T. S.; and Mast, J. W.: A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin. Orthop.,232: 26-36, 1988.23226 1988

Ganz, R.: Personal communication.

Gelberman, R. H.; Cohen, M. S.; Shaw, B. A.; Kasser, J. R.; Griffin, P. P.; and Wilkinson, R. H.: The association of femoral retroversion with slipped capital femoral epiphysis. J. Bone and Joint Surg.,68-A: 1000-1007, Sept. 1986.68-A1000 1986

Giunti, A.; Moroni, A.; Olmi, R.; Rimondi, E.; Soldati, D.; and Vicenzi, G.: The importance of the angle of anteversion in the development of arthritis of the hip. Italian J. Orthop. and Traumat.,11: 23-27, 1985.1123 1985

Goodman, D. A.; Feighan, J. E.; Smith, A. D.; Latimer, B.; Buly, R. L.; and Cooperman, D. R.: Subclinical slipped capital femoral epiphysis. Relationship to osteoarthritis of the hip. J. Bone and Joint Surg.,79-A: 1489-1497, Oct. 1997.79-A1489 1997

Grote, R.; Elgeti, H.; and Saure, D.: Bestimmung des Antetorsionswinkels am Femur mit der axialen Computertomographie. Röentgenblatter,33: 31-42, 1980.3331 1980

Hamacher, P.: Röntgenologische Normalwerte des Huftgelenskes CCD-Winkel and AT-Winkel. Orthop. Praxis,10: 23-28, 1974.1023 1974

Harris, W. H.: Etiology of osteoarthritis of the hip. Clin. Orthop.,213: 20-33, 1986.21320 1986 [PubMed]

Hernandez, R. J.; Tachdjian, M. O.; Poznanski, A. K.; and Dias, L. S.: CT determination of femoral torsion. AJR: Am. J. Roentgenol.,137: 97-101, 1981.13797 1981 [PubMed]

Hubbard, D. D.; Staheli, L. T.; Chew, D. E.; and Mosca, V. S.: Medial femoral torsion and osteoarthritis. J. Pediat. Orthop.,8: 540-542, 1988.8540 1988

Huguenin, P., and Bensahel, H.: Les anomalies de rotation de la hanche chez l'enfant. Chir. pédiat.,21: 231-237, 1980.21231 1980

Huguenin, P., and Bensahel, H.: Les rétroversions du col fémoral. Chir. pédiat.,23: 277-281, 1982.23277 1982

Jacquemier, M.; Noca, P.; Dick, R.; Bollini, G.; Moulia-Pelat, J. P.; Migliani, R.; and Faure, F.: Etude de l'antéversion fémorale dans les épiphysiolyses fémorales supérieures de l'adolescent. A propos de 25 cas. Rev. chir. orthop.,77: 530-536, 1991.77530 1991 [PubMed]

Jacquemier, M.; Jouve, J. L.; Bollini, G.; Panuel, M.; and Migliani, R.: Acetabular anteversion in children. J. Pediat. Orthop.,12: 373-375, 1992.12373 1992

Kitaoka, H. B.; Weiner, D. S.; Cook, A. J.; Hoyt, W. A., Jr.; and Askew, M. J.: Relationship between femoral anteversion and osteoarthritis of the hip. J. Pediat. Orthop.,9: 396-404, 1989.9396 1989

Leger, W.: Was leistet die Korrekturosteotomie in der Behandlung der Hüftarthrose?. Zeitschr. Orthop.,116: 180-186, 1978.116180 1978

Lequesne, M., and de Seze, S.: Le faux profil du bassin. Nouvelle incidence radiographique pour l'étude de la hanche. Son utilité dans les dysplasies et les différentes cexopathies. Rev. rhumat.,28: 643-652, 1961.28643 1961

McKibbin, B.: Anatomical factors in the stability of the hip joint in the newborn. J. Bone and Joint Surg.,52-B(1): 148-159, 1970.52-B(1)148 1970

Menke, W.; Hatz, O.; Schild, H.; and Müller, H. A.: Femurtorsionsbestimmung, antropometrische, röentgenologische und computertomographische Bestimmungsmethoden im Vergleich. Med. orthop. Tech.,103: 76-78, 1983.10376 1983

Menke, W.; Schmitz, B.; Schild, H.; and Köper, C.: Transversale Skelettachsen der unteren Extremitat bei Coxarthrose. Zeitschr. Orthop.,129: 255-259, 1991.129255 1991

Müller, M. E.: Die hüftnahen Femurosteotomien under Berücksichtigung der Form, Funktion und Beanspruchung des Hüftgelenkes. Stuttgart, Thieme, 1957.

Murphy, S. B.; Simon, S. R.; Kijewski, P. K.; Wilkinson, R. H.; and Griscom, N. T.: Femoral anteversion. J. Bone and Joint Surg.,69-A: 1169-1176, Oct. 1987.69-A1169 1987

Murray, D. W.: The definition and measurement of acetabular orientation. J. Bone and Joint Surg.,75-B(2): 228-232, 1993.75-B(2)228 1993

Ogata, S.; Moriya, H.; Tsuchiya, K.; Akita, T.; Kamegaya, M.; and Someya, M.: Acetabular cover in congenital dislocation of the hip. J. Bone and Joint Surg.,72-B(2): 190-196, 1990.72-B(2)190 1990

Papaspyrou, P.; Heinecke, A.; and Tönnis, D.: Überlebenszeitanalysen an Gelenken mit Dysplasiearthrose nach intertrochantarer Femurosteotomie. Zeitschr. Orthop.,135: 486-493, 1997.135486 1997

Pitkow, R. B.: External rotation contracture of the extended hip. A common phenomenon of infancy obscuring femoral neck anteversion and the most frequent cause of out-toeing gait in children. Clin. Orthop.,110: 139-145, 1975.110139 1975 [PubMed]

Pritchett, J. W., and Perdue, K. D.: Mechanical factors in slipped capital femoral epiphysis. J. Pediat. Orthop.,8: 385-388, 1988.8385 1988

Reikeras, O., and Hoiseth, A.: Femoral neck angles in osteoarthritis of the hip. Acta Orthop. Scandinavica,53: 781-784, 1982.53781 1982

Reikeras, O.; Bjerkreim, I.; and Kolbenstvedt, A.: Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop. Scandinavica,54: 18-23, 1983.5418 1983

Rippstein, J.: Zur Bestimmung der Antetorsion des Schenkelhalses mittels zweier Röntgenaufnahmen. Zeitschr. Orthop.,86: 345-360, 1955.86345 1955

Sennerich, T.; Sutter, P.; Ritter, G.; and Zapf, S.: Computertomographische Kontrolle des Antetorsionswinkels nach Oberschenkelschaftfrakturen des Erwachsenen. Unfallchirurg,95: 301-302, 1992.95301 1992 [PubMed]

Shands, A. R., Jr., and Steele, M. K.: Torsion of the femur. A follow-up report on the use of the Dunlap method for its determination. J. Bone and Joint Surg.,40-A: 803-816, July 1958.40-A803 1958

Stanitski, C. L.; Woo, R.; and Stanitski, D. F.: Femoral version in acute slipped capital femoral epiphysis. J. Pediat. Orthop.,Part B, 5: 74-76, 1996.Part B, 574 1996

Stanitski, C. L.; Woo, R.; and Stanitski, D. F.: Acetabular version in slipped capital femoral epiphysis: a prospective study. J. Pediat. Orthop.,Part B, 5: 77-79, 1996.Part B, 577 1996

Stanitski, D. F., and Kassab, S.: Rotational deformity in congenital hypoplasia of the femur. J. Pediat. Orthop.,17: 525-527, 1997.17525 1997

Swanson, A. B.; Greene, P. W., Jr.; and Allis, H. D.: Rotational deformities of the lower extremity in children and their clinical significance. Clin. Orthop.,27: 157-175, 1963.27157 1963 [PubMed]

Terjesen, T.; Benum, P.; Anda, S.; and Svenningsen, S.: Increased femoral anteversion and osteoarthritis of the hip. Acta Orthop. Scandinavica,53: 571-575, 1982.53571 1982

Terver, S.; Dillingham, M.; Parker, B.; Bjorke, A.; Bleck, E.; Levai, J. P.; Teinturier, P.; and Viallet, J. F.: Etude de l'orientation réelle du cotyle grace au tomodensitomettre axial ou scanner. Premiers resultats. J. radiol.,63: 167-173, 1982.63167 1982 [PubMed]

Tönnis, D.; Heinecke, A.; Nienhaus, R.; and Thiele, J.: Läß sich das Auftreten von Arthrose, Schmerz und Bewegungseinschränkung des Hüftgelenkes bei Hüftdysplasie vorausberechnen?. Zeitschr. Orthop.,117: 808-815, 1979.117808 1979

Tönnis, D.; Behrens, K.; and Tscharani, F.: A modified technique of the triple pelvic osteotomy: early results. J. Pediat. Orthop.,1: 241-249, 1981.1241 1981

Tönnis, D., and Tarhan, O.: Anderungen in der Rotation des Kniegelenkes bei Gangbildstörungen und Achsenfehlern. Orthop. Praxis,17: 235-238, 1981.17235 1981

Tönnis, D.: Die angeborene Hüftdysplasie und Hüftluxation im Kindes- und Erwachsenenalter. Unter Mitarbeit von H. Legal. Heidelberg, Springer, 1984.

Tönnis, D.: Congenital Dysplasia and Dislocation of the Hip in Children and Adults. New York, Springer, 1987.

Tönnis, D., and Heinecke, A.: Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J. Pediat. Orthop.,11: 419-431, 1991.11419 1991

Tönnis, D.; Arning, A.; Bloch, M.; Heinecke, A.; and Kalchschmidt, K.: Triple pelvic osteotomy. J. Pediat. Orthop.,Part B, 3: 54-67, 1994.Part B, 354 1994

Tönnis, D.: Triple pelvic osteotomy for lateral and anterior rotation of the dysplastic acetabulum. In Color Atlas and Text of Osteotomy of the Hip, pp. 42-50. Edited by M. F. Macnicol. London, Mosby-Wolfe, 1996.

Tönnis, D.: Rotational femoral osteotomy. In Color Atlas and Text of Osteotomy of the Hip, pp. 133-138. Edited by M. F. Macnicol. London, Mosby-Wolfe, 1996.

Tönnis, D., and Stanitski, D. F.: Early conservative and operative treatment to gain early normal growth in proximal femoral focal deficiency. J. Pediat. Orthop.,Part B, 6: 59-67, 1997.Part B, 659 1997

Trousdale, R. T.; Ekkernkamp, A.; Ganz, R.; and Wallrichs, S. L.: Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J. Bone and Joint Surg.,77-A: 73-85, Jan. 1995.77-A73 1995

Visser, J. D., and Jonkers, A.: A method for calculating acetabular anteversion, femur anteversion and the instability index of the hip joint. Netherlands J. Surg.,32: 146-149, 1980.32146 1980

Visser, J. D.; Jonkers, A.; and Hillen, B.: Hip joint measurements with computerized tomography. J. Pediat. Orthop.,2: 143-146, 1982.2143 1982

Watanabe, R. S.: Embryology of the human hip. Clin. Orthop.,98: 8-26, 1974.988 1974 [PubMed]

Wedge, J. H.; Munkacsi, I.; and Loback, D.: Anteversion of the femur and idiopathic osteoarthrosis of the hip. J. Bone and Joint Surg.,71-A: 1040-1043, Aug. 1989.71-A1040 1989

Weiner, D. S.; Cook, A. J.; Hoyt, W. A., Jr.; and Oravec, C. E.: Computed tomography in the measurement of femoral anteversion. Orthopedics,1: 299-306, 1978.1299 1978 [PubMed]

Weiner, L. S.; Kelley, M. A.; Ulin, R. I.; and Wallach, D.: Development of the acetabulum and hip: computed tomography analysis of the axial plane. J. Pediat. Orthop.,13: 421-425, 1993.13421 1993

Wiberg, G.: Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J. Bone and Joint Surg.,35-A: 65-80, Jan. 1953.35-A65 1953

Wilkinson, J. A.: Femoral anteversion in the rabbit. J. Bone and Joint Surg.,44-B(2): 386-397, 1962.44-B(2)386 1962

Wilkinson, J. A.: Experimental bone growth. In Proceedings of the British Orthopaedic Association. J. Bone and Joint Surg.,49-B(3): 583, 1967.49-B(3)583 1967

Wilkinson, J. A.: A post-natal survey for congenital displacement of the hip. J. Bone and Joint Surg.,54-B(1): 40-49, 1972.54-B(1)40 1972

Wilkinson, J. A.: Congenital Displacement of the Hip. New York, Springer, 1985.

Wissing, H., and Spira, G.: Die Bestimmung von Rotationsfehlern am Femur durch computertomographische Bestimmung des Antetorsionswinkels des Schenkelhalses. Unfallchirurgie,12: 1-11, 1986.121 1986 [PubMed]

Yoshioka, Y., and Cooke, T. D. V.: Femoral anteversion: assessment based on function axes. J. Orthop. Res.,5: 86-91, 1987.586 1987 [PubMed]

Zaoussis, A. L.; Adamopoulos, G.; Geraris, G.; Manoloudis, A.; and Galanis, I.: Osteotomy for osteoarthritis of the hip. A clinical and radiological survey. Internat. Orthop.,7: 223-228, 1984.7223 1984

Zippel, H.: Untersuchungen zur Normalentwicklung der Formelemente am Hüftgelenk im Washstumsalter. Beitr. Orthop. Traumat.,18: 255-270, 1971.18255 1971

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D. TÖNNIS, A. HEINECKE; Current Concepts Review - Acetabular and Femoral Anteversion: Relationship with Osteoarthritis of the Hip*. The Journal of Bone & Joint Surgery. 1999 Dec;81(12):1747-70.

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JBJS Case Connector

Deformity	Angle* (degrees)
CE	VCA	WBZ	CCD
Dysplasia	<20	<20	>14	—
Deep acetabulum	39 to 44	39 to 44	<-5	—
Protrusio acetabuli	>44	>44	—	—
Coxa vara	—	—	—	<126
Coxa valga	—	—	—	>139

Deformity	Angle* (degrees)
CE	VCA	WBZ	CCD
Dysplasia	<20	<20	>14	—
Deep acetabulum	39 to 44	39 to 44	<-5	—
Protrusio acetabuli	>44	>44	—	—
Coxa vara	—	—	—	<126
Coxa valga	—	—	—	>139

Grade	Range (degrees)	Description
-3	<10	Severely decreased
-2	10 to 14	Moderately decreased
1	15 to 20	Assumed normal range
+2	21 to 25	Moderately increased
+3	>25	Severely increased

Grade	Range (degrees)	Description
-3	<10	Severely decreased
-2	10 to 14	Moderately decreased
1	15 to 20	Assumed normal range
+2	21 to 25	Moderately increased
+3	>25	Severely increased

Grade	Instability Index	No. (Percent) of Patients (N = 159)*	No. (Percent) of Hips (N = 290)
-3	<20	77 (48)	110 (38)
-2	20 to <30	55 (35)	71 (24)
1	30 to 40	54 (34)	68 (23)
+2	>40 to 50	23 (14)	25 (9)
+3	>50	11 (7)	16 (6)

Extract

Introduction

Etiology of Altered Acetabular and Femoral Anteversion

Associated Conditions

Compensatory Torsional Deformities in the Lower Extremity

Diagnosis of Decreased Anteversion

Clinical and Radiographic Study

Materials and Methods

Data on the Patients

Imaging Studies

Measurement of Acetabular Anteversion

Measurement of Femoral Anteversion

Normal and Abnormal Ranges of Femoral and Acetabular Anteversion

Clinical Evaluation of Rotation of the Hip

Clinical and Radiographic Findings

Pain

Rotation of the Hip

Osteoarthritis

Effects of Various Combinations of Femoral and Acetabular Anteversion

Dysplasia of the Hip, Deep Acetabulum, or Protrusio Acetabuli

Slipped Capital Femoral Epiphysis, Coxa Vara, or Coxa Valga

Tibial Torsion

Operative Treatment

Selection of Patients

Operative Correction of Femoral Anteversion

Operative Correction of Acetabular Anteversion

Treatment Considerations

Treatment of Osteoarthritis

Conclusions and Recommendations

References

Topics

First Page Preview

References

Instability Index⁴³	No. of Patients (N = 143)*	No. of Hips (N = 250)	Percent of Hips with No Pain†	Percent (Ninety-five Percent Confidence Interval) of Hips with Pain†
°20	73	102	28	73 (62 to 81)
20 to <30	47	62	45	55 (42 to 68)
30 to 40‡	45	54	48	52 (38 to 66)
>40	22	32	25	75 (57 to 89)

Instability Index⁴³	No. of Patients (N = 118)*	No. of Hips (N = 189)	Internal Rotation (degrees)	External Rotation (degrees)	P Value†
<20	57	82	17	46	<0.001
20 to <30	33	40	18	39	<0.001
30 to ‡40	29	35	33	36	0.0414
>40	23	32	42	37	0.161

Instability Index⁴³	No. of Patients (N = 152)*	No. of Hips (N = 275)	Percent of Hips with No Osteoarthritis†	Percent (Ninety-five Percent Confidence Interval) of Hips with Osteoarthritis†
<20	73	103	59	41 (31 to 51)
20 to <30	55	71	70	30 (19 to 42)
30 to 40‡	52	65	75	25 (14 to 37)
>40	26	36	67	33 (19 to 51)

Group	Grade of Anteversion (Acetabular/Femoral)	No. (Percent) of Patients (N = 147)	No. (Percent) of Hips (N = 254)
1	-3/-3	23 (16)	26 (10)
2	-2, -3/-2, -3	62 (42)	78 (31)
3	-2, -3/+2,+3	18 (12)	24 (9)
4	+2, +3/-2, -3	39 (27)	53 (21)
5	-2, -3/1	12 (8)	13 (5)
6	1/-2, -3	45 (31)	50 (20)
7	1/1	7 (5)	7 (3)
8	+3/+3	3 (2)	5 (2)
9	+2,+3/+2,+3	11 (7)	16 (6)

Group	Grade of Anteversion (Acetabular/Femoral)	No. of Patients (N = 131)	No. of Hips (N = 239)	No. (Percent) of Hips with Pain
Grade 0	Grade 1	Grade 2	Grade 3
1	-3/-3	23	25	8 (32)	6 (24)	9 (36)	2 (8)
2	-2, -3/-2, -3	62	76	24 (32)	24 (32)	23 (30)	5 (7)
3	-2, -3/+2, +3	16	20	10 (50)	5 (25)	4 (20)	1 (5)
4	+2, +3/-2, -3	32	43	16 (37)	12 (28)	14 (33)	1 (2)
5	-2, -3/1	12	13	8	0	5	0
6	1 /-2, -3	36	40	13 (33)	15 (38)	12 (30)	0 (0)
7	1/1	5	5	2	1	1	1
8	+3/+3	3	5	1	3	0	1
9	+2,+3/+2,+3	8	12	2	8	1	1

Group	Grade of Anteversion (Acetabular/Femoral)	No. of Patients (N = 103)	No. of Hips (N = 178)	Internal Rotation* (degrees)	External Rotation* (degrees)	P Value†
1	-3/-3	17	20	17 ± 11.2	40 ± 9.9	0.00001
2	-2, -3/-2, -3	47	59	18 ± 11.7	44 ± 13.9	0.00000
3	-2, -3/+2, +3	10	13	50 ± 21.4	30 ± 16.6	0.00684
4	+2, +3/-2, -3	24	30	25 ± 20.0	40 ± 13.0	0.00067
5	-2, -3/1	8	9	21 ± 19.6	44 ± 16.3	0.05469
6	1/-2, -3	25	28	18 ± 14.5	46 ± 15.4	0.00000
7	1/1	3	3	22 ± 33.3	23 ± 16.1	1.00000
8	+3/+3	3	5	46 ± 27.2	42 ± 5.7	0.75000
9	+2, +3/+2, +3	7	11	42 ± 19.9	43 ± 8.1	0.97656

Grade	Characteristics
0	No signs of osteoarthritis
1	Slight narrowing of joint space, slight lipping at joint margin, slight sclerosis of femoral head or acetabulum
2	Small cysts in femoral head or acetabulum, increasing narrowing of joint space, moderate loss of sphericity of femoral head
3	Large cysts, severe narrowing or obliteration of joint space, severe deformity of femoral head, avascular necrosis

Group	Grade of Anteversion (Acetabular/Femoral)	No. of Patients (N = 139)	No. of Hips (N = 257)	No. (Percent) of Hips with Osteoarthritis
Grade 0	Grade 1	Grade 2	Grade 3
1	-3/-3	22	24	15 (63)	4 (17)	2 (8)	3 (13)
2	-2, -3/-2, -3	58	73	47 (64)	15 (21)	7 (10)	4 (5)
3	-2, -3/+2,+3	17	23	19 (83)	3 (13)	1 (4)	0 (0)
4	+2, +3/-2, -3	37	51	31 (61)	15 (29)	4 (8)	1 (2)
5	-2, -3/1	12	13	11	1	1	0
6	1/-2, -3	44	49	38 (78)	7 (14)	2 (4)	2 (4)
7	1/1	7	7	4	1	1	1
8	+3/+3	2	4	2	1	1	0
9	+2, +3/+2, +3	8	13	8	4	1	0

Deformity	No. of Patients	No. of Hips	Anteversion*
Grade -3	Grade -2	Grade 1	Grade +2	Grade +3
Dysplasia of the hip
Acetabular anteversion	25	31	9 (29)	5 (16)	11 (35)	1 (3)	5 (16)
Femoral anteversion	25	32	19 (59)	2 (6)	3 (9)	1 (3)	7 (22)
Deep acetabulum
Acetabular anteversion	35	40	10 (25)	8 (20)	9 (23)	5 (13)	8 (20)
Femoral anteversion	32	36	22 (61)	5 (14)	2 (6)	2 (6)	5 (14)
Protrusio acetabuli
Acetabular anteversion	8	12	2	2	2	2	4
Femoral anteversion	8	12	2	2	1	3	4

Group	Rotation of Knee	No. of Patients	No. of Hips	Femoral Anteversion*† (degrees)
1	0 to 5 degrees
	External	30	36	6.02 ± 7.86†
	Internal	26	31	8.87 ± 12.06†
2	6 to 10 degrees
	External	19	24	3.87 ± 11.98§
	Internal	17	22	12.14 ± 12.17§
3	>10 degrees
	External	13	16	3.00 ± 14.35
	Internal	23	31	16.16 ± 11.40

Class	Characteristics
1	Marked decrease: 2 grades of change, including a change from grade 2 to grade 1
2	Moderate decrease: 1 grade of change, except for a change from 2 to grade 1
3	No change
4	Worse pain

Class	Characteristics
1	Marked decrease: 2 grades of change, including a change from grade 2 to grade 1
2	Moderate decrease: 1 grade of change, except for a change from 2 to grade 1
3	No change
4	Worse pain

Type of Operation	No. of Hips
Rotation osteotomy of femur
Performed	39
Recommended	10
Valgus rotation osteotomy
Performed	10
Recommended	1
Derotation osteotomy	7
Valgus osteotomy	1
Rotation flexion valgus osteotomy	3
Rotation flexion osteotomy	3
Rotation osteotomy of acetabulum	3
Rotation osteotomy of acetabulum and femur	2
Triple osteotomy with rotation osteotomy of femur	15
Total hip arthroplasty recommended	14
Triple osteotomy without correction of decreased acetabular anteversion	8
Triple osteotomy without correction of decreased femoral anteversion	3

Type of Femoral Osteotomy	No. of Hips	Marked Decrease*	Moderate Decrease*	No Change*	Increase*
Varus	73	45 (62)	15 (21)	9 (12)	4 (5)
Valgus	9	5	1	3	0
Rotation	21	19 (90)	1 (5)	0 (0)	1 (5)
Varus + rotation	25	16 (64)	3 (12)	5 (20)	1 (4)
Valgus + rotation	8	6	2	0	0
Total	136	91 (67)	22 (16)	17 (13)	6 (4)