Association of femoral retroversion and out-toeing gait with development of hip osteoarthritis and treatment: a systematic review

Background and purpose: Femoral retroversion (FR) is known to be a predisposing factor for femoro-acetabular impingement and is hypothesized to constitute a risk factor for early osteoarthritis of the hip. We performed a systematic review to comprehensively evaluate the evidence for FR being associated with hip osteoarthritis (OA) and the results of early treatment among adolescents and young adults. Methods: A systematic literature search was conducted in biomedical databases (PubMed, Scopus, Web of Science, Cochrane, Google Scholar) from 1970 to 2023. Inclusion criteria were studies in English or German. Studies were selected based on predefined criteria and according to PRISMA guidelines. Results: Of 37 initial records, 11 studies were included, involving 1,807 patients and 785 cadavers. Most studies were conducted in North America (7), Europe (3), and Australia (1). Diagnostic modalities included clinical examination, radiography, computed tomography, and magnetic resonance imaging. Findings from preclinical and clinical studies suggest an association between FR and hip pain, impingement, and OA. Studies reported that 5-11% of patients requiring total hip replacement exhibited FR and emphasized pain in young adults as a prompt for torsional assessment. However, contradictory results regarding the need for surgical correction were found. Surgery appears effective in relieving hip pain. Concerns exist regarding spontaneous correction at a young age and the risk of overcorrection with surgery. Conclusion: Our review underscores the lack of evidence regarding FR as a risk factor for hip osteoarthritis, and contradictory results regarding the need for surgical correction were found.