FP2.2 Age and sex-related developmental changes in lesser trochanteric version and its relationship to femoral version in normal patients

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ID: 331205
2026
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Abstract
Abstract ICLA02 - Demystifying the Deformed Hip: Practical Principles of Pelvic and Femoral Osteotomies, Auditorium A (BMCC Level 1), October 8, 2026, 10:30 - 12:30 Introduction Femoral version is a major contributor of femoroacetabular impingement (FAI) and hip instability. Femoral anteversion is increased in childhood and remodels toward 15-25° at skeletal maturity. While segmental contributions to the overall femoral torsion have been described, the orientation of the lesser trochanter, an important biomechanical landmark serving as the insertion of the iliopsoas tendon, relative to the posterior condylar axis is less understood. We aimed to define normative lesser trochanteric version across age and examine its relationship to femoral anteversion in males and females. We hypothesized that lesser trochanteric version and femoral anteversion are highly correlated and both significantly decrease by age. Methods Following IRB approval, New Mexico Decedent Image Database (NMDID) was queried to identify CT scans with full coverage of the hip and femur from subjects with no documented bone and joint pathology (n=1,222 hips, 611 subjects, age: 30.4 +/- 8.8; 67% males). A custom-developed and validated program (VirtualHip, Boston Children’s Hospital) was used to automatically segment bones, identify landmarks, define anatomical coordinate system based on ISB recommendations, and measure anatomical features. Femoral anteversion and lesser trochanteric version relative to the posterior condylar axis were measured. Associations with age were evaluated using generalized additive models (GAM), stratified by sex. Relationships between femoral anteversion and lesser trochanteric version were assessed using linear regression. Results Femoral anteversion decreased with age until adolescence (P<0.01 both sexes), after which no further change was observed. There was no significant difference in femoral anteversion remodeling when comparing males and females. Lesser trochanteric version increased (more anteversion) in both males (P=0.013) and females (P=0.015). Males had a significantly larger trochanteric version (more anteverted) than females, after adjusting for age (P<0.001). Across the cohort, femoral anteversion and lesser trochanteric version were strongly positively correlated for both males (R2=0.36; p<0.001) and females (R2=0.41; p<0.001). Discussion This study describes the change in lesser trochanteric version with age in normal patients. Our data demonstrates that lesser trochanteric version increases with skeletal maturity in both males and females, and that change in femoral anteversion and lesser trochanteric version are strongly correlated. Further studies are needed to evaluate these parameters in patients with pathologic versional abnormalities. Significance/Clinical Relevance Defining the developmental course of lesser trochanteric version may inform the evaluation of patients with pathologic versional abnormalities. ultimately serving as a guide for selecting the appropriate level of osteotomy (intertrochanteric versus subtrochanteric) to optimize rotational correction.
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Authors David Liu, Mahdi Aghaalikhani, Alexandria Taylor, Yi‐Meng Yen, Young-Jo Kim, Mohammedreza Movahhedi, Ata M. Kiapour
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.010
URL
https://doi.org/10.1093/jhps/hnag043.010
Keywords Keywords not found

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