Change of Femoral Anteversion Angle in Children With Intoeing Gait Measured by Three-Dimensional Computed Tomography Reconstruction: One-Year Follow-Up Study

Abstract

Objective To evaluate femoral anteversion angle (FAA) change in children with intoeing gait depending on age, gender, and initial FAA using three-dimensional computed tomography (3D-CT). Methods The 3D-CT data acquired between 2006 and 2016 were retrospectively reviewed. Children 4 to 10 years of age with symptomatic intoeing gait with follow-up interval of at least 1 year without active treatment were enrolled. Subjects were divided into three groups based on age: group 1 (>= 4 and < 6 years), group 2 (>= 6 and < 8 years), and group 3 (>= 8 and < 10 years). Initial and follow-up FAAs were measured using 3D-CT. Mean changes in FAAs were calculated and compared. Results A total of 200 lower limbs of 100 children (48 males and 52 females, mean age of 6.1 +/- 1.6 years) were included. The mean follow-up period was 18.0 +/- 5.4 months. Average initial and follow-up FAA in children with intoeing gait was 31.1 degrees +/- 7.8 degrees and 28.9 degrees +/- 8.2 degrees, respectively. The initial FAA of group 1 was largest (33.5 degrees +/- 7.7 degrees). Followup FAA of group 1 was significantly reduced to 28.7 degrees +/- 9.2 degrees (p=0.000). FAA changes in groups 1, 2, and 3 were -6.5 degrees +/- 5.8 degrees, -6.4 degrees +/- 5.1 degrees, and -5.3 degrees +/- 4.0 degrees, respectively. These changes of FAA were not significantly (p=0.355) different among the three age groups. However, FAA changes were higher (p=0.012) in females than those in males. In addition, FAA changes showed difference depending on initial FAA. When initial FAA was smaller than 30 degrees, mean FAA change was -5.6 degrees +/- 4.9 degrees. When initial FAA was more than 30 degrees, mean FAA change was -6.8 degrees +/- 5.4 degrees (p=0.019). Conclusion FAA initial in children with intoeing gait was the greatest in age group 1 (4-6 years). This group also showed significant FAA decrease at follow-up. FAA changes were greater when the child was a female, younger, and had greater initial FAA.