ArticleJournal of orthopaedic surgery and research2026
The lesser trochanter index: detection of increased femoral version in patients with symptomatic hip disease.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFemoral version (FV) affects hip biomechanics and postoperative outcomes in developmental dysplasia of the hip (DDH) as well as femoroacetabular impingement (FAI). However, its assessment depends on advanced imaging modalities such as CT and MRI with limited clinical utility for cost-effective screening of FV. This study aimed to implement and test the diagnostic accuracy of the lesser trochanter index (LTI) as an indicator for increased femoral FV on pelvic radiographs in patients with symptomatic DDH and FAI.
methodsThis prospective, diagnostic cohort study included symptomatic patients with DDH (n = 194 patients) and FAI (n = 22 patients) undergoing hip preservation surgery. Patients underwent a standardized protocol of anteroposterior pelvic radiographs and magnetic resonance imaging (MRI) of the pelvis, hip and lower extremity. FV was measured in accordance to the Murphy method. The lesser trochanter morphology on pelvic radiographs was used to calculate the lesser trochanter index (LTI). It was predefined as positive to detect increased FV (>25/30° Murphy) with a cut-off value of > 1.5.
resultsA total of 409 hips in 216 patients were included. Patients with DDH were significant older (30.7 vs. 25.5, p = 0.008), were more frequently female (77.3% vs. 34.8, p < 0.001) and had a significant higher femoral version compared to FAI (28 vs. 21.8, p = 0.013). The LTI > 1.5 showed a high sensitivity (25°/30° FV - 90.9/93.1%), but a low specifity (25°/30° FV - 20.3/18.9%) to detect increased FV. The negative predictive value remained moderate (25°/30° FV - 65.5/81%), while the LTI has only a weak positive predictive value (25°/30° FV - 57.5/42.7%).
conclusionThe LTI represents a clinical useful and widely available indicator of increased FV and can optimize the use of subsequent MRI and CT assessment. However, due to its moderate diagnostic accuracy, the LTI is more a rule- out test, than a diagnostic marker of increased FV and cannot replace advanced imaging modalities.
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