Aims
Assessment of lower limb alignment is a cornerstone of orthopaedics. Few studies look
at rotational alignment in the axial plane as measured by femoral version (FV) and tibial
torsion (TT), both of which have implications for hip, knee, and ankle pathology. This
review provides an overview of the axial rotation and evaluates CT-b ased measurement
methods for FV and TT to identify the most reliable and reproducible techniques for use in
clinical practice.
Methods
A systematic PRISMA- guided review assessed original CT-b ased methods, examining
inter- and intraobserver reliability (intraclass correlation coefficient (ICC)), frequency of
use, and validation.
Results
Seven FV and nine TT CT- based techniques were identified. FV had a weighted mean of
17.8° anteversion (-9 ° to 60°). TT had a weighted mean of 30.8° (2° to 82°). ICCs ranged from
good to excellent. The Murphy method (FV) and Goutallier method (TT) had the highest
reliability and clinical utility.
Conclusion
Lower limb axial rotational profile plays an important role in the management of hip, knee,
and ankle arthroplasty surgery as well as many other orthopaedic pathologies. The Murphy
and Goutallier methods should be adopted as standard for measuring FV and TT. Their high
reproducibility and validation make them ideal for consistent clinical and research use.
