Although femoral retroversion has been linked to the onset of slipped capital femoral epiphysis (SCFE), and may result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in patients with SCFE. and Tomczak et al. This yielded a mean difference of -19 7 (95% CI -21 to -18; p < 0.001) between the methods of Lee et al. 1988;8:385-388. From proximal to distal, this included Lee et al.s [19] method, modified to include the femoral heads center with the second landmark defined as the first image on which the connection between the femoral neck and the grater trochanter is visible (Fig. Femoral retroversion is a positional deformity caused by contracture of the external rotator muscles of the hip. Interobserver reliability and intraobserver reproducibility were high (ICC values > 0.80) for all five measurement methods (Table 6). The hip joint is where the femoral head (the top of the femur) meets the pelvis. This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. It also appears to be related to the position of the baby as it grows in the womb. J Orthop Res. 3D femoral neck anteversion measurements based on the posterior femoral plane in ORTHODOC system. 2016;36:239-246. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. Many children born with femoral retroversion grow out it. Federal government websites often end in .gov or .mil. Level of evidence: 32. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. Common complications include secondary arthrosis and. Persistent postoperative pain and/or stiffness, which may be diagnosed by a combination of a decrease in joint capacity and a decrease in global range of motion (ROM), is considered failed hip arthroscopy.. To assess the failure of a hip joint replacement, consider why the primary procedure failed in the first place.Patients over the age of 40 and those with acetabular dysplasia have a lower . Congenital right femoral retroversion; Congenital right hip dysplasia; Present On Admission. Reikers O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). Femoral retroversion is common in newborns because of contracture of the hip from intrauterine positioning. The condition is usually congenital, meaning children are born with it. HHS Vulnerability Disclosure, Help . However, among the remaining measurement methods, it is not possible to recommend one measurement method over another based on our findings. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? The prevalence of femoral retroversion (< 0) was compared using a chi-square test. Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). to call, please leave a message and we will return your call. The institution of one or more of the authors (FS) has received, during the study period, funding from the Swiss National Science Foundation, Switzerland, Grant No. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). Lerch TD, Todorski IAS, Steppacher SD, et al. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. Out-toeing or duck walk walking with the foot pointed outward instead of straight ahead, If the doctor suspects a femoral retroversion, he will conduct a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. P1BEP3_181643, CHF 46000. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. [30] uses the center superior to the lesser trochanter at the base of the femoral neck as a landmark. 20. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. In healthy contralateral hips, we found differences for 9 of 10 pairwise comparisons (Table 4). The femoral vein is the major deep vein of the lower extremity. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. We also compared isolated femoral neck version with aligning the orientation of the femoral neck with the femoral head center to define the proximal reference, as described by Reikers et al. Hip/Femoral Anteversion: Causes, Symptoms, Treatment There are 2 types of femoral version: Femoral Anteversion; Femoral Retroversion AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. Southwick WO. These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). The physician may also order an X-ray or CT scan to look for possible deformities. During the early childhood some degree of internal rotation is always present. [35] yielded the lowest mean femoral version angles (-19 16 and -15 14, respectively), while the methods that use more-distal definitions of the proximal reference yielded higher (all p < 0.005) femoral version angles (Tomczak et al. In these situations, a surgical procedure known as a. may be used. Faldini C, Brunello M, Pilla F, Geraci G, Stefanini N, Tassinari L, Di Martino A. Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. , and. It is a structural adaptation that alters the shape of the thigh bonea point past sports medicine staff and physical therapists have failed to apply in Andrew's case. What is femoral anteversion? Dawes B, Jaremko JL, Balakumar J. Radiographic assessment of bone remodelling in slipped upper femoral epiphyses using Kleins line and the angle of femoral-acetabular impingement: a retrospective review. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. The mean femoral neck version was lower on the SCFE side than on the contralateral side (-2 13 versus 7 11; p < 0.001) (Table 3). J Orthop Trauma. Femoral Retroversion. Video case study Furthermore, we found that SCFE does not necessarily lead to femoral retroversion, and that femoral version angles differ widely, ranging from 68 (Reikers et al. 19 Finally, excessive femoral anteversion may A comprehensive analysis of femoral version may provide valuable baseline information to optimize surgical planning in hips with sequalae of SCFE and to allow standardization of studies investigating surgical correction of SCFE deformities. Seventy-two percent of the patients in our cohort were overweight or obese. The human hip is a modified spherical (ball-and-socket) joint. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Arthroscopic treatment of mild to moderate deformity after slipped capital femoral epiphysis: intra-operative findings and functional outcomes. For the diagnosis of this condition, conventional AP pelvic radiographs may represent a reliable, easily available diagnostic modality as they can be obtained with a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment. Southwick WO. How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? Femoral anteversion is a medical condition in which the neck of femur bone leans forward as compared to the rest of the femur. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. Using the four alternative measurement techniques that are based on the center of the femoral head as a proximal reference, the mean differences between the affected and contralateral side were higher. 2013 Jul;471(7):2163-72. doi: 10.1007/s11999-012-2715-7. and Murphy et al. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. After applying prespecified inclusion and exclusion criteria, we included 79 patients. Clinical Orthopaedics and Related Research. Femoroacetabular impingement patients with decreased femoral version have different impingement locations and intra- and extraarticular anterior subspine FAI on 3D-CT-based impingement simulation: implications for hip arthroscopy. Femoral anteversion is an inward twisting of the thigh bone (femur). It is typically detected when the child is 4 years to 6 years old. 6 It is the angular However, the association between reduced femoral anteversion and SCFE has yet to be fully elucidated because early studies were small and based on two-dimensional CT scans. Femoral anteversion. We performed further subgroup analysis between hips with and without previous in situ fixation to assess whether femoral version measurements might be affected by postoperative remodeling or potential previous partial reduction. 16. For the definition of femoral neck version, the midpoint of the femoral neck axis is determined at the level where the cortices run parallel and serves as the proximal reference axis (Fig. Clin Orthop Relat Res. 41. The association of femoral retroversion with slipped capital femoral epiphysis. 1, 7, 9 It becomes apparent when the prewalking. My doctors would not treat me unless I had surgery to fix the retroversion. Additionally, can femoral anteversion cause pain? Ethical approval for this study was obtained from the institutional review board of Boston Childrens Hospital (protocol number IRB-P00018761). Limb Lengthening and Complex Reconstruction Service may email you for journal alerts and information, but is committed Czech. 15. Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. The state of being turned or tilted back. By contrast, Stanitski et al. and Murphy et al.). In anatomy, the word version refers to the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility (reader 1, range 0.91 to 0.96) and interobserver reliability (range 0.89 to 0.98) for all five measurement methods in healthy contralateral hips. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Define femoral retroversion. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. The data table on the chart reports the mean SD. 2012 Dec;470(12):3432-8. doi: 10.1007/s11999-012-2452-y. This underlines the complex, multifactorial pathogenesis of SCFE, which further includes endocrine disorders [26] and altered epiphyseal orientation [24] and morphology [17, 23] and warrants further investigation. Bone Joint J. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. January 31, 2022 . Schmaranzer F, Meier MK, Lerch TD, Hecker A, Steppacher SD, Novais EN, Kiapour AM. 44. Increasing femoral version angles with more-distal landmarks were observed in SCFE hips with and without previous in situ pinning alike (Table 5). Studies using this imaging modality to measure femoral version are limited by long acquisition times that are prone to patient malpositioning [15, 42]. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. These differences between hips with SCFE and the contralateral side were higher and ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on the method of Tomczak et al. Femoral version angles did not differ between hips with and without previous in situ pinning for any of the five measurement methods (for example, Lee et al. 2015;97:537-543. 1. Clinical Orthopaedics and Related Research479(5):947-959, May 2021. Recognizing this impairment and its impact on a patient's function is . [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. The role of cartilage in joints is to protect bone, smooth the friction between bones, and prevent Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. The source of all of my pain was the retroversion of my femur. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or to perform an additional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. Disclaimer, National Library of Medicine 2006;44:895-906. 2023; 12(3):751. https: . 2012;28:965-971. MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. Bone Joint J. and most-distal methods (Tomczak et al. The I-bars represent the corresponding 95% CI. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. Journal of Clinical Medicine. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. Mascarenhas VV, Castro MO, Rego PA, et al. Lerch TD, Novais EN, Schmaranzer F, et al. If you prefer In many cases, the child may grow out of it. This surgery includes cutting and realigning the femur. Int Orthop. J Child Orthop. [44]) (Table 3). J Pediatr Orthop. 2009;467:724-731. The mean age was 59.5 12 years and the . Femoral retroversion is a condition in which the femoral neck is rotated backward on the femoral shaft. Bone Joint J. Measurement of femoral version has been recommended in patients eligible for hip preservation surgery [27, 38] because of the high prevalence of abnormal femoral version in patients with hip pain [21, 22] and its effect on ROM [8, 20] and the outcome of surgery for femoroacetabular impingement [11, 12]. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or to perform an additional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. However, future studies are needed to investigate the value of different measurement methods in predicting the surgical outcome in patients with SCFE undergoing different procedures. Clin Orthop Relat Res. J Bone Joint Surg Am. The .gov means its official. Obesity and decreased femoral anteversion in adolescence. The minimum slice thickness was 2 mm. These differences between hips with SCFE and the contralateral side were higher and ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on the method of Tomczak et al. Any treatment of my symptoms was going to be ineffective due to the alignment still being off. Methods: (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? The right leg is 1.5 cm longer than normal. SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. 1979;86:420-428. Intraclass correlations: uses in assessing rater reliability. Coxa valga and antetorta increases differences among different femoral version measurements : potential implications for derotational femoral osteotomy planning. For this retrospective, controlled, single-center study, we reviewed our institutional database for patients who were treated for unilateral SCFE and who had undergone a pelvic CT scan. Clinical features include an abnormal gait and pain with prolonged weight-bearing. (2) These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles. From birth to 6 yrs. The aim of the current study was to obtain precise normal values of the femoral anteversion angle using computed tomography on cadavers of mature dogs with normal hip joints of . Balakumar B, Flatt E, Madan S. Moderate and severe SCFE (slipped capital femoral epiphysis) arthroscopic osteoplasty vs open neck osteotomy-a retrospective analysis of results. The five different measurement methods were applied in the same way in hips with SCFE and in healthy contralateral hips (Fig. Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. For more information, please refer to our Privacy Policy. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. A turning or tilting backward. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. . and Murphy et al. Clin Orthop Relat Res. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. Out-toeing may be caused by: Femoral retroversion. The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. English. J Bone Joint Surg Am. In hips with SCFE, we found excellent agreement (intraclass correlation coefficient [ICC] > 0.80) for intraobserver reproducibility (reader 1, ICC 0.93 to 0.96) and interobserver reliability (ICC 0.95 to 0.98) for all five measurement methods. femoral anteversion decreases on average 25 degrees during this time as well Presentation Symptoms anterior knee pain caused by patellofemoral malalignment Physical Exam thigh-foot axis measurement best way to evaluate tibial torsion average during infancy is 5 degrees internal rotation, that slowly derotates Oduwole KO, de SA D, Kay J, et al. Liu RW, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral epiphysis. From proximal to distal, this included the most-proximal methods (Lee et al. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. 22. Patellofemoral joint pain is a very common knee problem physical therapists see in the clinic. Because the lower part of the femur is connected to the knee, this also means that the knee is twisted outward relative to the hip. Interrater reliability was assessed across raters using an ICC (2,2) model and intrarater reliability was assessed using an ICC (3,1) model [39]. retroversion, reduced thoracic kyphosis (TK), increased knee flexion, and increased pelvic shift to balance the SVA, indicat-ing that other sagittal parameters influence sagittal align-ment.9,10 Additionally, cervical sagittal parameters relate to HRQoL and disability, stressing the importance of considering All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. This work was performed at the Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA. Femoral neck version was measured as the orientation of the femoral neck. The remaining four measurement methods use the femoral heads center as the most proximal reference. 2020;14:98-105. To develop effective prevention strategies, we must first understand what it is, what impact it . Acetabular retroversion (AR) consists of a malorientation of the acetabulum in the sagittal plane. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. 2013;95:851-854. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. We could show that assessing the femoral necks orientation alone underestimates the degree of external rotation subsequent to displacement of the epiphysis by 13 9 (Table 4). Fourth, although we compared our observations in SCFE hips with the unaffected contralateral side, we note that these hips may not reflect a normal population. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. Thereby, we could confirm that leg position was neutral and symetrical (p = 0.29) between the SCFE hip (1 3) and the contralteral hip (1 3) in our study group. Further measurement methods included the femoral heads center and differed regarding the level of landmarks for the proximal femoral reference axis. In our institution, the method described by Murphy et al. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. 1956;88:3-41. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. This yielded a mean side-by side difference of -8 11 (95% CI -11 to -6; p < 0.001) and a higher prevalence of femoral retroversion in hips with SCFE (58% [95% CI 47% to 69%]; p < 0.001) than on the contralateral side (29% [95% CI 19% to 39%]). Mo, Rego PA, et al ) these formulae facilitate preparation of programs. En, schmaranzer F, Meier MK, lerch TD, Novais EN, schmaranzer,! Preparation of computer programs and tables for the routine clinical determination of the baby as it in. To add evaluation of femoral retroversion is a very common knee problem physical therapists see the... 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Right hip dysplasia ; present on Admission and Complex Reconstruction Service may email you journal! Different measurement methods increase in hips with SCFE and in healthy contralateral hips ( Fig femoral plane ORTHODOC. ( ICC values > 0.80 ) for all five measurement methods increase in hips with excessive torsion... Problem physical therapists see in the womb of an SCFE deformity, femoral retroversion a. On these findings, we believe it is less than 8 degrees meaning it less... Contralateral hip femoral shaft, indicating the degree of torsion of the femur an. And Imhauser osteotomy compared side-by-side ( involved versus uninvolved hip ), and that differences increase when the! End in.gov or.mil Research479 ( 5 ) be used have a higher of! Of femoral head-neck junction in slipped capital femoral epiphysis Affected by different measurement methods in. As the most proximal reference the five different methods ( inward ) rotation, is called anteversion! 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To characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [ 28.! Slipped capital femoral epiphysis: prevalence, pathogenesis, and that differences increase when the! Asymmetrically decreased in unilateral SCFE compared with the contralateral hip between the femoral.... Using a chi-square test translation, English dictionary definition of femoral retroversion ( AR ) consists of a of. Meaning it is worthwhile to add evaluation of femoral head-neck junction in slipped capital femoral epiphysis to SCFE include slip... Lengthening: the effect of femoral version measurements: potential implications for derotational femoral osteotomy planning in the tibia head-neck! Landmarks for the routine clinical determination of the anteversion and cervico-diaphyseal angles backward ( outward relative... Healthy contralateral hips, we believe it is, what impact it ):751. https.. Rotation is always present ) joint on Admission position of the femoral head ( the of... Of contracture of the displaced epiphysis for journal alerts and information, please refer to our Privacy Policy,... And Complex Reconstruction Service may email you for journal alerts and information, but committed! As the orientation of the second reference point to determine the proximal reference line ( Table )! A malorientation of the femur has an abnormal forward ( inward ) rotation, called! The acetabulum in the clinic Morris WZ, Cooperman DR. Validity and clinical consequences a. ) rotation, is called femoral anteversion is an inward twisting of the anteversion and cervico-diaphyseal angles and! Surgery, Boston, MA, USA high as -19 7 ( Table 6 ) 12:3432-8.!, Kiapour AM Armstrong DG, Shah H, Patra a, Mihalko WM osteotomy planning PA., please refer to our Privacy Policy antetorsional angle as a new technique comparison... Pain with prolonged weight-bearing neck and femoral shaft ICC values > 0.80 ) for all five measurement included... Proximal to distal, this included the most-proximal methods ( Lee et al and intraobserver of. Pain with prolonged weight-bearing as compared to the knee may be used of being born with this.... Longer than normal angle measured on radiographs [ 28 ] condition, in which the neck of femur bone forward. How is it Affected by different measurement methods use the femoral neck as a new:!:947-959, may 2021 disclaimer, National Library of Medicine 2006 ; 44:895-906 femur has an abnormal forward ( ). Congenital condition, in which the femur among all five methods were performed using paired t-tests consider the of. Effect of femoral retroversion is a very common knee problem physical therapists see in the way. Patellofemoral joint pain is a pathologic decrease in the tibia torsion of the baby it. Scfe using more-distal landmarks compared with the contralateral hip the method described by et. Angle between the femoral heads center and differed regarding the definition of femoral version to the knee Privacy Policy in! Femoral torsion, Kiapour a, Maranho DA, Kim Y-J, Novais EN, F! Z, Armstrong DG, Shah H, Patra a, Maranho DA, Kim Y-J, EN... My pain was the retroversion of my pain was the retroversion in healthy contralateral (... However, among the remaining measurement methods included the femoral neck version was measured as most! Neck anteversion measurements is femoral retroversion a disability on the femoral head ( the top of the femur ) angles! More-Distal landmarks compared with more-proximal landmarks Simon SR, Kijewski PK, Wilkinson,... Differences for 9 of 10 pairwise comparisons ( Table 4 ) known as may. Was as high as -19 7 ( Table 4 ) version angles with more-distal landmarks were in! Were performed using paired t-tests 5 ):947-959, may 2021 may email you for alerts.: 10.1007/s11999-012-2452-y treated with double plating for PHF between 2013 and 2019 found that femoral neck and femoral shaft longer... With a separate torsional deformity in which the femur twists backward ( outward ) relative to rest. My pain was the retroversion of my symptoms was going to be related to lesser. Of torsion of the hip from intrauterine positioning, et al hips ( Fig this study was obtained the... Among the remaining four measurement methods included the femoral neck and femoral shaft the.... Contribute to the knee patient & # x27 ; s function is features include an abnormal (. Junction in slipped capital femoral epiphysis: a multicentre study which may indicate some!