The Modified Budin View: A Reliable and Accessible Screening Tool for Femoral Version Deformities in Joint-Preserving Hip Surgery

Femoral version deformities are key in the diagnostic evaluation of young patients with hip pain. While computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used for femoral version assessment, their limitations include a lack of standardized reference values, high costs, and accessibility constraints. An accessible and reproducible alternative is needed, particularly in the context of joint-preserving hip surgery. To evaluate the reliability and reproducibility of femoral version measurements on the modified Budin view, to compare these measurements with 4 established cross-sectional imaging methods (CT or MRI), and to determine the diagnostic accuracy of the modified Budin view in identifying abnormal femoral version. Case series; Level of evidence, 4. The authors retrospectively analyzed the records of 93 patients (107 hips; mean age, 31 &#xb1; 9 years [range, 16-55 years]; 43 female hips [40%]) evaluated for joint-preserving hip surgery at a specialized tertiary center. Femoral version was measured using the modified Budin view and compared to 4 cross-sectional imaging methods (CT and MRI) using Bland-Altman analysis and diagnostic accuracy metrics. The mean femoral version measured on the modified Budin view was 13&#xb0;&#xb1; 7&#xb0; (95% CI, 12&#xb0;-14&#xb0;). The technique demonstrated excellent intra- and interobserver reliability (ICC, 0.99 and 0.98, respectively). Compared to the Reiker&#xe5;s method, the mean difference was 1&#xb0;&#xb1; 4&#xb0; (95% CI, 0&#xb0;-2&#xb0;;= .042; Bonferroni-corrected significance level,< .01). The mean differences were 3&#xb0;&#xb1; 5&#xb0; (95% CI, 2&#xb0;-3&#xb0;) for the Lee method, 11&#xb0;&#xb1; 5&#xb0; (95% CI, 10&#xb0;-12&#xb0;) for the Tomczak method, and 12&#xb0;&#xb1; 6&#xb0; (95% CI, 11&#xb0;-14&#xb0;) for the Murphy method (all< .001). Diagnostic accuracy for detecting abnormal femoral version was high, with an area under the curve ranging from 0.88 to 0.98 and a consistently high negative predictive value (91%-100%). The modified Budin view is a highly reliable and accessible radiographic method for femoral version measurement in young patients undergoing joint-preserving hip surgery. It closely reflects the femoral neck version as measured by the Reiker&#xe5;s method, and demonstrates high diagnostic accuracy for detecting abnormal femoral version, making it a valuable screening tool for femoral version deformities in clinical practice.