The Outcomes Of Proximal Femoral Derotation Osteotomy Performed Concurrently With Ipsilateral Hip Arthroscopy

Fransiska Guerreiro, Daniel Blyth, Vitali Goriainov, Andy Langdown

Queen Alexandra Hospital

The management of patients with rotational malalignment of the hip resulting in impingement is complex, especially if compounded by intra-articular pathology. Rotational correction of the proximal femur can be stabilised with either plates or intramedullary nails. We reviewed these methods of proximal femoral rotational correction when combined with hip arthroscopy.

We reviewed patients that underwent concurrent ipsilateral hip arthroscopy and proximal femoral derotation osteotomy (PFDO) for proximal femoral retroversion. PFDO was either stabilised with a plate (PS) or intramedullary nail (IMS). We analysed operative time, blood loss, time-to-union (radiologic), pain and functional outcomes.

Each group consisted of 7 patients with an average age at operation of 22 (PS) and 27 (IMS) years. All patients had associated intra-articular bony pathomorphology (CAM/pincer lesions and labral tears) treated during hip arthroscopy as the first step. Average proximal femoral retroversion was 5° (PS) and 7° (IMS). Subsequent PFDO operative time was 118 (105-130) and 95 (80-105) mins in PS and IMS groups, respectively. Blood loss was 450 (PS) and 280 mls (IMS). Average time-to-union was 8 and 7.6 months in PS and IMS groups, respectively. Average score improvements from pre-op to 12 months post-op were assessed using a VAS score, iHOT12, NAHS and UCLA.

The outcomes of PFDO stabilised with IM nail were superior to the plate. We feel that in the presence of combined intra- and extra-articular pathomorphology contributing to the FAI phenomenon which has failed to resolve non-operatively, both aspects need to be addressed.