gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)

25.10. - 28.10.2016, Berlin

Femoral osteotomies for torsional deformities decrease pain and increase function at a midterm followup of mean 3 years

Meeting Abstract

  • presenting/speaker Till Lerch - Inselspital Universitätsspital, Bern, Switzerland
  • Moritz Tannast - Inselspital Universitätsspital, Bern, Switzerland
  • Simon Steppacher - Inselspital Universitätsspital, Bern, Switzerland
  • Klaus Siebenrock - Inselspital Universitätsspital, Bern, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016). Berlin, 25.-28.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocWI19-706

doi: 10.3205/16dkou085, urn:nbn:de:0183-16dkou0855

Veröffentlicht: 10. Oktober 2016

© 2016 Lerch et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Torsional deformities of the femur have been recognized as a cause of femoroacetabular impingement (FAI) and hip pain. High femoral antetorsion can result in decreased external rotation and a posterior FAI, which is typically located extraarticular between the ischium and trochanter minor. Femoral osteotomies allow to correct torsional deformities to eliminate FAI. So far the mid-term results in patients undergoing femoral osteotomies for correction of torsional deformities have not been investigated.

Therefore, we asked if patients undergoing femoral osteotomies for torsional deformities of the femur have (1) decreased hip pain and improved function and (2) subsequent surgeries and complications?

Methods: We retrospectively evaluated 21 hips (18 patients) who underwent femoral osteotomies for correction of torsional deformities between April 2005 and October 2014. Twenty hips with excessive femoral antetorsion (52° ± 9°, range 37° - 68°) had a derotational femoral osteotomy. The mean age at operation was 26 ± 8 (16 - 51) years and 95% were female. Previous surgery were performed in 43% of the hips including hip arthroscopy (5 hips), acetabular osteotomy (2 hips), open reduction for high dislocation (2 hips), surgical hip dislocation (2 hips) and varus intertrochanteric osteotomy (1 hip). In 10 hips a concomitant offset correction and in 5 hips a concomitant periacetabular osteotomy were performed. The mean followup was 3 ± 2 (1 - 10) years. We used the anterior and posterior impingement test to evaluate pain. Function was assessed using the Merle d'Aubigné Postel score, WOMAC, UCLA activity score and Harris hip score. Subsequent surgeries and complications were recorded.

Results and Conclusion: The incidence of a positive anterior impingement test decreased from preoperatively 85% to 29% at latest follow-up (p<0.001). The incidence of a positive posterior impingement test decreased from preoperatively 90% to 5% at latest follow-up (p<0.001). The mean Merle d'Aubigné Postel score increased from 13 ± 2 (11 - 16) to 16 ± 1 (13 - 17) at latest followup (p<0.0001. For the WOMAC, UCLA and Harris hip score no preoperative values existed but at latest followup they all showed fair to good values with a mean WOMAC socre of 14 ± 16 (1 - 50), UCLA score of 5 ± 1 (3 - 7) and Harris hip score of 74 ± 16 (47 - 96). Subsequent surgeries included hardware removal in 13 hips and hip arthroscopy with offset creation in 1 hip. Complications occurred in 5 hips (24%) all graded Grade III according to Sink and included conversion to total hip arthroplasty in 1 hip, reosteosynthesis due to pseudarthrosis in 3 hips and hip arthroscopy for adhesiolysis in 3 hips.

Femoral osteotomies for the treatment of torsional deformities of the femur result in decreased pain and improved function in patients with FAI. However, these procedures are associated with a complication rate of 24% which is mainly due to pseudarthrosis and intraarticular adhesions in patients with concomitant offset correction.