gms | German Medical Science

Objectives: Patients with femoro-acetabular impingement (FAI) combined with femoral retroversion or reduced femoral version (FV) can be treated with open hip surgery or with hip arthroscopy. Some previous studies reported good clinical outcomes after hip arthroscopy, while for some hip surgeons femoral retroversion is a contraindication for hip arthroscopy. To assess (1) hip pain and range of motion (ROM), (2) subjective satisfaction (SSV), (3) subsequent surgeries and complications of symptomatic FAI patients that underwent rotational femoral osteotomies to increase FV.

Methods: A retrospective case series involving 18 patients (23 hips, treated between 2014-2018) with anterior hip pain that underwent rotational femoral osteotomies for treatment of anterior FAI was analyzed. Mean age was 25±6 years (57% male) with a minimum 1-year followup (mean followup 2±1 years). Indication for surgical treatment was a positive anterior impingement test, limited internal rotation in 90° of flexion(mean 9°±11) and in extension (mean 22°±11), anterosuperior chondrolabral damage in MR arthrography and CT-based measurement of abnormal decreased FV (mean 5°±3, Murphy method) and no osteoarthritic changes (Tönnis Grade 0). Subjective satisfaction was assessed with the subjective hip value (maximum 100%). 3D models of the pelvis and the proximal femur were used for impingement simulation to analyze exact location of impingement using a previously validated software. Intra- and extraarticular subspine FAI was presen in 85% using patient-specific 3D impingementsimulation. Rotational subtrochanteric femoral osteotomies (intraoperative correction of 20±4°) were combined (91%) with a surgical hip dislocation (SHD) for correction of cam deformities/labrum lesions.

Results:

1.

The prevalence of the positive anterior impingement test decreased significantly (p<0.001) from preoperatively 100% to 9%. Internal rotation in 90° of flexion increased significantly (p<0.001) from preoperative 10±8° (0-30) to 31±10° (15-50).

2.

Subjective satisfaction increased significantly (p<0.001) from preoperatively 33% to postoperatively 77%. The mean Merle d'Aubigné and Postel score increased significantly (p<0.001) from 14±2 (8-15) points to 17±1 (13-18, p<0.001) points. Most of the patients (85%) reported at followup, that they would undergo surgery again.

3.

At followup, all 23 hips were preserved (no conversion to THA). One hip (4%) underwent revision osteosynthesis and 11 hips (48%) underwent implant removal. Rotational femoral osteotomies to increase FV combined with cam resection and/or labral refixation improve hip pain and internal rotation in most of the patients at short term followup. Anterior impingement test was eliminated in most of the patients with femoral retroversion. We found a high subjective satisfaction and low complication rate.

Conclusion: Rotational femoral osteotomies to increase FV is a safe treatment for patients with femoral retroversion.