Decision Making in Combined Hip Arthroscopy and Femoral Derotational Osteotomy Surgeries

Femoral version abnormalities can contribute to intra-articular hip pathology. Combined hip arthroscopy with femoral derotational osteotomy (FDRO) has been shown to successfully treat those with intra-articular hip pathology with excessive anteversion or retroversion of the femur.

We describe the technique for combined hip arthroscopy and FDRO in patients with symptomatic intra-articular hip pathology in the setting of excessive anteversion or retroversion of the femur.

Hip arthroscopy is performed using standard anterolateral, modified mid-anterior, and distal anterolateral accessory portals. The labrum is repaired using a narrow diameter suture. Femoroplasty is performed with utilization of fluoroscopic imaging to assess resection. Dynamic flexion is performed as a final check of adequacy of resection. Capsular closure is performed in all cases. After hip arthroscopy, the patient is repositioned on a radiolucent table. A piriformis start point is obtained with a guide pin followed by standard opening reaming and ball-tipped guidewire placement. A femoral osteotomy is made just proximal to the isthmus and made through a lateral approach to the femur. Two K-wires are placed distal and proximal to the osteotomy site. A goniometer is then used to measure rotation. A drill is used to perforate the cortex circumferentially at the osteotomy site. After standard reaming, a sagittal saw is then used to start the osteotomy cut followed by an osteotome. An intramedullary nail is inserted over a ball-tipped guidewire while rotational reduction is assessed from the foot of the operating table. Distal interlocking screws are placed, and the nail is backslapped to create compression at the osteotomy site prior to placing proximal interlocking screws.

Recent studies show improved hip outcome scores in patients who undergo concomitant hip arthroscopy and FDRO for symptomatic abnormal femoral version.

Identifying patients who would benefit from concomitant surgeries requires thorough preoperative evaluation. Correct identification and treatment of these patients leads to improved outcomes.

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