Minimally invasive solutions for ischiofemoral impingement: case analysis and evolving surgical strategies

Variations in the femoral version are increasingly recognized as a cause of coxalgia due to impingement or instability. The true prevalence of these variations remains unknown. The authors report a case of bilateral ischiofemoral impingement (IFI) caused by excessive femoral anteversion treated with a subtrochanteric femoral derotational osteotomy and long intramedullary nailing. We report the case of a 22-year-old female patient with deep left hip pain, consistent with IFI, refractory to conservative treatment. Imaging revealed an ischiofemoral space (IFS) of 16 mm and a femoral anteversion of 34°. A subtrochanteric femoral derotational osteotomy stabilized with a long intramedullary nail was performed. At 18 months, the same surgical procedure was performed due to similar symptoms on the right side, with an IFS of 14 mm and femoral anteversion of 35°. Joint mobility was restored bilaterally, and the symptoms were resolved. Lesser trochanter resection has been reported as a surgical option for IFI in small case series. While conventional subtrochanteric femoral derotational osteotomy with plate fixation shows good functional outcomes, pseudarthrosis remains a concern. The authors' minimally invasive technique using the backstroke technique for osteotomy site compression helps prevent this complication while preserving the iliopsoas insertion. In this case study, a subtrochanteric femoral derotational osteotomy effectively treated bilateral IFI associated with increased femoral anteversion. The patient achieved excellent clinical outcomes with complete symptom resolution following successful consolidation of both osteotomies, though subsequent implant removal was performed to facilitate potential future surgeries.