Femoral Derotational Osteotomy for Idiopathic Excessive Femoral Anteversion: A Comparison of Surgical Techniques

The preferred surgical technique for the correction of idiopathic femoral anteversion refractory to conservative management remains controversial. This study compared outcomes between 2 femoral derotational osteotomy techniques for idiopathic femoral anteversion.

All patients >6 years with idiopathic femoral anteversion who underwent either an intertrochanteric or subtrochanteric femoral derotational osteotomy with plate fixation or diaphyseal osteotomy with derotation over an intramedullary (IM) nail between 2005 and 2022 at a single pediatric tertiary referral center were reviewed. Patients were excluded if they underwent any additional surgical procedure(s) on the ipsilateral lower extremity, or if they underwent derotational osteotomy for a primary indication other than idiopathic femoral anteversion. Patient characteristics were compared across treatment groups in a bivariate assessment, and multivariable regression modeling was used to determine associations between patient and condition characteristics and surgical outcomes. Complications were reported using the Clavien-Dindo-Sink classification.

One hundred twenty-four femurs in 73 patients were included, with a mean age of 13.3 years and a median follow-up of 2.5 years. Forty-nine patients underwent osteotomy with plate fixation, and 24 patients underwent osteotomy with IM nail fixation. Patients in the plate group were younger (12.5 vs. 14.8 y, P=0.02) and more likely to have been operated on by a hip surgeon (71% vs. 21%; P<0.001). Patients in the plate group reported a 10% complication rate (5/49), whereas those in the nail group reported a 13% complication rate (3/24) (P=0.35). After adjusting for age, surgeon type, simultaneous bilateral procedure, and year of procedure, time to weight-bearing was ∼66% longer in the plate group compared with the nail group, corresponding to an approximate difference of 6 weeks (15.7 vs. 9.5 wk; IRR=1.66; 95% CI: 1.17-2.34; P=0.006).

In cases of derotational osteotomy for correction of idiopathic excessive femoral anteversion, patients treated with proximal osteotomy and plate fixation tended to be younger and were more often treated by a hip surgeon than those treated with diaphyseal osteotomy and IM nail fixation. Both surgical approaches were found to have largely comparable clinical outcomes; time to weight bearing was significantly shorter in the nail group. Future investigations using patient-reported outcomes are warranted to further elucidate the absolute indications and optimal surgical treatment of this condition.

Level III-therapeutic.