Till D Lerch1,2, Florian Schmaranzer1,2, Simon D Steppacher1, Kai Ziebarth3, Moritz Tannast1,4, Klaus A Siebenrock1. 1. Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 2. Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 3. Department of Paediatric Orthopaedics, Children`s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Switzerland. 4. Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital, University of Fribourg, Switzerland.
Abstract
AIMS: To assess (1) hip pain and function and ROM; (2) subsequent surgeries, complications; and (3) subjective satisfaction and PROMs in patients undergoing femoral derotation osteotomies. METHODS: Femoral derotation subtrochanteric osteotomies to treat symptomatic posterior extraarticular ischiofemoral hip impingement were performed in 23 patients (25 hips) between 2013 and 2017. The mean age was 26 ± 8 years (96% female) with a minimum 2-year follow-up (mean follow-up of 4 ± 1 years). Surgical indication was a positive posterior impingement test and limited external rotation (mean 16° ± 8°) in extension in patients with abnormal high femoral version (mean 46° ± 9, measured on CT scans with the Murphy method) and high McKibbin instability index (mean 67°). Femoral osteotomies were combined with a surgical hip dislocation in 96% for cam resection and labrum or cartilage treatment. Preoperative MRI and 3D-CT with dynamic impingement simulation were evaluated. RESULTS: (1) The posterior impingement test decreased significantly from preoperatively 100% to 4% (p < 0.001). External rotation in extension increased significantly (p < 0.001) from preoperative 16° ± 8 to 44° ± 16°. The MdA score increased significantly from 14 ± 1 to 16 ± 2 (p < 0.001) points.(2) At follow-up, all 25 hips were preserved. No conversion to THA and no revision osteosynthesis was performed. 64% underwent complete hardware removal.(3) 80% of the patients reported at follow-up that they would undergo surgery again. Subjective satisfaction (SHV) increased significantly (p < 0.001) from preoperatively 24% to 84% postoperatively. CONCLUSIONS: Femoral derotation subtrochanteric osteotomies for the treatment of posterior extraarticular ischiofemoral hip impingement are safe and improve posterior hip pain and function and external rotation in mostly female patients with high femoral version and a high McKibbin instability index.
AIMS: To assess (1) hip pain and function and ROM; (2) subsequent surgeries, complications; and (3) subjective satisfaction and PROMs in patients undergoing femoral derotation osteotomies. METHODS: Femoral derotation subtrochanteric osteotomies to treat symptomatic posterior extraarticular ischiofemoral hip impingement were performed in 23 patients (25 hips) between 2013 and 2017. The mean age was 26 ± 8 years (96% female) with a minimum 2-year follow-up (mean follow-up of 4 ± 1 years). Surgical indication was a positive posterior impingement test and limited external rotation (mean 16° ± 8°) in extension in patients with abnormal high femoral version (mean 46° ± 9, measured on CT scans with the Murphy method) and high McKibbin instability index (mean 67°). Femoral osteotomies were combined with a surgical hip dislocation in 96% for cam resection and labrum or cartilage treatment. Preoperative MRI and 3D-CT with dynamic impingement simulation were evaluated. RESULTS: (1) The posterior impingement test decreased significantly from preoperatively 100% to 4% (p < 0.001). External rotation in extension increased significantly (p < 0.001) from preoperative 16° ± 8 to 44° ± 16°. The MdA score increased significantly from 14 ± 1 to 16 ± 2 (p < 0.001) points.(2) At follow-up, all 25 hips were preserved. No conversion to THA and no revision osteosynthesis was performed. 64% underwent complete hardware removal.(3) 80% of the patients reported at follow-up that they would undergo surgery again. Subjective satisfaction (SHV) increased significantly (p < 0.001) from preoperatively 24% to 84% postoperatively. CONCLUSIONS: Femoral derotation subtrochanteric osteotomies for the treatment of posterior extraarticular ischiofemoral hip impingement are safe and improve posterior hip pain and function and external rotation in mostly female patients with high femoral version and a high McKibbin instability index.
Entities:
Keywords:
Extraarticular posterior hip impingement; FAI; femoral osteotomies; femoral torsion; femoral version; femoroacetabular impingement; hip arthroscopy; hip instability; ischiofemoral hip impingement
Authors: Till D Lerch; Adam Boschung; Christiane Leibold; Roger Kalla; Hassen Kerkeni; Heiner Baur; Patric Eichelberger; Klaus A Siebenrock; Moritz Tannast; Simon D Steppacher; Emanuel F Liechti Journal: J Hip Preserv Surg Date: 2022-04-11
Authors: Till D Lerch; Sébastien Zwingelstein; Florian Schmaranzer; Adam Boschung; Markus S Hanke; Inga A S Todorski; Simon D Steppacher; Nicolas Gerber; Guodong Zeng; Klaus A Siebenrock; Moritz Tannast Journal: Orthop J Sports Med Date: 2021-05-28
Authors: Guodong Zeng; Celia Degonda; Adam Boschung; Florian Schmaranzer; Nicolas Gerber; Klaus A Siebenrock; Simon D Steppacher; Moritz Tannast; Till D Lerch Journal: Orthop J Sports Med Date: 2021-11-24
Authors: Markus S Hanke; Till D Lerch; Florian Schmaranzer; Malin K Meier; Simon D Steppacher; Klaus A Siebenrock Journal: EFORT Open Rev Date: 2021-06-28