Outcomes of femoral de-rotation osteotomy for treatment of femoroacetabular impingement in adults with decreased femoral anteversion

Decreased femoral anteversion is an often overlooked factor in femoroacetabular impingement (FAI), with potential to exacerbate both cam and pincer type impingement, or itself be the primary cause. Femoral de-rotation osteotomy (FDO) is a surgical option for symptomatic patients with such underlying bony deformity. This study aimed to investigate outcomes of FDO for management of symptomatic FAI in the presence of decreased (<5°) femoral anteversion. Secondary aims were to describe the surgical technique and assess complications. This study included 33 cases (29 patients) with average pre-operative anteversion measuring –3.1° (true retroversion). At an average follow-up of 1.5 years (19.8 months), 97% reported significant improvement. The overall average post-operative International Hip Outcome Tool (iHOT-33) score of 70.6 points (r: 23–98) compared to the average pre-operative score of 42.8 points (r: 0–56) for the 11 patients with available pre-operative scores suggests an overall improvement. The minimal clinically important difference for the iHOT-33 is 6.1 points. Patients with both pre- and post-operative iHOT-33 scores available demonstrated a statistically and clinically significant improvement of 37.7 (r: 13–70) points. There were three cases (9%) of delayed union and two cases (6%) of non-union early in the series which prompted evolution of the technique. Locking screw removal was performed in 33% of patients for a resultant overall re-operation rate of 45%. The findings suggest improvement in patient-reported outcomes can be achieved with FDO for symptomatic FAI in the setting of decreased femoral anteversion (<5°).