Summary

The outcomes of PFDO stabilised with IM nail were superior to the plate

Abstract

Introduction.

The management of patients with rotational malalignment of the hip resulting in impingement is complex, especially if compounded by intra-articular pathology. Rotational correction of proximal femur can be stabilised with either plates or intramedullary nails. We reviewed these two methods of proximal femoral rotational correction when combined with hip arthroscopy.

Methods.

We reviewed patients that underwent concurrent ipsilateral hip arthroscopy and proximal femoral derotation osteotomy (PFDO) for proximal femoral retroversion. PFDO was either stabilised with a plate (PS) or intramedullary nail (IMS). We analysed operative time, blood loss, time-to-union (radiologic), pain and functional outcomes.

Results.

Each group consisted of 7 patients, average follow-up 45 months (20-65). Average age at operation – 22 and 27 years in PS and IMS groups, respectively. All patients had associated intra-articular bony pathomorphology (CAM/pincer lesions and labral tears) treated during hip arthroscopy as the first step. Average proximal femoral retroversion was 5o (3-13) and 7o (2-15) in PS and IMS groups, respectively. Subsequent PFDO operative time was 118 (105-130) and 95 (80-105) mins in PS and IMS groups, respectively. Blood loss was 450 and 280 mls in PS and IMS groups, respectively. Average time-to-union was 8 and 7.6 months in PS and IMS groups, respectively. Average score improvements from pre-op to 12 months post-op were

- pain – 8 to 1.2 and 7.9 to 0.9 in PS and IMS groups, respectively;

- iHOT12 – 31.8 to 91.6 and 26.7 to 94 in PS and IMS groups, respectively;

- NAHS – 52.9 to 93 and 45 to 95.1 in PS and IMS groups, respectively;

- UCLA – 2.8 to 6.4 and 2.6 to 7 in PS and IMS groups, respectively.

Conclusion.

The outcomes of PFDO stabilised with IM nail were superior to the plate. We feel that in the presence of combined intra- and extra-articular pathomorphology contributing to the FAI phenomenon that failed to be resolved non-operatively, both aspects need to be addressed. Although the outcomes of concurrent hip arthroscopy and PFDO are encouraging, the question of timing of the two steps persists.