Introduction.

The primary objective was to determine clinical outcomes following Distal Tibial Derotation Osteotomy (DTDO) performed to manage hip pain in the presence of tibial maltorsion, and to review how co-existent pathomorphology affected the management.

Methods.

All patients undergoing DTDO for hip pain with tibial rotational deformities recognised as the predominant aetiology. Only patients older >50 years or presenting with degenerative joint changes and neuromuscular conditions were automatically excluded.

Associated ipsilateral MRI-defined intra-articular pathomorphology (Cam/pincer), non-Cam/pincer-related labral tears, and abnormal combined femoral/acetabular version (McKibbin Index (MI)) were noted. Pre-operative and interval post-operative functional outcomes were analysed.

Results.

Thirty-two patients underwent DTDO. Mean tibial torsion–48.8o (41-63o). Average age–27 years(18-44), average follow-up–30 months(16-45). Nine patients (28%) had a co-existent Cam/pincer and 8 (25%) – excessive MI (51-76o).

Overall, 63% of all patients (including 54% of patients with co-existent pathology) experienced significant hip functional improvement following DTDO alone.

Pre-operative vs 18 months post-operative scores were:

· iHOT-12–38 vs 96(p=0.0001);

· HOS-ADLS–54 vs 91(p=0.0009);

· HOS-ADLS graphical–46 vs 93(p=0.0005);

· HOS-SS–40 vs 87(p=0.0005);

· HOS-SS graphical–44 vs 85(p=0.001).

Statistically significant difference in all PROMs was attained at 12 months.

Conclusion.

Patients with hip pain and lower limb rotational malalignment frequently present with multi-level deformity and co-existent Cam/pincer. Malrotation correction should be prioritised. Significant proportion of symptomatic hip impingement patients (>50%) improve with tibial derotation alone even in the presence of co-existing pathomorphology. Functional recovery to near normal level is expected within a maximum of 12 months post-DTDO

More 2023 ISAKOS Congress Content

• Ankle / Foot / Calf Presentations
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• Knee Arthroplasty Presentations
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