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Knee Pain and Activity Outcomes After Femoral Derotation Osteotomy for Excessive Femoral Anteversion

Stambough, Jeffrey B., MD*; Davis, Lauren, MPH, CHES; Szymanski, Deborah A., RN; Smith, June C., MPH; Schoenecker, Perry L., MD†,‡; Gordon, J. Eric, MD†,‡

doi: 10.1097/BPO.0000000000000874
Lower Extremity

Background: Excessive femoral anteversion is a developmental condition that can become symptomatic into adolescence and manifest as anterior knee pain, tripping, and or problems with sports. Femoral derotational osteotomy about an antegrade intramedullary nail (IMN) is an accepted option to treat this condition. This is the first report of the clinical and functional outcomes of treatment of excessive anteversion with femoral derotational osteotomy stabilized with an IMN.

Methods: We prospectively enrolled 28 consecutive patients between 2013 and 2014 who underwent derotational osteotomy. Physical examination measures were used to calculate the amount of angular correction with focus on internal and external rotation of the hip, as well as the trochanteric prominence angle test of femoral anteversion. The International Knee Documentation Committee-9, Marx, and Tegner activity scales were 3 patient-reported outcomes recorded.

Results: After femoral derotation osteotomy over an IMN, femoral anteversion, as measured by the trochanteric prominence angle, improved an average of 29 degrees (P<0.0001). At 1-year minimum follow-up, 22 of 28 subjects (78.5%) demonstrated a mean significant improvement of 13 points for International Knee Documentation Committee-9 (SD=15.4, P=0.0007), which surpassed the level of minimal clinically important change. Furthermore, the Tegner inventory scores for the cohort improved by an average of 1.9 activity levels (SD=2.4, P=0.0012).

Conclusions: For adolescents with symptomatic excessive femoral anteversion, derotational osteotomy over an IMN offers a reliable surgical option that provides predictable deformity correction and significant improvements in both function and pain scales.

Levels of Evidence: Level II—prospective, consecutive, nonrandomized, internally controlled cohort study.

*Department of Orthopaedic Surgery, Washington University School of Medicine

Division of Orthopaedic Surgery, St Louis Children’s Hospital

Shriners Hospital for Children, St Louis, MO

J.E.G. receives royalties from OrthoPediatrics and acts as a consultant for that company as well. The remaining authors declare no conflicts of interest.

Reprints: Jeffrey B. Stambough, MD, Department of Orthopaedic Surgery, Washington University School of Medicine, 660S. Euclid Ave., Campus P.O. Box 8233, St Louis, MO 63110. E-mail: jeffrey.stambough@gmail.com.

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