Steiner Quinn, Zacharias Anthony J, Goodspeed David C, Spiker Andrea M
Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Froedtert South and the Medical College of Wisconsin, Pleasant Prairie, Wisconsin, USA.
Video J Sports Med. 2023 Aug 31;3(4):26350254231185152. doi: 10.1177/26350254231185152. eCollection 2023 Jul-Aug.
Femoral version abnormalities can contribute to intra-articular hip pathology. Combined hip arthroscopy with femoral derotational osteotomy (FDRO) has been shown to successfully treat those with intra-articular hip pathology with excessive anteversion or retroversion of the femur.
We describe the technique for combined hip arthroscopy and FDRO in patients with symptomatic intra-articular hip pathology in the setting of excessive anteversion or retroversion of the femur.
Hip arthroscopy is performed using standard anterolateral, modified mid-anterior, and distal anterolateral accessory portals. The labrum is repaired using a narrow diameter suture. Femoroplasty is performed with utilization of fluoroscopic imaging to assess resection. Dynamic flexion is performed as a final check of adequacy of resection. Capsular closure is performed in all cases. After hip arthroscopy, the patient is repositioned on a radiolucent table. A piriformis start point is obtained with a guide pin followed by standard opening reaming and ball-tipped guidewire placement. A femoral osteotomy is made just proximal to the isthmus and made through a lateral approach to the femur. Two K-wires are placed distal and proximal to the osteotomy site. A goniometer is then used to measure rotation. A drill is used to perforate the cortex circumferentially at the osteotomy site. After standard reaming, a sagittal saw is then used to start the osteotomy cut followed by an osteotome. An intramedullary nail is inserted over a ball-tipped guidewire while rotational reduction is assessed from the foot of the operating table. Distal interlocking screws are placed, and the nail is backslapped to create compression at the osteotomy site prior to placing proximal interlocking screws.
Recent studies show improved hip outcome scores in patients who undergo concomitant hip arthroscopy and FDRO for symptomatic abnormal femoral version.
DISCUSSION/CONCLUSION: Identifying patients who would benefit from concomitant surgeries requires thorough preoperative evaluation. Correct identification and treatment of these patients leads to improved outcomes.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
股骨扭转异常可导致髋关节内病变。髋关节镜联合股骨旋转截骨术（FDRO）已被证明能成功治疗股骨过度前倾或后倾且伴有髋关节内病变的患者。
我们描述了在股骨过度前倾或后倾情况下，对有症状的髋关节内病变患者进行髋关节镜联合FDRO的技术。
使用标准的前外侧、改良的中前侧和远端前外侧辅助入路进行髋关节镜检查。使用细直径缝线修复盂唇。利用荧光透视成像评估切除情况进行股骨成形术。进行动态屈曲作为切除充分性的最终检查。所有病例均进行关节囊闭合。髋关节镜检查后，患者重新安置在可透射线的手术台上。用导针确定梨状肌起点，随后进行标准的开口扩髓并放置球头导丝。在股骨峡部近端进行股骨截骨，通过股骨外侧入路完成。在截骨部位的远端和近端各放置两根克氏针。然后使用角度计测量旋转。用钻头在截骨部位沿圆周方向穿透皮质。在标准扩髓后，先用矢状锯开始截骨，然后用骨刀。在球头导丝上插入髓内钉，同时从手术台脚部评估旋转复位情况。放置远端交锁螺钉，在放置近端交锁螺钉之前，轻敲髓内钉以在截骨部位产生加压。
近期研究表明，对于有症状的股骨扭转异常患者，同时进行髋关节镜检查和FDRO后，髋关节结局评分有所改善。
讨论/结论：确定哪些患者能从联合手术中获益需要进行全面的术前评估。正确识别和治疗这些患者可改善预后。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者在提交本稿件以供发表时已包含患者的豁免声明或其他书面批准形式。
