Intertrochanteric derotational femoral osteotomy for pathological femoral anteversion without ligamentous instability. Technical note.

Abstract

Pathological femoral anteversion is recognized as a cause of anterior knee pain. Derotational femoral osteotomy is a promising surgical intervention for anterior knee pain patients with excessive femoral anteversion. It is indicated in disabling anterior knee pain recalcitrant to conservative treatment with femoral anteversion >25° measured according to Murphy's method. However, robust evidence for a universal cutoff is lacking. It is contraindicated in patients with pathological femoral anteversion without clinical symptoms. Moreover, it is contraindicated for cosmetic reasons. This technical note describes our surgical technique of derotational osteotomy to correct pathological femoral anteversion. Femoral anteversion is problematic because it changes the direction of the quadriceps muscle. An intertrochanteric osteotomy allows a longer bone length for the thigh muscles to adjust to a new direction. The distal fragment of the femur is externally rotated until the correction desired in the preoperative planning is achieved. Good clinical outcomes and few complications have been reported with this surgical technique.