ePoster #711 - ISHA Annual Scientific Meeting 2016

Clinical Outcomes Of Hip Arthroscopy In Patients With Femoral Retroversion: A Matched Study To Patients With Normal Femoral Anteversion

David E. Hartigan, MD, Westmont, IL UNITED STATES
Itay Perets, MD, Westmont, IL UNITED STATES
John P. Walsh, MA, Westmont, IL UNITED STATES
Edwin Chaharbakhshi, BS, Hinsdale, IL UNITED STATES
Mary R. Close, BS, Westmont, IL UNITED STATES
Benjamin G. Domb, MD, Chicago, IL UNITED STATES

American Hip Institute, Westmont, IL, UNITED STATES

FDA Status Not Applicable

Summary: This study directly compares patients with true femoral retroversion (zero or less) with patients who have normal version (10-20) in a pair match format and concludes that patients with femoral retroversion perform as well as those without femoral retroversion and should not be considered a deterrent for hip arthroscopy.

Background: Patients with femoral retroversion have decreased internal rotation from neutral rotation to the time of bony impingement on the acetabulum compared to patients with normal version. Previous publications have indicated that femoral retroversion may lead to inferior clinical outcomes in hip arthroscopy.
Purpose: To compare the outcomes of arthroscopic treatment of hip pathology in patients with femoral retroversion to patients with femoral version between 10-20 degrees.
Methods: Between November 2011 and September 2013, 790 hip arthroscopies were performed at this institution. Of these, 60 hip arthroscopies (7.6%) were performed on patients with femoral version =0, calculated on preoperative magnetic resonance imaging scan. A subjectively more aggressive femoroplasty was performed in these patients to accommodate their decreased internal rotation.
These patients were pair matched based on BMI +/- 5, age +/- 5 years, and Tönnis grade with 60 patients with a femoral version angle between 10-20 degrees. Exclusion criteria included: Perthes, inflammatory arthritis, SCFE, previous hip surgery, abductor repairs, hips with LCEA <20, Tönnis grade >1, and acetabular profunda or protrusio. Patient reported outcomes (PROs) were recorded preoperatively, at three months, and annually thereafter. PROs utilized were modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). Patient satisfaction was noted and radiographs were obtained at these time intervals as well. P-values <0.05 were considered statistically significant.
Results: Two patients from the non-retroverted group and one from the retroverted group required hip arthroplasty at an average of 19.5 and 23 months, respectively. Both groups demonstrated significant improvement from their preoperative state in all PROs and VAS (p<0.001). No differences in preoperative, postoperative, change in PRO scores, or osteoarthritis progression shown on radiographs between the groups.
Conclusion: Patients with femoral retroversion reported similar outcomes compared to patients with normal femoral version when undergoing hip arthroscopy. Both groups had similar improvements from the preoperative state and neither group demonstrated significant progression of osteoarthritis on radiographs at greater than two-year follow-up. When treating femoral retroversion, a slightly more aggressive femoroplasty may diminish the patient’s predisposition to inferior outcomes.