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

Background: Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences, including more extensive interventions with severe complications and functional disability. This study aimed to compare the clinical, radiological, and complication outcomes of simultaneously versus two-stage surgical procedures (open reduction and proximal femoral derotation osteotomy) in the treatment of DDH with excessive femoral anteversion among a sample of Iraqi children aged less than three years old. Methods: A total of 26 DDH cases were treated in two groups (GI, GII) at Al-Wasity Teaching Hospital (Baghdad, Iraq) from January 2014 to March 2015. GI (15 hips) in 13 patients subjected to simultaneous open reduction (with/without salter osteotomy) and proximal femoral derotation osteotomy. GII (18 hips) in 13 patients operated in two stages procedure; open reduction (with/without salter osteotomy) followed by proximal femoral derotation osteotomy six weeks later. Results: At the time of operation, the average age was 21.79±3.51months (range: 18-30). The mean follow-up period was 10.36 ±1.45 months (range, 8 -12). Statistically, the postoperative clinical, radiological, and complication findings were not significantly different between the two groups. However, in post-operative clinical assessment (McKay's criteria), the satisfying results (excellent and good) were 93% in GI and 88% in GII, respectively. Moreover, in radiological assessment (Severins classification), the satisfying results (excellent and good) were 94% in GI and 83% in GII, respectively. Two cases of re-dislocation and avascular necrosis (AVN) were reported in GII. Conclusion: When the clinical and radiological findings of one and two-stage open reduction and proximal femoral derotation osteotomy procedures are similar, the one-stage is more likely to overcome the two-stage in terms of minimizing the cost, length of stay and the risk of AVN of the femoral head.

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Clinical Outcomes in Soft Tissue Repair Surgery With and Without Femoral Derotation Osteotomy for Patellar Dislocation: A Retrospective Study

10.21203/rs.3.rs-112206/v1 ◽

2020 ◽

Author(s):

Chongyi Fan ◽

Guangmin Yang ◽

Yingzhen Niu ◽

Yirong Xu ◽

Ming Li ◽

...

Keyword(s):

Soft Tissue ◽

Clinical Outcomes ◽

Tissue Repair ◽

Patellar Dislocation ◽

Femoral Anteversion ◽

Anteversion Angle ◽

Soft Tissue Repair ◽

Derotation Osteotomy ◽

Vas Scores ◽

Group 2

Abstract Background: The purpose of our study was to report the clinical outcomes of isolated soft tissue repair or combined femoral derotation osteotomy (DFO) in patients with patellar dislocation with increased femoral anteversion angle (FAA).Methods: A total of 63 patients with patellar dislocation were retrospectively reviewed in this study. 33 patients received isolated soft tissue repair (group 1) and 30 patients were a combination with a femoral deroration osteotomy (group 2). CT were used to assess the correction of the femoral anteversion angle, the tibia tuberosity-trochlear groove (TT-TG) distance, patellar tilt (PTA), and the congruence angle (CA) following the two surgical programs. Subjective scores, such as Kujala, International Knee Documentation Committee (IKDC), Lysholm ,Tegner, and visual analogue scale (VAS) scores, were used to evaluate knee function.Results: In group 2, the mean of the FAA was corrected to15.76 ±2.02° postoperatively compared with 29.16± 2.87° preoperatively (P < 0.001). The TT-TG distance was decreased from 19.03 ±2.52 mm before surgery to 17.80 ±2.24 mm after surgery (< 0.001). Besides, Postoperative PTA and CA were corrected in both groups (P < 0.001). Kujala, IKDC, Lysholm and VAS scores of between groups were significantly improved after operation (P < 0.001). Furthermore, Compared with the isolated soft tissue repair surgery, the combined surgery achieve better postoperative outcomes in Kujala, (IKDC), Lysholm and VAS scores (P < 0.001). Conclusion: Although DFO can be used in combination with DFO to achieve better results, it should also be tailored to the individual and reduce patient suffering.

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