TY - JOUR
T1 - Knee Pain and Activity Outcomes after Femoral Derotation Osteotomy for Excessive Femoral Anteversion
AU - Stambough, Jeffrey B.
AU - Davis, Lauren
AU - Szymanski, Deborah A.
AU - Smith, June C.
AU - Schoenecker, Perry L.
AU - Gordon, J. Eric
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - 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.
AB - 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.
KW - derotation osteotomy
KW - excessive femoral anteversion
KW - intramedullary nail
KW - knee pain
KW - patient-reported outcomes
UR - http://www.scopus.com/inward/record.url?scp=84987860716&partnerID=8YFLogxK
U2 - 10.1097/BPO.0000000000000874
DO - 10.1097/BPO.0000000000000874
M3 - Article
C2 - 27636916
AN - SCOPUS:84987860716
SN - 0271-6798
VL - 38
SP - 503
EP - 509
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
IS - 10
ER -