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Arthroscopic Labral Repair and Open Derotational Osteotomy for Femoroacetabular Impingement With Excessive Anteversion

March 01, 2020

Contributors: Dylan Lowe, MD; Darryl Whitney, MD; Thomas Youm, MD, FAAOS; David Kirby, MD

Background Femoroacetabular impingement (FAI) leads to chondral defects and labral degeneration of the hip joint, which initially results in pain and functional limitations and eventually progress to osteoarthritis. FAI is associated with femoral version abnormalities, which may result in aberrant joint stresses and joint degeneration. Management of the hip joint without femoral version correction may result in failure given persistent joint dysfunction. Hip arthroscopy is an effective treatment option for patients with FAI, with outcomes similar to those of open treatment. Hip arthroscopy in combination with mini-open femoral osteotomy is an efficient one-stage surgical procedure for the management of femoral version abnormalities in patients with FAI. The use of a femoral nail for fixation of the osteotomy allows for no additional postoperative weight-bearing or rehabilitation restrictions. Purpose This video demonstrates arthroscopic labral repair for followed by mini-open derotational femoral osteotomy for the treatment of a patient with combined cam and pincer FAI and a labral tear. Methods The anatomy, classification, diagnosis, and management of abnormal femoral version in a patient with FAI are reviewed. The video discusses surgical indications and considerations, including optimal preoperative imaging studies and our chosen technique for femoral osteotomy. The case presentation of a 20-year-old woman with FAI and excessive femoral anteversion is discussed. Hip arthroscopy with arthroscopic débridement of the femoral neck and acetabular rim, arthroscopic labral repair, and mini-open femoral osteotomy with femoral intramedullary nail fixation are performed Results A suction seal is obtained via the labral repair, with fluoroscopic imaging revealing adequate cam lesion resection. Femoral version is corrected to 15° via intramedullary nail fixation. Conclusion Femoral acetabular impingement may be a source of osteoarthritis, which is compounded in patients with abnormal femoral version. Management of both pathologies may modify the disease course and improve functional outcomes. Hip arthroscopy in combination with mini-open femoral osteotomy is a safe and effective method for the one-stage management of this complex disease.