2021 ISAKOS Biennial Congress Paper
Can Hip Pain Be Treated With Tibial Malrotation Correction?
Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, Southampton UNITED KINGDOM
Mohamed Zubair Farook, MBBS, D.Ortho, FRCS (Orth), Reading UNITED KINGDOM
Rajiv Kaila, MRCS, MSc, MFSEM(UK), FEBOT, Reading UNITED KINGDOM
Tom CB Pollard, MD, FRCS (Tr & Orth), Reading, Berkshire UNITED KINGDOM
Antonio J. M. D. Andrade, MB BS, M.Sc., FRCS(Tr&Orth), Crowthorne, Berkshire UNITED KINGDOM
Royal Berkshire Hospital, Reading, UNITED KINGDOM
FDA Status Not Applicable
Summary
Correction of tibial malrotation is a viable treatment for hip impingement.
Abstract
Introduction.
Contribution of tibial malrotation to hip joint kinematics and impingement, especially with certain activities, is poorly understood. Tibial malrotation treatment includes Distal Tibial Derotation Osteotomy (DTDO). We aimed to determine DTDO clinical effectiveness in patients with hip symptoms.
Materials.
A review of patients undergoing DTDO between 2018-2020. DTDO was routinely stabilised with tibial plate (EVOS,S&N). We reviewed our management of tibial torsion and associated ipsilateral pathology: MRI-defined intra-articular pathomorphology (CAM/pincer) and non-CAM/pincer-related labral tears, as well as excessive combined femoral/acetabular version (McKibbin Index (MI) >50o). If presenting symptoms resolved, patients were discharged at 1year.
Results.
27 patients underwent DTDO for hip pain, 3 – for hip and knee pain. Mean tibial torsion was 48.6o (41-63o). Average age–27years (18-44), average follow-up–20months (3-36).
Thirteen patients (43%) had a co-existent CAM/pincer and 7 (23%) – excessive MI (51-76o). Of 13 CAM/pincer patients post-DTDO:
• 2 patients settled (discharged)
• 4 had hip arthroscopy prior to DTDO
- 1 settled post-DTDO (discharged)
- 3 are persistently symptomatic <1yr follow-up, including 1 with excessive MI (51o)
• 3 with persistent hip symptoms >1yr post-DTDO underwent and 1 awaits hip arthroscopy (all with normal MI)
• 4 patients <1yr post-DTDO are improving.
Of 17 non-CAM/pincer patients:
• 4 had labral tears
- 2 settled post-DTDO (discharged)
- 2 – clinically improving (<1yr follow-up)
• 7 had excessive femoral/acetabular version
- 2 – discharged
- 5 – under review (<1yr follow-up)
• 6 others discharged
• no direct hip interventions were required to date.
Four patients required plate removal, no complications were identified.
Conclusion.
Patients with rotational malalignment frequently present with multi-level deformity and high prevalence of co-existent CAM/pincer. Hip arthroscopy for intra-articular pathology prior to malrotation correction is likely to fail. Malrotation correction should be prioritised. Significant proportion of symptomatic hip impingement patients (=45%) improve with tibial derotation.