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Can Hip Pain Be Treated With Tibial Malrotation Correction?

Can Hip Pain Be Treated With Tibial Malrotation Correction?

Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, UNITED KINGDOM Mohamed Zubair Farook, MBBS, D.Ortho, FRCS (Orth), UNITED KINGDOM Rajiv Kaila, MRCS, MSc, MFSEM(UK), FEBOT, UNITED KINGDOM Tom CB Pollard, MD, FRCS (Tr & Orth), UNITED KINGDOM Antonio J. M. D. Andrade, MB BS, M.Sc., FRCS(Tr&Orth), UNITED KINGDOM

Royal Berkshire Hospital, Reading, UNITED KINGDOM


2021 Congress   Abstract Presentation   5 minutes   Not yet rated

 

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Summary: Correction of tibial malrotation is a viable treatment for hip impingement.


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.


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