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Tibial Derotation Osteotomies are Effective in Improving Hip Pain and Function

Tibial Derotation Osteotomies are Effective in Improving Hip Pain and Function

Fransiska Dhyana Guerreiro , MBBS, MSc, MRCS, UNITED KINGDOM Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, 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

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Sports Medicine

Summary: Tibial Derotation Osteotomies Are Effective In Improving Hip Pain And Function.


The primary objective was to determine clinical outcomes following Distal Tibial Derotation Osteotomy (DTDO) performed to manage hip pain in the presence of tibial maltorsion, and to review how co-existent pathomorphology affected the management.


All patients undergoing DTDO for hip pain with tibial rotational deformities recognised as the predominant aetiology. Only patients older >50 years or presenting with degenerative joint changes and neuromuscular conditions were automatically excluded.

Associated ipsilateral MRI-defined intra-articular pathomorphology (Cam/pincer), non-Cam/pincer-related labral tears, and abnormal combined femoral/acetabular version (McKibbin Index (MI)) were noted. Pre-operative and interval post-operative functional outcomes were analysed.


Thirty-two patients underwent DTDO. Mean tibial torsion–48.8o (41-63o). Average age–27 years(18-44), average follow-up–30 months(16-45). Nine patients (28%) had a co-existent Cam/pincer and 8 (25%) – excessive MI (51-76o).

Overall, 63% of all patients (including 54% of patients with co-existent pathology) experienced significant hip functional improvement following DTDO alone.

Pre-operative vs 18 months post-operative scores were:

· iHOT-12–38 vs 96(p=0.0001);

· HOS-ADLS–54 vs 91(p=0.0009);

· HOS-ADLS graphical–46 vs 93(p=0.0005);

· HOS-SS–40 vs 87(p=0.0005);

· HOS-SS graphical–44 vs 85(p=0.001).

Statistically significant difference in all PROMs was attained at 12 months.


Patients with hip pain and lower limb rotational malalignment frequently present with multi-level deformity and co-existent Cam/pincer. Malrotation correction should be prioritised. Significant proportion of symptomatic hip impingement patients (>50%) improve with tibial derotation alone even in the presence of co-existing pathomorphology. Functional recovery to near normal level is expected within a maximum of 12 months post-DTDO

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