Femoral Derotational Osteotomy Alone or Combined With Hip Arthroscopy Is Superior to Arthroscopy Alone in Patients With Femoral Retroversion

PURPOSE: To compare patient-reported outcomes in patients with femoral retroversion (<5° of femoral anteversion) treated with either isolated hip arthroscopy (HA), femoral derotation osteotomy (FDO), or a combined procedure. METHODS: Patients treated between 2013 and 2019 were identified from an institutional hip preservation registry. Inclusion criteria were age 14 to 60 years, femoral version <5° as measured on preoperative computed tomography, and a minimum 1-year follow-up. Patients underwent isolated HA, isolated FDO, or combined HA + FDO. The primary outcome was improvement in the modified Harris Hip Score. Secondary outcomes included hip range of motion, postoperative complications, revision surgery rates, and achievement of minimum clinically important difference (MCID), substantial clinical benefit, and patient acceptable symptomatic state (PASS). RESULTS: A total of 82 patients met the inclusion criteria. The combined HA + FDO group had the greatest improvement in modified Harris Hip Score, followed by the FDO group, then the HA group (P = .001). A significantly higher proportion of FDO patients achieved the MCID (95%) compared to HA patients (67%) (P = .03). PASS was also more frequently achieved in the FDO and combined groups (90% and 78%, respectively) compared to HA (48%) (P = .004). No patients required conversion to total hip arthroplasty. CONCLUSIONS: In patients with femoral retroversion, treatment with FDO, either alone or combined with HA, resulted in greater improvements in functional outcomes and higher rates of MCID and PASS compared to isolated hip arthroscopy. LEVEL OF EVIDENCE: Level III, retrospective comparative case series.