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. 2025 Oct;49(10):2473-2479.
doi: 10.1007/s00264-025-06646-6. Epub 2025 Aug 29.

Femoral rotational osteotomy for posterior hip impingement in young adults with increased femoral version

Khaled M Emara  1 , Ramy Ahmed Diab  1 , Ahmed K Emara  2 , Mohamed Eissa  1 , Ahmed Ezzat  1 , Mohamed Amr Hemida  1 , Hassan Abdel Hamid Abdel Fattah  3
Affiliations

Femoral rotational osteotomy for posterior hip impingement in young adults with increased femoral version

Khaled M Emara et al. Int Orthop. 2025 Oct.

Abstract

Purpose: Posterior femoro-acetabular impingement in patients with increased femoral version can result in significant hip pain, chondro-labral injury, and limited range of motion. Femoral rotational osteotomy may address these issues by correcting excessive femoral anteversion.

Methods: This retro-spective case series included 25 adolescents (mean age 14.8 years) with symptomatic increased femoral version (> 35°) treated between 2015 and 2022. Inclusion required hip pain, limited range of motion, and increased femoral version confirmed on computed tomography. Patients underwent femoral external rotational osteotomy targeting a post-operative femoral version of ~ 15°. Outcomes assessed included femoral version, hip range of motion, and Harris Hip Score pre-operatively, at six months, and at two years post-operatively.

Results: Mean femoral version improved significantly from 39° ± 3° pre-operatively to 19° ± 7° post-operatively (P < 0.001). Internal rotation decreased from 54° ± 9° to 32° ± 8°, while external rotation increased from 38° ± 4° to 44° ± 5° (P < 0.001). Mean Harris Hip Score improved from 62.5 ± 10.3 to 86.1 ± 6.4 at 6 months, with sustained results at two year follow-up. Radiographic union was achieved in all patients, and no major complications were observed.

Conclusion: Femoral rotational osteotomy is a safe and effective treatment for posterior hip impingement in young patients with excessive femoral version.

Keywords: Femoral version; Hip impingement; Rotational osteotomy.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pre-operative and 6-month post-operative comparison of femoral version (FV). A significant reduction was observed following femoral rotational osteotomy (P < 0.001)
Fig. 2
Fig. 2
Changes in external rotation (ER) and internal rotation (IR) from preoperative to 6-month and 2-year postoperative follow-up. ER significantly increased, while IR significantly decreased postoperatively (P < 0.001)
Fig. 3
Fig. 3
Improvement in Harris Hip Score (HHS) from preoperative to 6-month and 2-year postoperative assessments, demonstrating sustained functional gains following surgery (P < 0.001)
See this image and copyright information in PMC

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