Femoral Retroversion in the Setting of Multiple Failed Hip Arthroscopies

A 21-year-old female athlete presented to Cleveland Clinic’s Center for Hip Preservation with persistent right hip and groin pain, as well as mechanical symptoms she had been experiencing since her last surgery about two years prior to this encounter. Her symptoms were inhibiting achievement of her athletic goals.

Atul Kamath, MD, Director of the Center for Hip Preservation and staff surgeon in the Orthopaedic and Rheumatologic Institute, notes that imaging revealed normal morphology of the proximal femur and the acetabulum; however, the MRI slice showed a tear of the acetabular labrum. Advanced imaging studies show normal morphology and coverage of the femoral head by the acetabulum.

3D study images show intertrochanteric and subspine areas of femoral acetabular impingement. “Of key note on the 3D studies,” says Dr. Kamath “is the low femoral version 2.2 degrees, which is relative retroversion of the femur, when compared to normative female populations of this age.”

Her diagnosis included a labral tear, subspine and intertrochanteric impingement and femoral retroversion.

Video case study

In this short video case study, Dr. Kamath discusses his decision to perform a revision hip arthroscopy to address her labral pathology and a revision labral repair with subspine compression, all through the arthroscope. “At this point in the case I was only able to afford 5 degrees more of internal rotation at 90 degrees of flexion, so I therefore performed a derotational osteotomy… in the subtrochanteric region,” he notes. “I added 20 degrees of anteversion to her femur to then afford 35 degrees of internal rotation in dynamic examination under anesthesia while in flexion.”

See the advanced imaging and listen to the full details of the case, including postoperative outcomes and the patient’s full return to athletic activities, on Cleveland Clinic’s YouTube channel.