Femoral versus acetabular osteotomy for treating combined version deformities leading to femoroacetabular impingement: a case-control matched study

The aim of this study was to compare outcomes between anteverting proximal femoral osteotomy (APFO) and anteverting periacetabular osteotomy (APAO) for femoroacetabular impingement syndrome (FAIS) due to combined acetabular retroversion (ARV) and femoral retrotorsion (FRT). We also compared these outcomes with hip arthroscopy (HA) for FAIS without ARV or FRT. Twelve patients with ARV and FRT underwent either APAO (six) or APFO (six) at two centres. A control group of 24 patients underwent HA for FAIS without version abnormality. Outcome measures included various hip scores, time to radiological bony union, complications, and conversion to hip arthroplasty. At the 2-year follow-up, no AFPO or APAO hips required arthroplasty. Patient-reported outcome scores showed no significant difference between the APAO and APFO groups: Non-Arthritic Hips Scores (NAHS) (APAO: median 72, range 52-78; APFO: 76, 52-80, P = .76), International Hip Outcome Tool 12 (iHOT-12) (APAO: 64, 48-70 vs. APFO: 55, 46-72, P = .57), EuroQol 5 Dimension Visual Analogue Scale (APAO: 72, 57-78 vs. APFO: 75, 49-80 P = .78), and University of California Los Angeles Score (APAO: 7, 4-8 vs. APFO: 6, 4-9 P = .43). APAO patients achieved radiological union faster (10.2 weeks: 6.6-19.3 vs. 19.2 weeks: 12-23, P = .05). Aside from metalwork removal, one AFPO patient required revision intramedullary nail to induce union. Compared to AFPO or APAO, HA patients (NAHS: 86.7, 72.1-94.1; iHOT-12: 73.1, 63.2-88.1) had better outcome scores (P < .05). Both APFO and APAO can achieve good outcomes and short-term survivorship for combined ARV and FRT, although function may be inferior to HA in patients without rotational abnormalities.