title: Biomechanical changes associated with femoral derotational osteotomy.
abstract: Torsional deformities of the femur in children may occur as a result of either idiopathic or neuromuscular disorders and may be corrected with derotational osteotomies. Regardless of the underlying etiology, neither the effects of the torsional pathologies nor the alterations resulting from corrective osteotomies are well understood. A study of children with isolated femoral anteversion undergoing a single corrective procedure may assist in understanding the biomechanics of the pathology and the efficacy of surgical correction. A multicenter retrospective study included 25 subjects with idiopathic femoral anteversion who underwent femoral derotational osteotomy and had completed pre and postoperative gait analyses. Both changes with surgery and comparisons to typically developing controls were analyzed. Reduced gait pathology and expected improvements in hip rotation and foot progression were found with derotational osteotomy. Overall gait pathology and pathological differences in pelvic tilt, hip flexion moment and knee adduction moment were found comparing anteversion subjects with typically developing subjects. Following surgery, only hip rotation was significantly and clinically different from typically developing subjects, changing from relatively inward to outward. Idiopathic femoral anteversion creates multifaceted and significant alterations to normal gait and should not be considered solely a cosmetic issue. Additionally, the efficacy of derotational osteotomy is illustrated and may be more broadly applied to other conditions where pathologic femoral anteversion is present.
authors.affiliation: Motion Analysis Laboratory, Shriners Hospitals for Children, 1275 Fairfax Rd., Salt Lake City, UT 84103, USA; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA. Electronic address: bmacwilliams@shrinenet.org.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: MacWilliams
authors.affiliation: Walter E. Griffin and Agnes M. Griffin Motion Analysis Laboratory, Shriners Hospitals for Children, 911 W. 5th, Spokane, WA 99204, USA. Electronic address: mmcmulkin@shrinenet.org.
authors.forename: Mark L
authors.initials: ML
authors.lastname: McMulkin
authors.affiliation: Motion Analysis Laboratory, Shriners Hospitals for Children(®), 950 West Faris Rd., Greenville, SC 29605, USA. Electronic address: rdavis@shrinenet.org.
authors.forename: Roy B
authors.initials: RB
authors.lastname: Davis
authors.affiliation: Motion Analysis Laboratory, Shriners Hospitals for Children(®), 950 West Faris Rd., Greenville, SC 29605, USA. Electronic address: dwestberry@shrinenet.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Westberry
authors.affiliation: Walter E. Griffin and Agnes M. Griffin Motion Analysis Laboratory, Shriners Hospitals for Children, 911 W. 5th, Spokane, WA 99204, USA. Electronic address: gbaird@shrinenet.org.
authors.forename: Glen O
authors.initials: GO
authors.lastname: Baird
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA. Electronic address: peter.stevens@hsc.utah.edu.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Stevens
mesh_terms: D000293:Adolescent; D060750:Bone Anteversion / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005260:Female; D005269:Femur / Q000503:physiopathology / Q000601:surgery*; D005684:Gait / Q000502:physiology*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular; D012189:Retrospective Studies
keywords: Derotational osteotomy; Femoral anteversion; Gait analysis