Biomechanical changes associated with femoral derotational osteotomy

•Significant pathology is reported with the Gait Deviation Index in children with IFA.•Knee abduction moments are altered in IFA and may have long term impacts on joint cartilage.•Compensatory ability of subjects results in many subtle changes in gait.•Gait pathology from a group of patients is best captured with a multidimensional index.•Femoral derotational osteotomy effectively eliminates gait pathology in IFA.

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.