What is DFO?
The term derotational femoral osteotomy (DFO) refers to a procedure designed to treat severe rotational abnormalities of the femur. The rotational alignment of the femur is called femoral torsion and normally ranges from 10° – 20° of antetorsion, meaning that the femur “looks” to the front of the hip joint. Femoral torsion > 40° (severe femoral antetorsion) is generally considered pathologic, and in the setting of a shallow socket or loose hip ligaments may contribute to hip instability (dysplasia), requiring corrective surgery via DFO. These patients tend to walk with their “toes-in” and relatives will note that growing up they preferred to sit in the “W-position” with their hips internally rotated. Conversely, femoral torsion < –10° (severe femoral retrotorsion) is also considered pathologic as it often contributes to hip impingement (FAI), requiring corrective DFO. These patients walk with their “toes-out” and have significant difficulty flexing and internally rotating their hips. Certain childhood hip disorders (slipped capital femoral epiphysis (SCFE)) often result in femoral retrotorsion, which becomes problematic in adolescence and early adulthood. Intermediate values of femoral torsion (between –10° and 40°) rarely require surgical correction.
How is a DFO performed?
All patients scheduled for a DFO first undergo a minimally invasive hip arthroscopy (performed the same day as the DFO) to address damage inside the hip joint. The DFO is performed in a minimally invasive way under general anesthesia through one 2-inch incision and one 1/2-inch incision on the outer aspect of the hip and thigh, respectively. The femur bone is cut and re-rotated to the optimal alignment prior to being stabilized with an inflatable rod placed in the inner cavity of the bone. The surgery typically takes 1 – 2 hours and patients remain in the hospital for 2 – 3 days. Patients are allowed to put 50% weight on the operative leg immediately following surgery and gradually progress each week. Bony healing takes 6 – 12 weeks.
What is the typical timeframe for recovery from DFO?
It is important to realize that the speed of recovery depends largely on the extent and type of damage in the hip along with other patient related factors. Generally speaking, though, the majority of patients can expect to:
- Go home on post-operative day 2 – 3
- Resume normal daily household activities within 2 – 3 weeks
- Take prescription pain medication for 2 – 3 weeks
- Return to a desk-job with intermittent walking at 2 – 3 weeks
- Drive a car at 2 weeks
- Walk unassisted and without a limp by 4 – 6 months
- Start running at 4 – 6 months
- Return to unrestricted sports participation or a labor-intensive occupation at 6 – 8 months
Will I need to do physical therapy following DFO?
Absolutely. Physical therapy is critical to ensure that you get the best outcome from your surgery. With the guidance of your therapist, you will progressively advance through the various stages of your rehabilitation, as outlined in our post-operative protocol. Your therapist will have some flexibility to safely modify your progression in order to meet your specific goals and expectations.
Patients have to “re-train” their quadriceps and gluteus muscles as they get adjusted to the new rotational position of the femur. It takes time to build back the strength and bulk of these muscle groups following normal post-operative atrophy that occurs during recovery.
How successful is DFO?
Bony healing following DFO is very successful with the vast majority of patients progressing to uneventful healing. The key to a successful outcome, in general, is proper patient selection and identification of the problem. Abnormal femoral rotation is a relatively new consideration in the treatment of hip instability (dysplasia) and hip impingement (FAI). As such, its role as a contributor to these problems is still an active area of research. At SCHI, we believe in a comprehensive approach to treatment that addresses all potential contributors to pain and dysfunction. This is the best way to ensure that you will not have residual pain or limitations following your recovery.
Am I a good candidate for DFO?
Whether DFO is a worthwhile option for you depends on a number of factors, including:
- Your age
- Your particular diagnosis or pattern of injury
- The extent of arthritis or cartilage damage
In general, the outcomes of DFO are best in patients < 40 years of age with focal or discrete structural damage and minimal arthritis. Dr. Garabekyan will guide you through the various considerations in helping you decide whether DFO is right for you.
Choosing the treatment option that is right for you involves careful consideration of your diagnosis, duration and severity of symptoms, desired level of activity, as well as social and financial elements. You are not alone in this process.
As you research your condition, please write down all of your questions and bring them with you to your next appointment. Dr. Garabekyan and his team at SCHI will take time to address all of your concerns, until you are completely satisfied with your treatment plan.
We look forward to helping you get your life back.