Derotational Femoral Osteotomy (DFO): A Surgical Solution for Femoral Torsion and Hip Pain

Derotational Femoral Osteotomy (DFO) is a specialized surgical procedure used to correct abnormal femoral version—a structural issue that can lead to hip pain, impingement, and joint instability. It is especially relevant for patients with hip dysplasia, femoroacetabular impingement (FAI), or persistent pain despite conservative treatment.

In this post, we’ll explain what a derotational femoral osteotomy is, who it’s for, what the surgery involves, and what recovery looks like—so you can better understand whether this procedure might be right for you.

What Is a Derotational Femoral Osteotomy?

A derotational femoral osteotomy is a joint-preserving surgery that involves cutting the femur (thigh bone) and rotating it to a more anatomically correct position. This realignment helps improve the function of the hip joint and can alleviate chronic pain, instability, or limited motion.

The surgery is typically performed at the proximal or mid-shaft femur, depending on the patient’s anatomy and the degree of rotational correction needed.

Why Is Femoral Version Important?

Femoral version refers to the natural twist of the femur. It is measured in degrees and classified as:

• Normal femoral version: 10–20 degrees

• Increased femoral anteversion: Femur is twisted inward (internal rotation)

• Femoral retroversion: Femur is twisted outward (external rotation)

Abnormal femoral torsion can cause:

• Hip impingement or instability

• Labral tears

• Early cartilage damage

• Pain with running, sitting, squatting, or pivoting

• Toe-in or toe-out gait abnormalities

When these issues don’t respond to physical therapy or hip arthroscopy, a derotational osteotomy may be the most effective treatment.

Who Might Need a Derotational Femoral Osteotomy?

Patients who benefit most from DFO typically include:

• Young athletes or active individuals with persistent hip pain

• Patients with femoral anteversion >30° or retroversion <5°

• Individuals with failed prior hip arthroscopy or recurrent labral tears

• Those diagnosed with hip dysplasia or FAI who also show significant rotational deformities

• Patients with abnormal gait patterns or chronic groin/buttock pain

Advanced imaging such as CT scan with 3D torsional analysis is essential for diagnosing femoral version abnormalities.

How Is a Derotational Femoral Osteotomy Performed?

Here’s a simplified overview of the surgical process:

1. Preoperative planning using 3D imaging to determine the angle of correction.

2. Controlled bone cut (osteotomy) is made in the femoral shaft.

3. The femur is then rotated to the correct version (either internally or externally).

4. Fixation with a metal plate and screws stabilizes the bone while it heals.

5. Postoperative imaging confirms correct alignment and fixation.

The procedure is often combined with hip arthroscopy or periacetabular osteotomy (PAO) in patients with complex hip deformities.

What to Expect During Recovery

Recovery from DFO requires a structured rehab plan and close orthopedic follow-up. Here's a general timeline:

• Hospital stay: 1–3 days

• Crutches or walker: Non-weight bearing for 6–8 weeks

• Bone healing: Typically complete by 3–4 months

• Physical therapy: Starts within 2–4 weeks post-op

• Return to sport or running: 6–12 months depending on progress

Patients must commit to physical therapy to restore strength, gait mechanics, and hip mobility.

Benefits of Derotational Femoral Osteotomy

• Corrects abnormal femoral torsion

• Reduces hip impingement and pain

• Improves joint congruency and function

• Preserves the native hip joint

• Delays or prevents osteoarthritis

When performed for the right indications, DFO offers long-term pain relief and functional improvement—especially for those with failed prior interventions.

Potential Risks and Considerations

• Infection or wound complications

• Delayed or non-union of the bone

• Hardware irritation

• Over- or under-correction

• Nerve or vascular injury (rare)

• Need for future surgery or hardware removal

Choosing a surgeon experienced in hip preservation and deformity correction is critical to minimizing risks and achieving the best outcome.

Is DFO the Right Choice for You?

If you’ve been diagnosed with hip dysplasia, FAI, or chronic hip pain and imaging shows abnormal femoral torsion, a derotational femoral osteotomy could be the key to restoring your mobility and preventing further joint damage.

Your orthopedic team may also consider a combined approach, involving PAO or labral repair, based on the severity of structural issues.

Related Search Terms

• Femoral anteversion surgery

• Hip torsion correction

• Derotational osteotomy hip

• Abnormal femoral version treatment

• Joint-preserving hip surgery

• Hip instability in young adults

Final Thoughts

Derotational femoral osteotomy is an advanced orthopedic procedure designed to correct one of the lesser-known but highly impactful causes of hip pain: abnormal femoral version. When nonsurgical treatments fail, this procedure can provide lasting relief and preserve the natural hip joint for years to come.

Curious if DFO could help relieve your hip pain?

Schedule a consultation with our hip preservation team to get personalized recommendations based on your imaging and symptoms.