EP1.21 A Novel Intraoperative Measurement Technique for Proximal Femoral Rotational Osteotomy Using a Digital Inclinometer: Early Reliability and Accuracy Results

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ID: 331050
2026
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Abstract
Abstract Background Abnormal femoral version is an established contributor to hip dysfunction, predisposing patients to instability, impingement, and osteoarthritis. Proximal femoral rotational osteotomy (PFRO) is an effective intervention for symptomatic femoral malversion, yet conventional techniques rely on subjective intraoperative assessment, contributing to variability in correction accuracy. This study describes a novel surgical technique using a digital inclinometer to provide objective, quantifiable intraoperative measurement of femoral rotational correction. Surgical Technique Through a lateral subvastus approach, two bicortical Kirschner wires are placed proximal and distal to the planned osteotomy site. A digital inclinometer measures the angular relationship between these wires before the osteotomy is performed, establishing a baseline reference. Following osteotomy the distal femur is rotated until the inclinometer confirms the planned angular correction has been achieved between the two wires relative to the initial measurement. The osteotomy is then fixed with a plate and screws. Methods Nine patients undergoing PFRO were prospectively evaluated. The accuracy of intraoperative inclinometer-derived correction was assessed by comparison with femoral version measured on pre- and postoperative CT imaging, with the CT-derived correction representing the reference standard. Inter- and intra-observer reliability of CT measurements were assessed using intraclass correlation coefficients (ICC). Agreement between intraoperative and CT-derived correction was evaluated using Spearman’s rank correlation and Bland–Altman analysis. Results All nine patients were female (mean age 29.6 years; mean BMI 27.5); six underwent anteverting and three retroverting osteotomies. Inter- and intra-observer reliability of CT measurements were both excellent (ICC 0.90). Intraoperative inclinometer measurements correlated strongly with CT-derived correction (Spearman ρ = 0.87, p = 0.002), with a mean bias of 0.13° and 95% limits of agreement of −6.5° to 6.8°. Conclusion This technique offers a simple, reproducible, and low-cost method for objective intraoperative measurement during PFRO, integrating seamlessly into standard surgical workflows without navigation or complex instrumentation. Early results demonstrate strong agreement between intraoperative and postoperative CT measurements. Larger prospective studies are required to determine whether improved measurement accuracy translates to superior clinical outcomes.
Reference Key
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Authors Jonathan Cann, Kartik Logishetty, Jonathan Hutt, Alastair Dick
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.205
URL
https://doi.org/10.1093/jhps/hnag043.205
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