The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on combined bony and soft tissue reconstruction for hip joint stabilisation in proximal focal femoral deficiency (PFFD).


Children are sometimes born with defects of the hip joint and upper thigh bone, called proximal femoral focal deficiency, often abbreviated to PFFD. Surgical treatment, aiming to produce as functional a leg as possible, may be appropriate. This may also involve a corrective operation on the hip joint (sometimes referred to as the ‘superhip' procedure). The initial operation may be combined with other surgery to lengthen the leg and treat other problems such as poor knee function at the same time or at a later date.

Coding recommendations

This procedure cannot be expressed in the OPCS-4 classification by a single code. Procedures could vary for each patient depending on the severity of the condition, and these would be coded on a case by case basis based on the specific procedures carried out, they would be combined with the ICD-10 diagnosis code:

Q72.4 Longitudinal reduction defect of femur

Proximal femoral focal deficiency

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)