Coxa Vara
Anatomical notes
The femur is a complex collecting structure. Its neck axis, together with the diaphysis axis, forms the natural neck-diaphyseal angle. For regular body biomechanics, it is 125-130 degrees in adults and 130-135 degrees in children. However, the angle changes under the influence of several factors or as a result of congenital defects. If its value falls below the mark of 120 degrees, it is said about Coxa Varus – varus deformity of the hip. It affects the entire musculoskeletal system, posture, gait, and joints’ resistance to wear and tear.
Causes of Coxa Vara disease
The disease is divided into two large groups:
- congenital;
- acquired.
The congenital defect is noticeable early. Already in the first two years of life, the child can see that the limb is shortened and there is a slight limp. At the same time, the joint itself is fully mobile. If the pathology is not treated by eight years of age, the difference in leg length is 6-10 cm. To date it is not known exactly, why this congenital defect occurs.
Acquired pathology is formed for a variety of reasons:
- rickets. In parallel, other consequences of rickets are also noted – the characteristic shape of the chest and skull;
- trauma. Not the primary cause;
- endocrinologic diseases. Overweight and delayed sexual development play a role.
It also distinguishes the adolescent form of the disease, which develops at the age of 12-18 and progresses gradually.
Symptoms
Coxa Vara shows itself after the child has started walking. Parents observe a slight limp. The length of the limbs does not always have a big difference; it increases over time. Limping is a sign of unilateral disease. With bilateral gait becoming “wobbly,” lumbar lordosis increases: the spine curves so that the abdomen is strongly protruding forward, and the buttock – backward becomes higher than normal. As a result, the person resembles a duck. Sometimes, there is a pain syndrome and increased fatigue after prolonged walking or exercise.
Diagnosis of Coxa Vara Disease
The first step is for the doctor to collect an anamnesis and examine the patient. Signs of the disease are visible to an experienced specialist with the naked eye. The second step is radiography, which determines the exact angle. The radiograph in Coxa Vara shows a broad band of lumen in the neck of the femur. The angle is much less than 120 degrees, even less than 90 degrees in most cases. A related diagnosis may be a developmental anomaly of the foot. It is a congenital varus or valgus deformity of the foot, also requiring correction.
How to live with that?
What problems does Coxa Vara create in terms of everyday life? These are primarily psychological complexes, physical discomfort, and aesthetic defects. It is possible to live with the pathology, but the quality of life is significantly reduced. Limping and improper gait interfere with sports activities and forming social ties. That especially affects the emotional state of adolescents.
On the physical side, Coxa Vara slowly leads to dire consequences. The load on the musculoskeletal system is distributed unevenly, and scoliotic posture develops. Over time, coxarthrosis—arthrosis of the hip joint—occurs. Cartilage degenerates and synovial lubrication dries up. The bones rub against each other, and osteophytes grow and cause severe pain. As a result, movement is further restricted, and the joint itself is destroyed.
Prevention
In order to prevent the occurrence of acquired Coxa Vara, the following recommendations should be followed:
- Support of the endocrine system during pregnancy. Since the disease, in most cases, is congenital, its prevention is difficult. A pregnant woman needs to monitor the state of the endocrine system and consult a specialist in time in case of complaints;
- Complete nutrition of the expectant mother. Adequate intake of calcium, vitamin D, and folic acid. All of that contributes to the normal development of the fetus and reduces the risk of defects. Genetic pathology is notpreventable;
- Timely examination by an orthopedist. Every child should be examined by an orthopedist at 3-4 months. That makes it possible to detect the disease in time and take treatment;
- Timely, quality treatment for dysplasia because dysplasia is one of the causes of Coxa Vara. If detected in a baby, the situation can be remedied with stirrups and massage at the earliest stages.
- Rehabilitation after injuries. The primary prevention of Cox Varus disease in adults is quality rehabilitation after injuries.
Coxa Vara treatment
It is almost impossible to treat Coxa Vara with conservative methods. All conservative tactics are aimed at improving the quality of life. These are massages, physiotherapy, and drugs to relieve inflammation. Many people need psychological support. Therefore, if the child has manifested pathology, it is better to perform surgery at an early age. There are two ways: prosthetics of the joint and osteotomy. The child’s development is known to be directly related to the beginning of walking. Prosthetics significantly postpones this process; as a consequence, emotions, psyche, speech apparatus, and other functions suffer. Osteotomy is a gentler intervention and as well effective. It restores the natural position of the bones and the joints. The operation is performed under anesthesia; rehabilitation after that is 1-4 months. Even after a couple of weeks, a person can walk independently. The only inconvenience is the fixation apparatus on the legs. It is installed during the operation and supports the anatomical position of the joint. This procedure makes it possible:
- to get rid of Coxa Vara quickly and permanently;
- to get the kid back on his feet faster;
- not to perform a major surgical procedure with possible complications;
- to undergo light minimally invasive treatment.
All of these treatment options are available in more than 600 hospitals worldwide (https://doctor.global/results/diseases/coxa-valga). For example, Femoral osteotomy can be done in 14 clinics across Turkey for an approximate price of $4.6 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/femoral-osteotomy).
Rehabilitation
In most cases, the surgery is effective and lifelong. In the postoperative period, the main thing is to follow the doctor’s instructions regarding exercise, physiotherapy, work, and rest.
