Coxa vara is a deformity of the neck of the femur that forms a more obtuse angle to the femur compared to a healthy person. Impaired walking and pain as well as progressive aggravation are the result. The most effective measure is coxa vara surgery.
What is coxa vara?
Coxa vara refers to an orthopedic condition of the hip (“coxa”). In this condition, the angle between the thigh and the neck of the femur is less than 120°. As a result, the hip is bent outwards (“vara”). This reduction of the CCD angle (“centrum-collum-diaphyseal angle”) occurs in two variants, which are differentiated according to the underlying causes: One is congenital (coxa vara congenita), the other is acquired coxa vara. In older people, a flattening of the CCD angle up to 115° is considered a common sign of aging. This is because the decrease in the diaphyseal angle is a continuous process that begins in infancy. Thus, infants have a raised hip, and in them the CCD angle is 140°. This “coxa valga” usually regresses during adolescence and is the opposite of the coxa vara.
Causes
Coxa vara congenita remains obscure in its exact causes. Embryonic growth restriction could be triggered not only by pure genetics but also by external influences (nutrition, chemicals). In adolescents and the elderly, coxa vara is usually due to impaired formation and maintenance of bone substance. Vitamin D deficiency resulting in rickets leads to bone softening. The neck of the femur is then no longer able to withstand the stresses and deforms. If this disease occurs in adulthood, the physician speaks of osteomalacia. In addition to D-avitaminosis, other metabolic deficiency symptoms may be considered in this syndrome. If the kidney excretes too much phosphate, the substance for bone formation is missing. Hormonal dysfunction may also play a role. Fractures of the femoral neck, bone infections, and tumors are other causes of coxa vara.
Symptoms, complaints, and signs
Coxa vara is primarily noticeable by the characteristic leg length discrepancy. As a result, affected individuals usually limp – doctors refer to this as “Trendelenburg gait” – and suffer from various accompanying symptoms. Hip pain and muscle weakness in the affected region are characteristic. As the disease progresses, the stability of the hip joint decreases – pseudarthrosis develops. Eventually, the affected leg can no longer be moved at all and the patient only drags it behind. Provided that it is treated quickly, this can be avoided by using various aids such as walking aids or a wheelchair. In general, affected persons suffer from restricted movement. This favors malpositions and premature joint wear. Physical fatigue occurs quickly, especially with higher loads. Pain occurs more quickly and the risk of strains is increased. In children, coxa vara is often not noticed until after the first year of life. Then the child begins to walk and the extent of the condition becomes apparent. Accompanying coxa vara can be circulatory problems in the affected area. Paralysis, sensory disturbances and nerve pain are also possible. Based on these symptoms, the disease can be clearly diagnosed and treated in a targeted manner.
Diagnosis
Coxa vara is a diagnosis that initially starts from symptoms such as pain or difficulty walking. Since the muscles no longer attach optimally due to the bone deformation, their force effect is reduced. This leads to rapid fatigue of the musculoskeletal system and also to strains, especially under higher loads. As a result, patients complain of pain and loss of performance. Unnatural” movements can also be observed when walking. Typical is the slumping of the pelvis with every step, called “Trendelenburg gait” by doctors. Eye-catching in unilateral coxa vara is the shortening of the affected leg. These patients limp. Because of these signs, the deformity initially remains undetected in young children until they begin to walk. If the above symptoms are present, the orthopedist will take x-rays at various levels to confirm the diagnosis. Without treatment, the condition worsens because the geometric-static load on the hip is constantly increasing.Progressive bone and joint deformities are then the result of an initially discrete coxa vara.
Complications
Various complications occur with coxa vara, and in most cases there is a deformity in the legs. These may also be shortened, leading to limitations in the patient. Often, severe pain occurs in the hip area due to coxa vara. This also means that the affected person can no longer perform sports. It is not uncommon for this pain to spread to other regions of the body. The muscles are also affected by the disease and hurt. They can also no longer be loaded in the usual way. This reduces the quality of life enormously. Strains can occur in different regions of the body. Treatment is aimed primarily at reducing the pain and movement restrictions. In severe cases, surgical intervention is necessary, although this does not lead to further complications. Further treatment is then carried out by an orthopedist. The musculoskeletal system must be relieved to prevent further pain. As a rule, this means that the patient can no longer perform physical activities and sports without further ado. In many cases, patients also limp if coxa vara is not treated properly.
When should you see a doctor?
When nonspecific pain in the hip or thigh area is noticed, an appointment should be made with a primary care physician. If the discomfort develops into muscle weakness, this indicates coxa vara, which must be clarified. In the event of subsequent complaints such as strains or a fracture of the neck of the femur, it is best to visit a hospital. The same applies if signs of pseudoarthrosis are noticed or the overall complaints increase. If psychological problems, sleep disturbances or a general feeling of malaise arise as a result of the complaints, these should also be clarified. With a deformity of the legs must go to an orthopedist. In children, coxa vara often occurs in connection with Perthes disease. Rickets, Niemann-Pick disease, various metabolic diseases or a poorly healed fracture can also lead to deformity of the hip. Anyone who belongs to these risk groups should consult a doctor quickly if they experience any of the symptoms mentioned above. If deformities or other complications have already developed, emergency medical services should be contacted.
Treatment and therapy
Coxa vara always requires treatment. Conservative therapy aims to relieve pressure on the hip joint. For the purpose, the patient must wear an orthosis. This is an individually made frame that diverts pressure from the joint to the pelvis. This is to prevent the neck of the femur from bending further. In young children, an orthosis can even straighten the neck of the femur to its physiological state. In severe cases, only surgery can help. In this case, the surgeon cuts the neck of the femur and fixes it in the correct position with metal splints. This material can be removed again after such a “valgus rearrangement osteotomy”. The operation is certainly the most effective therapy for coxa vara.
Outlook and prognosis
In most cases, surgical intervention is necessary for coxa vara. This surgery relieves all symptoms, so there are no further restrictions in the life of the affected person. Without treatment, those affected by coxa vara suffer from severe pain and also from walking difficulties and thus from significant restrictions in everyday life. The symptoms also worsen over time if the disease is not treated. There is pain in the hip and also muscle weakness. The hip joint itself is very unstable, so that movement is restricted. As a rule, most sufferers of coxa vara limp because of the difference in leg length. The symptoms of coxa vara can be relatively well alleviated by wearing a prosthesis. The hip joint is thereby relieved and supported, so that ordinary movements are possible again for the affected person. A prosthesis can also be used for smaller children. Surgical intervention is necessary for coxa vara if wearing the prosthesis does not improve the symptoms. This will completely relieve the discomfort.
Prevention
Coxa vara is a disease with no possibility of prophylaxis. The most important thing is early detection, which is a prerequisite for optimal healing. Therefore, a physician should be consulted immediately if a child experiences any discomfort in the hip. Parents will certainly keep a close eye on their children as they learn to walk. If any abnormalities come to light, a visit to the orthopedist is indicated. This is because there is a chance of surgery-free healing of coxa vara in young children.
Follow-up care
After therapy for coxa vara is completed, there should be continuous follow-up care and regular follow-up examinations. In the case of surgery, the patient will need to slowly begin to re-acclimate to previously familiar movement patterns. Inpatient treatment with daily exercise sessions can help to restore the ability to move. Since muscular imbalances can occur as a result of the disease as well as the subsequent treatment, strengthening of the buttock and pelvic muscles is necessary to maintain a healthy range of motion. Exercises tailored to the individual clinical picture can be learned from doctors and physiotherapists and then performed independently following medical treatment. It is important to maintain continuous training sessions even after the end of (inpatient) therapy. This is the only way to maintain the success of the treatment and prevent possible relapses. Regular follow-up examinations help to obtain a holistic view of the course of the disease and the progress made. In this way, patients can be helped to plan a daily routine adapted to their individual state of health and to lead a life largely free of symptoms. In this context, it is always important for patients to keep a close eye on themselves. If unaccustomed pain or problems occur in the course of movement, a doctor should always be consulted promptly, even after treatment has been completed, in order to avoid possible incorrect loading.
What you can do yourself
In the case of congenital coxa vara, the affected person can have an active influence in alleviating the existing symptoms. This includes controlling their own weight and practicing specific supportive movements. Weight gain in excess of the normal weight should be avoided as a matter of principle. Excess weight puts additional strain on the skeletal system and the complaints increase in intensity. Additional physiotherapeutic exercises and training sessions should be performed. These prevent complaints and can be carried out at any time on one’s own responsibility. For the best possible result, the exercises should be applied daily. e same tips are recommended for an acquired coxa vara. In addition, however, here is the possibility to avoid the disease in advance. Overstraining and heavy loading of the hip should be avoided. Regular sports activities can help to prevent the disease or to initiate appropriate countermeasures already in the early stages. Poor posture can be corrected with good self-reflection. Posture can be consciously noticed and changed at any time in everyday life. Information about optimal posture when sitting, walking or running helps to recognize faults and to eliminate them. Discomfort of the muscles due to one-sided movements should be avoided. Sleeping conditions should also be monitored and improved under certain circumstances.
