Coxa vara is a misalignment of the femoral neck that forms a more obtuse angle to the femur compared to healthy people. Impairment of walking and pain as well as a progressive aggravation are the result. The most effective measure is an operation on the coxa vara.
What is coxa vara?
Coxa vara describes an orthopedic disease of the hip (“Coxa”). The angle between the thigh and the femoral neck is less than 120 °.
As a result, the hip is bent outwards (“vara”). This reduction of the CCD angle (“Centrum-Collum-Diaphysen-Winkel”) occurs in two variants, which are differentiated according to the underlying causes: on the one hand the congenital (Coxa vara congenita), on the other hand the acquired Coxa vara.
In older people, a flattening of the CCD angle up to 115 ° is considered a common sign of old age. The decrease in the diaphyseal angle is a continuous process that begins in childhood. Small children, for example, have raised hips and their CCD angle is 140 °. This “coxa valga” usually regresses during adolescence and is the opposite of the coxa vara.
Causes
Coxa vara congenita remains in its exact causes in the dark. An embryonic growth disorder could not only be triggered genetically, but also by external influences (nutrition, chemicals).
In adolescents and older people, coxa vara is mostly due to impaired formation and maintenance of the bone substance. A vitamin D deficiency, which leads to rickets, leads to softening of the bones. The thigh neck is then no longer able to withstand the strain and deforms. If this disease occurs in adulthood, the doctor speaks of osteomalacia.
In addition to D-avitaminosis, other metabolic deficiency symptoms can also be considered in this syndrome. If the kidneys excrete too much phosphate, the substance for bone formation is missing. Hormonal malfunctions can also play a role. Fractures of the femoral neck, bone infections and tumors are other causes of coxa vara.
Symptoms, ailments & signs
A Coxa Vara is primarily noticeable through the characteristic difference in leg length. As a result, those affected mostly hobble – doctors refer to this as the “Trendelenburg gait” – and suffer from various accompanying symptoms. Characteristic are hip pain and muscle weakness in the affected region.
As the disease progresses, the stability of the hip joint decreases – pseudarthrosis develops. Finally, the affected leg can no longer be moved at all and is only pulled behind by the patient. Assuming rapid treatment, this can be avoided by using various aids such as walking aids or a wheelchair.
In general, those affected suffer from restricted mobility. This promotes misalignments and premature joint wear. Physical fatigue occurs quickly, especially with higher stress. Pain occurs more quickly and the risk of strains is increased. In children, a Coxa Vara is often only noticed after the first year of life.
Then the child begins to walk and the extent of the disease becomes noticeable. At the same time as the Coxa Vara, circulatory disorders can occur in the affected area. Symptoms of paralysis, sensory disorders 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 with symptoms such as pain or walking difficulties. Since the muscles no longer apply optimally due to the deformation of the bones, their force effect is reduced.
This leads to rapid fatigue of the musculoskeletal system and strains, especially with higher loads. As a result, patients complain of pain and poor performance. “Unnatural” movements can also be observed when walking. Typical is the sagging of the pelvis with every step, referred to by doctors as the “Trendelenburg gait”.
The shortening of the affected leg is noticeable in unilateral coxa vara. These patients hobble. Due to these signs, the malposition in the toddler initially remains undetected until it begins to walk.
In the event of the symptoms mentioned, the orthopedic surgeon will take X-rays in different planes and confirm the diagnosis. Without treatment, the condition worsens because the geometric-static load on the hip increases steadily. Progressive bone and joint deformations are then the result of an initially discrete coxa vara.
Complications
Various complications occur with coxa vara, whereby in most cases there is a misalignment in the legs. These can also be shortened and thus lead to restrictions for the patient. Often there is severe pain in the hip area due to the coxa vara. This means that the person affected can no longer do 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 are painful. They can no longer be burdened normally either. This reduces the quality of life enormously. There may be strains in different regions of the body.
The treatment is primarily aimed at reducing pain and restricted mobility. In severe cases, surgery is necessary, although there are no further complications. Further treatment is then carried out by an orthopedic surgeon.
The musculoskeletal system must be relieved so that there is no further pain. As a rule, the patient can no longer easily perform physical activities and sports. In many cases, if the coxa vara is not treated properly, patients will hobble too.
When should you go to the doctor?
If an unspecific pain in the hip or thigh area is noticed, an appointment should be made with the family doctor. If the symptoms develop into muscle weakness, this indicates a coxa vara, which must definitely be clarified. If you have any subsequent symptoms such as strains or a fracture of the femur, it is best to go to a hospital. The same applies if signs of pseudoarthrosis are noticed or the symptoms increase overall.
If the complaints give rise to mental problems, sleep disorders or a general malaise, this should also be clarified. With a misalignment of the legs it is necessary to go to an orthopedic surgeon. In children, coxa vara is often associated with Perthes disease.
Rickets, Niemann-Pick disease, various metabolic diseases or a poorly healed fracture can also lead to deformed hips. Anyone who belongs to these risk groups should consult a doctor quickly if they experience the symptoms mentioned. If misalignments or other complications have already set in, the emergency medical service should be contacted.
Treatment & Therapy
Coxa vara always needs treatment. Conservative therapy aims to relieve the hip joint. To do this, the patient must wear an orthosis.
This is a custom-made frame that transfers the pressure from the joint to the pelvis. This is to prevent the femoral neck from kinking any further. In small children, an orthosis can even cause the femoral neck to straighten up to a physiological state.
In severe cases, only an operation will help. The surgeon cuts through the femoral neck and fixes it in the correct position with metal splints. This material can be removed again after such a “valgus adjustment osteotomy”. The operation is definitely the most effective therapy for coxa vara.
Outlook & forecast
In most cases, Coxa vara requires surgery. This procedure alleviates all symptoms so that there are no further restrictions in the life of the person affected.
Without treatment, those affected with Coxa vara suffer from severe pain and also from walking difficulties and thus from significant restrictions in everyday life. The symptoms worsen over time if the disease is not treated. There is pain in the hip and muscle weakness. The hip joint itself is very unstable, which means that movement is restricted. As a rule, most people with Coxa vara hobble due to the different leg lengths.
The symptoms of Coxa vara can be relieved relatively well by wearing a prosthesis. The hip joint is relieved and supported so that normal movements are possible again for the person concerned. A prosthesis can also be used in smaller children. Surgical intervention is necessary with Coxa vara if wearing the prosthesis does not improve the symptoms. This completely alleviates the symptoms.
Prevention
Coxa vara is a clinical picture without the possibility of prophylaxis. The most important thing is early detection, which is a prerequisite for optimal healing. A doctor should therefore be consulted immediately if there are problems with the hip. Parents are sure to watch their children closely as they learn to walk. If there are any abnormalities, a visit to the orthopedic surgeon is indicated. Because in small children there is a chance of an operation-free healing of the coxa vara.
Aftercare
After treatment of a Coxa vara has been completed, continuous follow-up treatment and regular follow-up examinations should take place. In the event of an operation, the patient will have to slowly begin to get used to the previously accustomed motion sequences. Inpatient treatment with daily training sessions can help restore mobility.
As muscular imbalances can occur as a result of the disease and the subsequent treatment, it is necessary to strengthen the buttocks and pelvic muscles in order to maintain a healthy sequence of movements. Exercises tailored to the individual clinical picture can be learned from doctors and physiotherapists and then carried out independently after medical treatment.
It is important to maintain continuous training units even after the end of (inpatient) therapy. This is the only way to maintain the success of the treatment and prevent possible relapse symptoms. Regular follow-up examinations help to get a holistic view of the course of the disease and the progress made.
In this way, the patient can be helped to plan an everyday life that is adapted to the individual state of health and to lead a largely symptom-free life. Always good self-observation by the patient is important. Should unusual pain or problems arise in the course of movement, a doctor should always be consulted promptly, even after the treatment has been completed, in order to avoid any incorrect stress.
You can do that yourself
In the case of a congenital coxa vara, the person affected can actively influence the alleviation of the existing symptoms. This includes controlling one’s own weight and training in targeted supportive movements. A weight gain that goes beyond the normal weight also should be avoided. If you are overweight, the skeletal system is additionally stressed and the symptoms increase in intensity.
You should also work with physiotherapeutic exercises and training units. These prevent complaints and can be carried out independently at any time. For the best possible result, the exercises should be used daily.
The same tips are recommended for an acquired Coxa vara. However, there is also the option of avoiding the disease in advance. Avoid overstressing and straining the hips. Regular sporting activities can help to prevent the disease or to initiate appropriate countermeasures in the early stages.
Bad posture can be corrected with good self-reflection. The posture can be consciously perceived and changed in everyday life at any time. Information about an optimal posture while sitting, walking or running helps to recognize mistakes and to correct them. Muscle discomfort caused by one-sided movements should be avoided. The sleeping conditions must also be controlled and, if necessary, improved.
