Diseases

Coxa Vara – Causes, Symptoms & Treatment

Cox summer

Coxa vara is a malposition of the neck of the femur, which forms a more obtuse angle to the femur than a healthy one. Impaired mobility and pain as well as progressive deterioration 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°.

The hip is thus 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) and the other is acquired coxa vara.

In older people, a flattening of the CCD angle to 115° is considered a common sign of aging. Because the decrease in the diaphyseal angle is a continuous process that begins in childhood. For example, small children have raised hips, and their CCD angle is 140°. This “coxa valga” usually regresses during adolescence and is the opposite of coxa vara.

causes

Coxa vara congenita remains in the dark in its exact causes. An embryonic growth disorder could be triggered not only purely genetically, but also by external influences (nutrition, chemicals).

In adolescents and older people, coxa vara is usually due to impaired formation and maintenance of bone substance. A vitamin D deficiency resulting in rickets leads to softening of the bones. The neck of the femur can then no longer cope with the loads and deforms. If this disease occurs in adulthood, the doctor speaks of osteomalacia .

In addition to D-avitaminosis, other metabolic deficiency symptoms can be considered in this syndrome. If the kidneys excrete too much phosphate, the substance for bone formation is missing. Hormonal dysfunction may also play a role. Femoral neck fractures, bone infections and tumors are other causes of coxa vara.

Symptoms, Ailments & Signs

A coxa vara is primarily noticeable through the characteristic leg length difference. As a result, those affected 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 – a non -union develops . Finally, the affected leg can no longer be moved at all and is only pulled behind by the patient. Assuming prompt 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 sets in quickly, especially under higher loads. 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. Accompanying the coxa vara, there can be circulatory disorders in the affected area. Symptoms of 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.

Diagnose

Coxa vara is a diagnosis that is initially based on symptoms such as pain or difficulty walking. Since the muscles are no longer optimally attached due to the deformation of the bones, their strength is reduced.

Especially with higher loads, the musculoskeletal system tires quickly and strains occur . As a result, patients complain about pain and a drop in performance. “Unnatural” movement sequences can also be observed when walking. The sagging of the pelvis with every step is typical, referred to by doctors as the “Trendelenburg gait”.

In the case of unilateral coxa vara, the shortening of the affected leg is obvious. These patients are limping. Due to these signs, the deformity in the small child initially remains undetected until it starts to walk.

In the case of the symptoms mentioned, the orthopedist will take X-rays at different levels and confirm the diagnosis. Without treatment, the condition worsens because the geometric-static load on the hip is constantly increasing. Progressive bone and joint deformations are then the result of an initially discrete coxa vara.

complications

Various complications occur with coxa vara, most of which lead to a misalignment of the legs. These can also be shortened and thus lead to limitations in the patient. Severe pain in the hip area often occurs due to the coxa vara. As a result, the person concerned can no longer do any 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 become painful. They can also no longer be charged normally. This reduces the quality of life enormously. Strains can occur in different parts of the body.

The main aim of the treatment is to reduce pain and restricted movement. In serious cases, an operation is necessary, although there are no further complications. Further treatment is then carried out by an orthopaedist.

The musculoskeletal system must be relieved so that there is no further pain. As a rule, the patient can no longer easily carry out physical activities and sports. In many cases, patients also limp if the coxa vara is not treated properly.

When should you go to the doctor?

If a non-specific pain in the hip or thigh area is noticed, an appointment with the family doctor should be made. If the symptoms develop into muscle weakness, this indicates a coxa vara, which must be clarified. In the case of subsequent complaints such as strains or a femoral neck fracture, it is best to go to a hospital. The same applies if signs of pseudoarthrosis are noticed or if the symptoms increase overall.

If mental problems, insomnia or general malaise set in as a result of the symptoms, this should also be clarified. If your legs are misaligned, you need to see an orthopedist . In children, a 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 hip deformity. Anyone who belongs to this risk group should consult a doctor as soon as possible if they experience the symptoms mentioned. If malpositions or other complications have already set in, the medical emergency service should be contacted.

Treatment & Therapy

Coxa vara always requires treatment. Conservative therapy aims to relieve the hip joint. For this purpose, 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 neck of the femur to straighten up to its physiological state.

In severe cases, only surgery can help. The surgeon cuts through 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 corrective osteotomy”. Surgery is certainly the most effective therapy for coxa vara.

Outlook & Forecast

In most cases, a surgical intervention is necessary for coxa vara. This procedure alleviates all symptoms so that there are no further restrictions in the life of the person concerned.

Without treatment, those affected with Coxa vara suffer from severe pain and also from walking difficulties and thus from significant limitations in everyday life. The symptoms also worsen over time if the disease is not treated. Hip pain and muscle weakness occur. The hip joint itself is very unstable, resulting in limited mobility. As a rule, most people with Coxa vara limp because of the different leg lengths.

The symptoms of coxa vara can be alleviated relatively well by wearing a prosthesis. This relieves and supports the hip joint, so that normal movements are possible again for the person concerned. A prosthesis can also be used in smaller children. A surgical procedure is necessary for coxa vara if wearing the prosthesis does not improve the symptoms. This completely alleviates the symptoms.

prevention

Coxa vara is a clinical picture with no possibility of prophylaxis. The most important thing is early detection, which is a prerequisite for optimal healing. Therefore, a doctor should be consulted immediately if you have problems with your hips. Parents will be sure to keep a close eye on their children as they learn to walk. If there are any abnormalities, a visit to the orthopedist is indicated. Because in infancy there is a chance of healing the coxa vara without surgery.

aftercare

After treatment of a coxa vara has been completed, continuous follow-up treatment and regular follow-up examinations should take place. In the case of an operation, the patient will have to slowly begin to get used to previously used movements again. Inpatient treatment with daily training units can help to restore mobility.

Since muscular imbalances can occur as a result of the disease and subsequent treatment, it is necessary to strengthen the buttocks and pelvic muscles in order to maintain healthy movement. Exercises tailored to the individual clinical picture can be learned by doctors and physiotherapists and then carried out independently following medical treatment.

It is important to maintain continuous training units even after the end of (inpatient) therapy. This is the only way to ensure the success of the treatment and to prevent any recurrence of symptoms. Regular follow-up examinations help to get a holistic view of the course of the disease and the progress that has been 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. Good self-observation by the patient is important at all times. Should unusual pain or problems in the course of movement occur, a doctor must always be consulted promptly, even after the treatment has been completed, in order to avoid any incorrect strain.

You can do that yourself

In the case of congenital coxa vara, the person affected can actively influence the alleviation of the existing symptoms. This includes controlling one’s own weight and training specific supporting movement sequences. Weight gain that exceeds the normal weight should be avoided as a matter of principle . If you are overweight , the skeletal system is put under additional strain and the symptoms increase in intensity.

You should also work with physiotherapy 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.

If you have an acquired coxa vara, the same tips are recommended. In addition, however, there is the possibility of avoiding the disease in advance. Overstraining and heavy strain on the hips should be avoided. Regular sporting activities can help to prevent the disease or to initiate appropriate countermeasures in the early stages.

Poor posture can be corrected with good self-reflection. The posture can be consciously perceived and changed at any time in everyday life. Information about optimal posture when sitting , walking or running helps to identify mistakes and eliminate them. Muscle discomfort from one-sided movements should be avoided. The sleeping conditions should also be checked and possibly improved.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.