Coxa Vara

Introduction:
The general term coxa vara includes any condition in which the
neck-shaft angle of the femur is less than the normal of about 120
degree. The angle is sometimes reduced to 90 degrees or less.
Mechanism:
The deformity is caused mechanically by the stress of body
weight acting upon a femur that is defective or abnormally soft.

Classification:
1. Congenital
a. Congenital coxa vara
b. Congenital short femur with coxa vara
c. Congenital bowed femur with coxa vara
2. Acquired
a. Capital coxa vara
i. Perthe’s disease
ii. Chondro-osteodystrophy
iii. Septic arthritis of hip
b. Epiphyseal coxa vara
i. Slipped capital femoral epiphysis
c. Cervical coxa vara
i. Children – Rickets, bony dystrophy
ii. Adults – Paget’s disease, osteomyelitis, Fibrous
dysplasia

Disadvantage of coxa vara

Pathology:
 It is due to a defect of endochondral ossification in the medial
part of the femoral neck.
 When the child starts to crawl/ stand, the femoral neck bends or
develops a stress fracture and with continued weight bearing it
collapses increasingly into varus & retroversion.
 Sometimes there is also shortening or bowing of the femoral
shaft.
 As the child grows, the proximal femur keeps elongating but the
neck–shaft angle goes into increasing varus.
 The condition is bilateral in about one-third of cases.
Congenital. Part of the
femoral
neck remains as unossificd
Clinical features cartilage, which gradually
 Usually diagnosed when the child starts to walk.bends during childhood
Limping / waddling gait (congenital
coxa vara; infantile coxa
 The leg is short and the thigh may be bowed.
X-rays show
 the femoral neck
o is in varus; even < 90 degree and
o abnormally short.
 Often there is a separate fragment of bone in a triangular notch
on the inferomedial surface of the femoral neck.

Because of the distorted anatomy, it is difficult to measure the neck–

shaft angle.
A helpful alternative is to measure Hilgenreiner’s epiphyseal angle –
the angle subtended by a horizontal line joining the centre (triradiate
cartilage) of each hip and another parallel to the physeal line; the
normal angle is about 30 degrees while the angle on the abnormal
side is much larger. At maturity the deformity may be quite bizarre.
With bilateral coxa vara the patient may not be seen until he or she
presents as a young adult with OA.