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Coxa vara: surgical outcomes of valgus osteotomies
K Carroll1, S Coleman, P M Stevens
1Shriners Hospital, Intermountain Unit, Salt Lake City, Utah, USA.
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Valgus osteotomy for coxa vara has a 50% recurrence rate. Correcting Hilgenreiner
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Pediatric Surgery
Background:
- Valgus-producing femoral osteotomy is the standard surgical treatment for significant coxa vara.
- High recurrence rates (30-70%) are reported following this procedure.
- A 15-year retrospective review of coxa vara cases treated with valgus osteotomy was conducted.
Purpose of the Study:
- To evaluate the outcomes of valgus osteotomy in children with coxa vara.
- To identify factors influencing recurrence and long-term success.
- To assess the effectiveness of surgical correction on hip joint development and function.
Main Methods:
- Retrospective review of 26 children (37 hips) undergoing valgus osteotomy for coxa vara (congenital and acquired).
- Evaluation of recurrence rates based on various surgical parameters and radiographic measurements.
- Assessment of acetabular depth, congruency, pain relief, and gait correction at follow-up.
Main Results:
- Overall recurrence rate was 50%.
- Correction of Hilgenreiner's epiphyseal angle to <38 degrees correlated with a 95% non-recurrence rate.
- Head-shaft angle was not a reliable indicator of correction.
- Early correction (before age 10) resulted in excellent acetabular development and functional outcomes in 83% of cases.
Conclusions:
- Valgus osteotomy for coxa vara has a high recurrence rate.
- Precise radiographic correction, specifically of Hilgenreiner's epiphyseal angle, is crucial for preventing recurrence.
- Timely surgical intervention before age 10 improves long-term hip joint morphology and function.
Abstract:
Since the 1950s, valgus-producing femoral osteotomy has been the preferred treatment for significant coxa vara. Despite well-performed surgeries, the literature cites recurrence rates of 30-70%. The present study reviews our past 15 years of surgical experience for coxa vara; 26 children with 37 affected hips were retrospectively evaluated for outcome following valgus osteotomy. Both congenital and acquired types of coxa vara were included. Overall recurrence rate following valgus osteotomy was 50%. Age at time of surgery, type of surgery, and type of implant and etiology were found to have no bearing on recurrence. However, if Hilgenreiner's epiphyseal angle was corrected to < 38 degrees, 95% of children had no recurrence of varus. In contrast, head-shaft angle was found not to be a reliable indicator of appropriate correction. Only six of 37 hips required pelvic osteotomy (five Pemberton, one Chiari) for dysplasia, and four of these had developmental dysplasia of the hip as the underlying etiology for their coxa vara. However, if the proximal femur was corrected and maintained before age 10, 83% of children had excellent acetabular depth, spherical congruency, relief from pain, and correction of Trendelenburg gait at latest follow-up.