4 causes of coke vara - what is the disease and how to avoid it?

Contracture of the hip joint

Often the cause of contracture of the hip joint is also long-term immobilization of the limb in a plaster cast, when the joint capsule and periarticular tissues wrinkle and the muscles permanently shorten.
Paralytic contracture of the hip joint is observed as a consequence of flaccid and spastic paralysis. Contracture in the flexion and adduction position occurs as a complication of infantile paralysis. To weaken the adductor muscles of the thigh, the tendons of the long adductor muscle at the pubic bone are cut.

Bilateral spastic contracture in the position of adduction and flexion accompanies Little's disease. A patient suffering from Little's disease walks in small steps, alternately crossing his knees bent and turned in the middle.

Walking improves after transection of the obturator nerve. Spastic contracture of the hip joint of a temporary nature is observed with paranephritis, psoitis and tuberculous coxitis.

Looseness of the hip joint develops with flaccid infantile paralysis, extending to the muscles connecting the pelvis with the upper end of the thigh, as well as after wide resections of the hip joint.

After gunshot wounds of the hip joint with fragmentation of the femoral head and damage to the acetabulum, ankylosis usually develops, and occasionally excessive mobility develops.

In case of a unilateral dangling hip joint, joint arthrodesis is performed. The articular cartilage is removed from the femoral head and acetabulum, the upper end of the femur is inserted into the articular cavity and fixed with bone nails, which are driven through the posterior and upper wall of the acetabulum. To support the hip and limit excessive mobility, a bone canopy is also formed over its upper end from a bone flap taken from the ilium.

COXA VARA

In a normal relationship, the neck and diaphysis of the femur form an angle ranging from 108 to 145°, with an average of about 125°.
A greater downward inclination of the neck with a decrease in the angle to straight and even acute represents a pathological condition called coxa vara. A more straightened position of the neck in relation to the diaphysis with the formation of an angle greater than 145° is called coxa valga.

Coxa vara is a common disease observed in its own form. It appears as if it were primary or is one of the manifestations or consequences of another disease, for example, osteochondropathy, tuberculosis of the hip joint, osteomyelitis, or a neck fracture.

There are three forms of coxa vara:

Congenital coxa vara is a consequence of a slowdown in the normal process of ossification of the cervix or, perhaps, sometimes a consequence of improper positioning of the fetal legs with insufficient amniotic fluid.

The childhood form of coxa vara occurs quite often, mainly in girls. The disease begins in early childhood and is apparently associated with rickets or dyschondroplasia of the growth cartilage of the femoral neck.

The first clinical symptoms of the disease usually appear at the age of about 4-5 years or slightly later. The child’s gait resembles the gait of congenital dislocation of the hip joint, i.e. the child walks swaying, gets tired easily, and complains of pain in the hip joint.

Upon examination, attention is drawn to the protrusion of the greater trochanter and its high standing compared to the other side. The apex of the greater trochanter is located above the Roser-Nelaton line. The leg is shortened.

Some movements in the hip joint are limited. Flexion is limited. Particularly characteristic is the limitation of hip abduction and rotation midline. Trendelenburg's sign is constant. When making a diagnosis, you need to keep in mind congenital dislocation of the hip joint, the similarities to which are great. An x-ray helps resolve doubts.

Juvenile coxa vara is observed during puberty, as well as in adolescents aged 14 to 17 years, more often in boys. Apparently, the femoral neck bends mainly under the influence of pressure on the fragile bone from the weight of the body, especially during prolonged standing or carrying heavy objects.

In adolescence, plow vara can be a consequence of osteochondropathy of the femoral head, in old age - disfiguring arthrosis.

The disease usually develops gradually. Initially, patients complain of pain when standing for long periods of time. After resting in a horizontal position, the pain stops. Sometimes, usually after an injury, the pain immediately becomes so acute that the thought of a femoral neck fracture arises.

The symptoms are generally the same as those of the childhood form of coxa vara. In the juvenile form, in addition to the downward curvature of the femoral neck, there is often a posterior curvature of the femoral neck with the formation of a convexity forward. In pronounced cases of this type, the leg assumes a position of adduction and lateral rotation. The diagnosis is confirmed by X-ray data.

An x-ray image shows a curved neck and a bent down head, and in a later period, in addition, deformation.

The goal of conservative treatment is to prevent further development of the disease, which is solved by unloading the joint. To do this, prolonged standing is prohibited, and walking with an orthopedic device, on crutches, and cycling is recommended. Sometimes constant traction is used. General restorative treatment is prescribed.

To monitor the progress of the disease, X-rays are taken periodically. In cases of significant impairment of limb function and prolonged pain, surgical intervention in the form of subtrochanteric osteotomy is resorted to. After cutting the bone, the fragments are installed to form an angle open to the side.

Patients with coxa vara can perform work that is not associated with great physical stress, prolonged walking and prolonged standing.

COXA VALGA

Coxa valga is the position of the neck in relation to the femoral shaft at an angle greater than 145°.
Coxa valga can be congenital or acquired. Acquired coxa valga develops when there is no load on the femoral head, for example, after amputation or when the traction of the muscles attached on one side to the pelvic bones on one side and to the upper end of the thigh on the other, which is observed in infantile paralysis and progressive muscular atrophy. The gait with plow valga is very similar to the gait with plow vara.

Distinctive features are the ability to abduct the hip and the location of the apex of the greater trochanter on or below the Rosener-Nelaton line.

An accurate diagnosis is made using an x-ray. Conservative treatment is aimed at strengthening the gluteal muscles (massage, baths). Surgical intervention is indicated only when the head is mobile and consists of the formation of a bone canopy over the head, holding the head in the glenoid cavity. A subtrochanteric osteotomy is also performed.

Description

The axis of the femoral neck and diaphysis form an angle, which under normal conditions is 125-130 degrees in adults and 130-135 in small patients.

Under the influence of various factors, this indicator may decrease or increase. If the neck-shaft angle is reduced and is less than 120 degrees, we are talking about coxa vara.

Attention! Among the etiological factors for the development of coke vara are: congenital pathological changes, trauma, previous rickets, and static disorders.

Features of the clinic, diagnosis and treatment tactics of varus deformity of the femoral neck in children

Authors: Jalilov A.P., Karimov Zh.N., Jalilova Sh.P., Akbarova N.P., Tashkent Pediatric Medical Institute, Department of Traumatology, Orthopedics with Neurosurgery, Uzbekistan

print version

This paper presents the results of a survey of 28 patients aged 1 to 14 years who were undergoing inpatient and outpatient treatment at the clinic of the Tashkent Pediatric Medical Institute. The purpose of the study was to study some features of varus deformity of the femoral neck in children. Depending on their age, they were divided into 2 groups: 10 children - under the age of 1 year, 18 - from 1 year to 3 years. Treatment tactics were chosen based on clinical and radiological examination. Conservative treatment was recommended for patients under 3 years of age with varus deformity of the femoral neck, and only surgical treatment for children over three years of age.

Causes

The reasons for the appearance of coxa vara are quite diverse. The disease can develop as a result of congenital anomalies, or be of a traumatic or rachitic nature. In addition, there are childhood and youth deformities of the hip joint.

The basis for childhood pathology is the process of inappropriate restructuring of the neck and vertical region of the femur. The phenomenon is caused by a primary violation of enchondral ossification in its middle zone.

In addition, varus changes in the femoral neck are often diagnosed in the case of systemic pathologies, including fibrous osteodysplasia, pathological fragility of bone tissue, and dyschondroplasia.

The disease can also develop as a result of surgery or as a consequence of pathological conditions of bone tissue. In the latter case we are talking about tuberculosis, osteomyelitis, etc.

Therapeutic exercises for arthrosis of the hip joint

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With age, a person's freedom of movement decreases. This especially applies to those who suffer from various joint diseases. At the same time, any movement causes pain, stiffness is felt and there is a high probability of injury. The most common cause of problems is arthrosis of the hip joints, or coxarthrosis. Many patients with an advanced form of the disease are forced to constantly take potent medications, and any movement is still accompanied by pain.

To avoid such joint destruction, it is necessary to begin complex treatment on time. Therapeutic exercises are very useful for arthrosis of the hip joint. It is special exercises that help the patient strengthen the muscles and regain the ability to move without pain.

This is especially important for coxarthrosis, because without proper treatment, the disease leads to joint destruction and disability.

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Functions of physical therapy

Exercise therapy and dosed physical activity are necessarily included in the complex treatment of coxarthrosis. This disease cannot be cured with medications alone; without special exercises, the destruction of the joint will continue. Therefore, exercise therapy is prescribed at any stage of the disease. Gymnastics for arthrosis of the hip joint performs the following functions:

• strengthens muscles and ligaments that protect the joint from damage;
• improves blood circulation;
• accelerates metabolism, reduces body weight, which is very important for reducing stress on joints;
• helps to gain confidence in movement and prevent injuries;
• reduce the risk of developing tumors, osteoporosis, diabetes and heart attack.

Who should not do gymnastics

All exercises for coxarthrosis are selected strictly individually. The specialist takes into account not only the specifics of the development of the disease, its stage, but also the patient’s health status. There are diseases for which any physical activity is contraindicated:

• hernia of the spine or groin area;
• severe pathologies of the heart;
• high degree of hypertension;
• exacerbation of coxoarthrosis.

In addition, you should not exercise if there is increased pressure, especially intracranial pressure, high body temperature, or exacerbation of any chronic diseases or infectious diseases. Exercises are not recommended for women on menstruation days.

Rules for performing exercises

For physical therapy to be beneficial, it is very important to follow certain rules. Otherwise, exercise can harm your joints and lead to injury. The main rule of exercise therapy for arthrosis of the hip joints is gradualism; the load must be increased without allowing pain to appear. Another rule that all patients should remember is that you need to exercise regularly. Only daily exercise will help the joint restore mobility.

In addition, during classes you must follow other rules:

• You can only exercise during the period of remission, when there is no pain;
• before classes it is necessary to warm up the muscles;
• the starting position before the exercise should not increase the load on the joint;
• each exercise must be performed smoothly, sudden movements are unacceptable;
• Between different exercises it is necessary to pause to rest;
• the total class time should not exceed 30 minutes;
• it is necessary to control the heart rate and avoid excessive stress;
• After completing all the exercises, it is advisable to do a light self-massage of the hips and joint areas.

What exercises should not be done with coxarthrosis?

If the hip joint is damaged, many exercises are contraindicated:

• squats;
• rotational movements in the hip joint;
• long walking;
• jumping;
• cycling or exercise on an exercise bike;
• sudden movements that lead to increased stress on the joint.

How to practice

The exercise therapy complex should be developed by a specialist, taking into account the individual characteristics of the disease and the general health of the patient. First, classes are held in a medical institution, then you can do the exercises at home. But you must follow all the rules and recommendations of experts.

To practice at home, you need to have a special hard mat, since most exercises are performed lying down or sitting on the floor. You will also need a stable chair with a back. For self-study, you should use only those exercises that are recommended by a specialist.

What physical activities are the most beneficial?

With coxarthrosis, especially in the initial stages, dosed physical activity is very important. In addition to a special exercise therapy complex, you can engage in various sports. Only professional sports, jumping and weight lifting are excluded. The following physical activities are very useful:

• swimming;
• skiing;
• yoga;
• walking.

The best exercises for coxarthrosis

1. Lie on your stomach and relax. You need to slowly raise one leg and slowly lower it. Same thing with the other leg. Then you can complicate the exercise: hold your leg in the raised position for a few seconds, raise your leg bent at the knee, lift both legs and spread them, and then bring them together on weight. The number of repetitions can be increased to 10.
2. Lying on your back, bend one leg at the knee. The other leg is slowly bent and pulled towards the chest, then straightened and lowered to the floor. Repeat the same with the other leg.
3. Lie on your back, bend your knees and place them shoulder-width apart. Leaning on your shoulders and legs, you need to lift your pelvis up.
4. While sitting on the floor, you need to move forward or backward using your gluteal muscles. The movements should be accompanied by intense vibrations with the arms bent at the elbows.
5. Sit on a chair. Lean forward, trying to reach your toes. Avoid pain. Repeat the exercise up to 10 times.
6. Sit on a chair, spread your legs slightly. Lean forward and rest your elbows on your inner thighs. Next, the body is rocked from side to side.
7. Stand with one foot on a low stand and hold on to the wall with your hand. Swing your free leg back and forth. The exercise is performed slowly. Number of repetitions – up to 15 times.

Diagnostics

When making an initial visit to a specialist (orthopedist), the doctor performs a visual examination: with a stable hip joint, the limbs are the same in length, the abduction of the leg is not limited. In the process of diagnosing childhood dystrophic coxa vara, as well as acquired pathology in adults, an x-ray examination is performed. During the procedure, internal rotation of the leg is mandatory. In some cases, the patient is shown an ultrasound of the joint tissue and a CT or MRI.