Thammanoon Srisaarn1, Krits Salang2, Benjamin Klawson3, Kitiwan Vipulakorn2, Ornusa Chalayon4, Perajit Eamsobhana4. 1. Department of Orthopaedic Surgery, Faculty of Medicine Phramongkutklao Hospital, Bangkok, Thailand. 2. Department of Orthopaedic Surgery, Faculty of Medicine, Khon Kean Hospital, Khon Kean, Thailand. 3. Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. 4. Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
BACKGROUND: Coxa vara is a hip deformity in which the femoral neck-shaft angle decreases below its normal value. Standard surgical treatment for this condition is corrective valgus osteotomy. Appropriate correction of the Hilgenreiner-epiphyseal angle is important to prevent recurrence. The purpose of this study is to: 1) evaluate the recurrence of the deformity at the latest follow up; and 2) find the appropriate angle of correction associated with the lowest recurrence. METHODS: 34 hips in 31 patients who underwent surgery for treatment of coxa vara from 2005 to 2014 were included. Patient-reported outcomes, Hilgenreiner-epiphyseal angle, and neck-shaft angle were assessed preoperatively, postoperatively, and at latest follow-up. RESULTS: The mean age at surgery was 10.99, with a range of 5-30, years. Preoperative neck-shaft angle ranged from 60 to 100 degrees, and Hilgenreiner-epiphyseal angle ranged from 60 to 90 degrees. At the latest follow up, the neck-shaft angle ranged from 120 to 135 degrees and the Hilgenreiner-epiphyseal angle ranged from 22 to 35 degrees (p < 0.001). The Harris hip score improved from 47.20 (34-66) to 79.68 (60-100) (p < 0.001). There was no recurrence of deformities at the mean follow up of 37.87 months. CONCLUSION: Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to > 120 degrees in order to prevent recurrence of the deformity. Majority of the patients were reported improvement of hip function. However, a longer-term follow up is required to determine further outcomes regarding to recurrence of the deformity.
BACKGROUND: Coxa vara is a hip deformity in which the femoral neck-shaft angle decreases below its normal value. Standard surgical treatment for this condition is corrective valgus osteotomy. Appropriate correction of the Hilgenreiner-epiphyseal angle is important to prevent recurrence. The purpose of this study is to: 1) evaluate the recurrence of the deformity at the latest follow up; and 2) find the appropriate angle of correction associated with the lowest recurrence. METHODS: 34 hips in 31 patients who underwent surgery for treatment of coxa vara from 2005 to 2014 were included. Patient-reported outcomes, Hilgenreiner-epiphyseal angle, and neck-shaft angle were assessed preoperatively, postoperatively, and at latest follow-up. RESULTS: The mean age at surgery was 10.99, with a range of 5-30, years. Preoperative neck-shaft angle ranged from 60 to 100 degrees, and Hilgenreiner-epiphyseal angle ranged from 60 to 90 degrees. At the latest follow up, the neck-shaft angle ranged from 120 to 135 degrees and the Hilgenreiner-epiphyseal angle ranged from 22 to 35 degrees (p < 0.001). The Harris hip score improved from 47.20 (34-66) to 79.68 (60-100) (p < 0.001). There was no recurrence of deformities at the mean follow up of 37.87 months. CONCLUSION: Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to > 120 degrees in order to prevent recurrence of the deformity. Majority of the patients were reported improvement of hip function. However, a longer-term follow up is required to determine further outcomes regarding to recurrence of the deformity.
Authors: Cornelius S Fischer; Jens-Peter Kühn; Henry Völzke; Till Ittermann; Denis Gümbel; Richard Kasch; Lyubomir Haralambiev; René Laqua; Peter Hinz; Jörn Lange Journal: Acta Orthop Date: 2019-11-18 Impact factor: 3.717