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Coxa valga dnbid

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Lecture Presentation

Lecture Presentation

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  • 1. Coxa Valga D. N. Bid
  • 2.  
  • 3.  
  • 4.
    • Fig. 1: AP Pelvis. Bilateral superior and lateral subluxation. Right greater than left.
    • Note secondary hip dysplasia on right side.
  • 5.
    • Introduction: Coxa valga is defined by an increase in the femoral neck-shaft angle, compared
      • � to age-appropriate standards.
      • � It is commonly present in patients with cerebral palsy and may lead to such complications as femoral head dislocation.
  • 6.
    • Presentation: Coxa valga is generally noted in patients with known underlying neuromuscular or skeletal disease.
      • � Commonly, Spasticity in the adductor muscles of the hip will overpower the hip abductors and extensors, leading to deformity.
      • � They may have impaired ambulation and sitting balance secondary to bilateral adduction contractures or windswept deformities.
      • � Decubitus ulcers and pain may also be present, secondary to the resultant positioning.
  • 7.
    • Diagnostic Evaluation:
    • The diagnosis of coxa valga depends on the measurement of the femoral neck-shaft angle on a true anterioposterior radiograph.
      • � The angle is present between the midaxis of the femoral shaft and a line along the midaxis of the femoral head/neck.
      • � Femoral anteversion (which is also commonly present in patients with cerebral palsy) and rotation may have projectional effects on the radiograph, causing the false appearance of coxa valga as well.
      • � Therefore, one must take care to recognize the possible geometric distortions of the true angle when reading films.
      • � Once subluxation occurs, medial/lateral flattening of the femoral head can be seen.
      • � In dislocation, a pseudoacetabulum can be seen along the lateral margin of the ilium.
      • � CT and MRI have also been suggested as imaging modalities.
      • � However, slice orientation and thickness must be accounted for when calculating the degree of torsion.
  • 8.
    • Differential Diagnosis:
      • Neuromuscular disorders (i.e. cerebral palsy, spinal dysraphism, poliomyelitis);
      • skeletal dysplasias;
      • juvenile idiopathic arthritis
  • 9.
    • Treatment/Course:
    • Severe coxa valga may lead to lateral subluxation or dislocation of the femoral head.
    • � Subluxation occurs superolaterally due to the forces of the spastic flexors and adductors of the hip.
    • � Chronic subluxation /dislocation can result in acetabular dysplasia and secondary degenerative joint disease.
    • � Non-surgical measures to prevent subluxation include physical therapy and exercises, aimed at stretching the spastic agonist muscles and strengthening the weaker antagonist muscles.
    • � Orthotic devices and casting may also be employed to ensure better positioning.
    • � Newer therapies to reduce spasticity in cerebral palsy include intrathecal baclofen and local injections of botulinum toxin.
    • � Surgical therapies may also be required, including tenotomy, neurectomy/dorsal rhizotomy, and varus derotation osteotomy.
  • 10.  
  • 11. The End

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