In patients with coxa vara, the affected hip exhibits a decreased angle between the neck and head of the femoral bone, as a result of a deficient developmental process of the cartilage. The neck of the hipbone may lack in length and its inner medial region may also be subject to fractures. The coxa vara developmental abnormality is closely linked to spondylometaphyseal dysplasia [10] and irregularly formed acetabuli [11], as can be understood from the diversity of the acetabular index and sourcil slope of healthy and affected patients.

Congenital coxa vara is not symptomatic, as the infant is unable to walk and express themselves. Developmental coxa vara is the disease type that emerged early in childhood and causes hip pain and limping, caused by a leg length discrepancy. Acquired coxa vara manifests in the same way as the developmental for of the condition. 

• Weakness

  Since coxa vara is caused by the strain of weight-bearing on a weakened femoral neck, one finds that the cases fall into certain groups, depending on the etiology of the weakness. A classification now generally used is as follows: 1. [jamanetwork.com]

  Five of the 12 hips with trochanteric overgrowth had abductor weakness. A postoperative HE angle of 35 degrees or less and a HS angle of 130 degrees or more was correlated with consistently satisfactory results. [ncbi.nlm.nih.gov]

  These include: trauma SCFE Legg-Calve-Perthes Epidemiology males and females affected with equal frequency bilateral in 33 to 50% of cases Presentation Presents with painless waddling Trendelenburg gait (when bilateral) due to abductor weakness from tension [m.blog.naver.com]

  The abductors and extensors of the hips were weak in some that resulted in limping and Trendelenburg gait. [online.boneandjoint.org.uk]

  A tabletop examination may reveal weak abductors, a prominent greater trochanter, decreased abduction due to a decreased articulo-trochanteric distance, and coxa vara. [thehealthscience.com]

• Dysostosis

  Citation metadata Document controls Main content Abstract : We describe a rare case of unilateral development of coxa vara secondary to metaphyseal dysostosis encountered in a 6-year-old boy. [go.gale.com]

  Metaphyseal dysostosis Other skeletal dysplasias * References. † References. ‡ References. [musculoskeletalkey.com]

  Also included in this category are secondary varus changes due to generalized skeletal conditions or dysplasias such as Morquio disease ( mucopolysaccharidosis type IV ), cleidocranial dysostosis, metaphyseal diaphyseal dysplasia, and metaphyseal dysostosis [emedicine.medscape.com]

  […] back/soft)/cong, sysi/epon, injr proc, drug(M01C, M4) v · d · eCongenital malformations and deformations of musculoskeletal system / musculoskeletal abnormality (Q65–Q76, 754–756.3) Appendicular limb / dysmelia Upper clavicle / shoulder: Cleidocranial dysostosis [enacademic.com]

• Fatigue

  BACKGROUND: Theoretically, coxa vara substantially modifies the biomechanical conditions of the femoral neck, increasing the effect of direct muscle pull and leading to fatigue of opposing muscle groups; such modifications would appear to favour the appearance [ncbi.nlm.nih.gov]

  Chronic Fatigue Syndrome Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here. [meta.org]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: August 5, 2019 [patientslikeme.com]

  Introduction A decreased neck-shaft angle that is associated with an ossification defect in inferior femoral neck Causes include congenital defect acquired conditions that leads to fatigue fracture with physiologic stress of weight bearing. [m.blog.naver.com]

• Surgical Procedure

  A two-stage surgical procedure was planned to correct the deformity. The first stage involved correction of the coxa vara and fixation with a hip plate. [ncbi.nlm.nih.gov]

  The most common surgical procedure was an osteotomy. A wedge- or pie-shaped piece of bone was removed. It may be reinserted on the other side to further change the angulation. In a few cases, the osteotomy was accompanied by a derotation procedure. [eorthopod.com]

  This we believe is the conservative form of treatment in spite of a surgical procedure. To read this article in full you will need to make a payment References Fairbanks H.A.T. Infantile or Cervical Coxa Vara, The Robert Jones Birthday Volume. [surgjournal.com]

  Femoral osteotomy procedures are technically easier in the older child because more bone stock is present. Earlier surgical intervention may allow the hip, including the acetabulum, to remodel more completely. [emedicine.medscape.com]

• Thin Skin

  Surgery can sometimes be performed to provide better coverage in thin-skinned areas, remove skin “nubbins” or occasionally elongate the bone for a prosthetic fitting. Depending on the age and goals of the patient, a prosthesis can be worn. [childrensortho.com]

• Freckles

  The silicone can be sculpted and painted to match each patient’s size and skin tone, including details like wrinkles, veins and freckles. Silicone skins can be made to go over prostheses, including below-knee or above-knee leg prostheses. [childrensortho.com]

• Coxa Vara

  BACKGROUND: Coxa vara is a rare condition. Surgical correction of coxa vara has been challenging. A few reports present correction coxa vara in multiple causes. [ncbi.nlm.nih.gov]

  Developmental coxa vara has been distinguished from the other types as it occurs at the level of the proximal femoral physis. In this chapter we discuss normal proximal femoral development and the pathophysiology of coxa vara. [semanticscholar.org]

  […] on Coxa vara Images of Coxa vara Photos of Coxa vara Podcasts & MP3s on Coxa vara Videos on Coxa vara Evidence Based Medicine Cochrane Collaboration on Coxa vara Bandolier on Coxa vara TRIP on Coxa vara Clinical Trials Ongoing Trials on Coxa vara at [wikidoc.org]

  Archive Abstract Coxa vara adolescentium is a distinct entity. It consists of a disturbance of the nutrition of the epiphyseal line of the upper end of the femur. It results in various degrees of coxa vara if it is not properly treated. [journals.lww.com]

• Arthritis

  arthritis; enthesitis-related arthritis (often positive for human leukocyte antigen HLA-B27); and “other” arthritis, disease that does not fall into any of the groups listed. [ajronline.org]

  BACKGROUND Coxa vara and pseudoarthrosis of the femoral neck after septic hip arthritis is a very rare disease. [ncbi.nlm.nih.gov]

  • Secondary to: • Arthritis. • Ligamentous Injuries. • Fractures. • Pagets Disease. 38. Management. •With No Associated Arthritis: Corrective Osteotomy. •Uni Compartmental Arthritis: • Corrective Osteotomy or Partial Joint Replacement. [slideshare.net]

• Lordosis

  In all previous reports, non-inflammatory pattern of arthropathy involving the peripheral joints with typical coxa vara deformity were described, and in a few cases spine abnormalities, including kyphosis, lordosis, or scoliosis. [ncbi.nlm.nih.gov]

  Unilateral cases present with painless limp and bilateral cases present with a waddling gait and increased lumbar lordosis. [dergi.totbid.org.tr]

  […] bilateral in 33 to 50% of cases Presentation Presents with painless waddling Trendelenburg gait (when bilateral) due to abductor weakness from tension abnormalilty painless limp (when unilateral) leg length discrepancy if unilateral excessive lumbar lordosis [m.blog.naver.com]

  Other physical characteristics may include outward "flaring" of the bones of the lower rib cage, lumbar lordosis, pain in the legs, and/or hip deformities in which the thigh bone is angled toward the center of the body (coxa vara). [diki.pl]

  […] skeletal abnormalities prenatal development history effect on their activities FHX Symptoms Gait abnormality painless wadding Trendelenberg gait when bilat due to abductor weakness from tension abnormality Painless limb when unilateral LLD excessive lumbar lordosis [brainscape.com]

• Genu Valgum

  Because changes in shape of the femur naturally affects the knee, coxa valga is often combined with genu varum (bow-leggedness), while coxa vara leads to genu valgum (knock-knees). [diki.pl]

  Genu Varum & Genu Valgum Knock Knees Bow Legs 22. [slideshare.net]

  Extremities appear slightly shortened, with severe coxa vara, genu valgum, multiple accessory epiphyses in hands and feet, and talipes equinovarus. [thefreedictionary.com]

  KNEE Genu Valgum (knock-kneed) Tibia/fibula (not the joint itself) head away from midline Genu Varum (bow-legged) Tibia/fibula (not the joint itself) head toward midline ANKLE Talipes Valgus Sole faces away from midline Also called eversion and pronation [drvxray.com]

• Hip Dislocation

  Research of Congenital Coxa Vara has been linked to Hip Dislocation, Congenital, Congenital Abnormality, Arthropathy, Epiphysis Disorders, Degenerative Polyarthritis. [novusbio.com]

  Developmental coxa vara is a rare condition with an incidence of 1 in 25 000 live births, 20 times rarer than congenital hip dislocation.1 It has a preponderance in black people and its natural history if untreated is one of progressive varus deformity [emj.bmj.com]

  Under the category of other forms falls any other occurrence due to the following reasons: Tuberculosis Osteomalacia Traumatization Deforming arthritis Congenital Hip dislocation (also congenital) Senile atrophy Fibrosing osteitis Osteomyelitis Unknown [symptoma.com]

  Dislocation of hip / Hip dysplasia · Upington disease · Coxa valga · Coxa vara knee: Genu valgum · Genu varum · Genu recurvatum · Discoid meniscus · Congenital patellar dislocation · Congenital knee dislocation foot deformity: varus (Club foot / Pigeon [enacademic.com]

• Waddling Gait

  Clinical History Radiographic and computed tomographic findings of a 21-year-old male patient with a painless waddling gait, were presented. Imaging Findings A 21-year-old male patient presented with a waddling gait, without pain. [eurorad.org]

  […] sign - mimic DDH Gait - short-leg - trendelenburg sag - abductor lurch - if bilateral - waddling gait Decreased ROM - especially abduction & IR Radiology Inverted Y - inferior sclerotic metaphyseal triangle - pathognomonic of developmental Varus femoral [boneschool.com]

  Patient walks with Trendelenburg limp in unilateral coxa vara and a waddling gait in bilateral coxa vara. [boneandspine.com]

  Unilateral cases present with painless limp and bilateral cases present with a waddling gait and increased lumbar lordosis. [dergi.totbid.org.tr]

• Abnormal Gait

  Presentation Abnormal gait associated with right hip pain. Loading images... Pelvis x-ray demonstrating a right hip deformity characterized by a reduced angle between the head and neck of the femur. [radiopaedia.org]

  Shrot status and later abnormal gait associated with coxa vara are common clinical feature. A 6 years 4 months old boy progressive bilateral coax vara were transferred with abduction limitation of the hip. [synapse.koreamed.org]

  Many patients have persistent gait abnormalities and functional impairment at long-term follow-up, regardless of prior treatment. LEVEL OF EVIDENCE: Level III-retrospective cohort. [ncbi.nlm.nih.gov]

  Early degenerative changes - untreated get severe early OA & often require THR early Symptoms Present at walking age with abnormal gait - painless limp Signs Patient is short with hyperlordosis of spine & waddling gait - limb-length discrepancy - trendelenburg [boneschool.com]

• Irritability

  Major problems that were envisaged were the following: Prolonged maintenace of a fixator on the femur could give rise to lot of muscle irritation, pain and stiffness of the knee. [hwbf.org]

  Ischiogluteal bursitis : the ischiogluteal bursa is located over the ischial tuberosity and may irritate the sciatic nerve. With this type bursitis, pain is usually acute and very intense. [therapyedu.com]

  Bone formation started as a hazy shadow in the abductors, which could have been due to muscle irritation by the wires. [jorthoptraumatol.springeropen.com]

• Paresis

  The neuromuscular disorders are characterized by a progressive peripheral neuropathy with variable combinations of laryngeal dysfunction (i.e., vocal fold paresis), respiratory dysfunction, and joint contractures. [ncbi.nlm.nih.gov]

• Seizure

  Calcium feedback hemostasis is impaired, and children with OPT are at risk of developing hypocalcemia with attendant tetanic seizures and secondary hyperparathyroidism. [ncbi.nlm.nih.gov]

The diagnosis of coxa vara requires radiography and, possibly, magnetic resonance imaging (MRI) and a computed tomography (CT) to be diagnosed.

A plain radiograph is an excellent tool to evaluate the positioning of the head and neck of the femur. Coxa vara findings include the angle between these two structures being smaller than 120° and the greater trochanter being uplifted above the head of the femur. The growth plate may also be oriented vertically.

An MRI can be used to better illustrate epiphyseal plates and a CT helps to find out whether there has been any rotation of the hipbone, whether inwards or outwards.

Treatment of coxa vara is solely surgical. There is no general agreement amongst the surgical community as to when the procedure should be performed: some surgeons suggest that it should be done as early as possible, as younger patients have better chances to heal properly and acquire a new, fully functional, normal junction. Detractors argue that performing the procedure at a an older age is optimal, since the hipbone will have reached its full potential and will be no longer subject to developmental changes.

Irrespective of the patient's age, surgery is conducted in order to remodel the femoral head/neck intersection. Simultaneously, abductors muscles are repaired, if damaged, and discrepancies in the length between the two legs are also resolved. Children that are younger than 10 years old undergo epiphysiodesis of the greater trochanter. other therapeutic schemes include trochanteric repositioning and Pauwels Y-osteotomy.

All patients with coxa vara caused by trochanteric overgrowth should be closely monitored, since they run a risk of recurrence. Any visible leg length difference should be noted and examined. Patients who undergo appropriate correction with trochanteric repositioning respond well to treatment.

Coxa vara may be a developmental abnormality, an acquired, or congenital one. Congenital coxa vara suggests that it arose prior to birth, during the development of the fetus. There is no consensus as to exactly how this deformity is induced; however, various theories have been proposed. The condition is considered a result of increased pressured in the womb due to an abnormal fetal position or caused by some type of bone abnormality that hiders its own growth.

Coxa vara is defined as acquired, when it is generated by another condition or event, such as traumatization of the hip region, of loss of bone continuity (fractures). Developmental coxa vara manifests early in the age of childhood and deteriorates gradually as the young patient grows.

Pediatric patients exhibit a high risk of developing coxa vara after a fracture of the femoral neck [4]. Data [5] has shown that such fractures, when sustained by young individuals, induce severe complications, such as nonunion, avascular necrosis, shortened extremity, coxa valga, coxa vara and premature epiphyseal fusion. Coxa vara, in particular, accounts for 8% of these complications.

A premature cessation of epiphyseal growth is one of the factors greatly contributing to the development of coxa vara; its incidence has not been accurately calculated, with studies exhibiting rates that fluctuate between 6-62%.

Developmental coxa vara is not frequently observed (incidence estimated at 1:25.000 births) [6].

Histologic data has shown that chondrocytes isolated from hips affected by coxa vara have undergone a deficient developmental process. Their columnar architecture exhibits abnormalities and cartilaginous matrix is calcified [7] [8]. The abnormal cartilage structure does not allow for the full development of the metaphysis and inadvertently causes osteoporotic phenomena and decreased resistance to the forces exerted on that area. The force on the junction between the acetabula and femur causes compression both vertically and horizontally in relation to the physis [9]. A weakened junction tends to bend inwards because it cannot support the aforementioned stress.  

Congenital coxa vara cannot be prevented. Acquired forms of the deformity can be anticipated, should a patient be affected by a condition that may cause it, and therefore, proper treatment of the underlying condition will minimize hip abnormality risk. Patients who have sustained hip traumas, or suffer from osteomalacia, deforming arthritis or osteomyelitis, should be closely monitored in order to diagnose coxa vara as early as possible. The earlier an intervention is possible, the better the outcome will be. The distance between the hip joint and the greater trochanter is a useful indicator of coxa vara that can be measured for monitoring causes.

The degrees of the angle formed between the head and neck of the femoral bone is vital to the structure and functionality of this skeletal component. In children, this is usually a 135° to 145° angle [1]. In cases where the neck and head are positioned in a different way, at a smaller or greater angle, coxa vara and coxa valga [2] result respectively.

Coxa vara involves an angle between these two structures that is reduced to < 120° and is an abnormality of the hipbone's neck. It can be congenital, developmental or a complication of a coexistent disease, like fibrous dysplasia or rickets [3].

The prevailing classification of coxa vara suggests the categorization of the deformity into 2 categories: adolescentium and other forms. Under the category of other forms falls any other occurrence due to the following reasons:

• Tuberculosis
• Osteomalacia
• Traumatization
• Deforming arthritis
• Congenital
• Hip dislocation (also congenital)
• Senile atrophy
• Fibrosing osteitis
• Osteomyelitis
• Unknown

Therefore, there are two distinct coxa vara forms. False coxa vara is associated with an underlying condition, which causes inflammation or trauma to the neck of the femoral bone, thus altering the anatomy of its angle. The other type, true coxa vara, arises from lesions that are not inflammatory and render the hipbone's neck to be unable to resist the weight and other types of forces exerted on it. True coxa vara is frequently observed amongst the adolescent population. In children affected by skeletal dysplasia, coxa vara tends to be an escalating condition.

In order to understand the definition of coxa vara, one should be familiar with the anatomy of the hip joint. the hip joint is the connection between the top part of the femoral bone (or thighbone) and the pelvic region. The top part of the thighbone is called the "head" and the part of the longer bone immediately below it is the neck. the head and neck form a horizontal angle with each other.

Coxa vara is an abnormal formation of this angle, which is less than 120°. This is a result of defective development of the bone and causes hip pain and a difference in the length of the two legs and subsequent limping.

An individual may be affected with coxa vara since birth; this constitutes the congenital type. Developmental coxa vara means that a patient was not born with it, but it was a result of abnormal development. This is usually to be seen early in childhood, as the individual first starts to walk. Coxa vara can also be a complication of another condition, usually one that affects the bones, like osteomyelitis or bone fracture, with this being the third type, acquired coxa vara. In general, the condition is rare, as it is observed at a rate of 1 in 13,000-25,000 live births.

Both men and women are affected equally. Coxa vara may be present in one joint or both. Patients experiencing hip pain and movement restriction should always visit their physician, who is responsible for evaluating the hip status. Coxa vara is most of the times diagnosed in young ages, due to hip pain and limping, but older patients can be affected with the acquired deformity type. A plain x-ray , an MRI or CT scan will help the physician diagnose the hip condition. in cases of coxa vara, treatment is exclusively surgical, as the condition does not resolve on its own.

1. Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. Emerg Med J. 2001 Jul;18(4):314.
2. Clohisy JC, Nunley RM, Carlisle JC, Schoenecker PL.Incidence and Characteristics of Femoral Deformities in the Dysplastic Hip. Clin Orthop Relat Res. 2009; 467(1): 128–134.
3. DiFazio R, Kocher M, Berven S, Kasser J. Coxa vara with proximal femoral growth arrest in patients who had neonatal extracorporeal membrane oxygenation. J Pediatr Orthop 2003; 23: 20-26.
4. Eberl R, Singer G, Ferlic P, Weinberg AM, Hoellwarth ME. Post – traumatic coxa vara in children following screw fixation of the femoral neck. Acta Orthop. 2010 Aug;81(4):442-5.
5. Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury. 2005 Jan;36(1):123-30.
6. Lam F, Hussain S, Sinha J. An unusual cause of a limp in a child: developmental coxa vara. Emerg Med J. 2001 Jul;18(4):314.
7. Chung SM, Riser WH. The histological characteristics of congenital coxa vara: a case report of a five year old boy. Clin Orthop. 1978 May; (132):71-81. 
8. Bos CF, Sakkers RJ, Bloem JL, et al. Histological, biochemical, and MRI studies of the growth plate in congenital coxa vara. J Pediatr Orthop. 1989 Nov-Dec; 9(6):660-5. 
9. Ranade A, McCarthy JJ, Davidson RS. Acetabular changes in coxa vara. Clin Orthop Relat Res. 2008 Jul; 466(7):1688-91
10. Currarino G, Birch JG, Herring JA. Developmental coxa vara associated with spondylometaphyseal dysplasia (DCV/SMD): "SMD-corner fracture type" (DCV/SMD-CF) demonstrated in most reported cases. Pediatr Radiol. 2000 Jan;30(1):14-24.
11. Ranade A, McCarthy JJ, Davidson RS. Acetabular changes in coxa vara. Clin Orthop Relat Res. 2008 Jul;466(7):1688-91.