Long-term Outcomes of Operative and Nonoperative Treatment of Congenital Coxa Vara.
BACKGROUND
Congenital coxa vara (CCV) is a rare hip condition with few long-term studies. The purpose of this study was to assess clinical, radiographic, and functional outcomes after operative and nonoperative treatment of CCV, assess reliability of radiographic parameters, and investigate risk factors for recurrence after surgery.


METHODS
Retrospective review was performed of all CCV patients treated at 1 institution from 1980 to 2010. In addition, patients were recalled for additional follow-up x-rays, modified Harris Hip Score (mHHS), and gait analysis. Radiographic measurements [neck-shaft angle (NSA), head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), and femoral neck length (FNL)] were assessed for reliability using intraclass correlation coefficients. Multivariate analysis was performed to identify risk factors for recurrence after surgery.


RESULTS
Forty-six hips in 32 patients were reviewed. Mean age at presentation was 5.4±4.9 years. Mean follow-up was 11.8±5.8 years. Valgus proximal femoral osteotomy was performed in 27 hips (20 patients). Initial deformity was greater in the operative group (NSA 90±17 degrees, HEA 68±19 degrees) versus nonoperative patients (NSA 122±19 degrees, HEA 34±14 degrees) (P<0.0001), but radiographic outcomes were similar at follow-up. Most nonoperative hips had normal FNL growth rates (80%), but resolution of varus NSA occurred in only 21%. In contrast, 56% of operative hips showed decreased FNL growth rates. Interobserver reliability was excellent for HEA (0.98), NSA (0.90), and FNL (0.89), and good for HSA (0.79). Repeat osteotomy was performed in 6 cases (22%). No significant predictors for recurrence were identified. At long-term follow-up for recalled patients, 72% had significantly abnormal gait, and 50% had fair-poor functional outcomes (mHHS<79).


CONCLUSIONS
Valgus osteotomy corrects severe deformity in CCV with improved clinical and radiographic outcomes. HEA and NSA are the most reliable radiographic measurements of proximal femoral deformity in CCV. Recurrence is not uncommon, but no predictors were identified. Many patients have persistent gait abnormalities and functional impairment at long-term follow-up, regardless of prior treatment.


METHODS
Level III-retrospective cohort.
Department of Orthopedic Surgery, NorthShore University HealthSystem, Evanston, IL.
David W
DW
Roberts
Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children.
Yavuz
Y
Saglam
Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children.
Adriana
A
De La Rocha
Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children.
Brigid N
BN
Frasquillo
Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children.
Kirsten
K
Tulchin-Francis
Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children.|Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX.
Harry K W
HKW
Kim
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D060905:Coxa Vara / Q000151:congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005272:Femur Neck / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies