Valgus osteotomy for congenital coxa vara.

Congenital coxa vara is a rare disease which can result in a significant disability if untreated or improperly treated. In this retrospective review of eight patients (12 hips) with congenital coxa vara, there were five boys and three girls. Four patients had bilateral involvement and four had unilateral involvement. At the time of surgery, the average age was 7.9 years. All patients underwent valgus intertrochanteric osteotomy with wires or blade-plates for fixation. The mean Hilgenreiner-epiphyseal angle was 75 degrees before surgery and improved to 25 degrees after surgery. The mean neck-shaft angle improved from 95 degrees to 137 degrees immediately after the osteotomies and was 125 degrees at the final follow-up. At a minimum two year follow-up only three hips in three patients maintained more than 80% correction. These three patients all had developmental coxa vara. The acetabular depth improved significantly in the patients with developmental coxa vara, especially in two patients (three hips) who underwent surgery before 6 years of age. Closure of physeal plates was found in three patients (five hips) before surgery and occurred in two patients (two hips) after surgery. After surgery, only two patients had persistent soreness. One patient walked with a limp, and the other, with multiple epiphyseal dysplasia had significant leg length discrepancy. Our results show that valgus osteotomy can correct varus deformities of the proximal femur and improve function. If performed early, it can also prevent the development of hip dysplasia in patients with developmental coxa vara. However, the response of acetabular development was variable in patients with coxa vara due to skeletal dysplasia, despite valgus osteotomy.