La hip, in Latin “coxa”, is the part of the body that connects the lower limbs to the trunk. It is also called " hip joint ". It plays an important role in the rotation and flexion of the trunk as well as in walking. It may be subject to malformation or dysplasia. In this article, we will be particularly interested in an attack at the level of the femoral neck. This is commonly called the coxa valga. Learn more about this hip disorder.
Definition and anatomy
To connect the trunk and the lower limbs, the hip consists of two bones, including the femur (thigh bone) and the iliac bone (pelvic bone).
Elongated in shape, the femur is the longest bone in the human body. It is also the largest bone. The femur is divided into three parts:
- a proximal end which is at the level of the hip;
- a distal end which is located at the level of the knee;
- a diaphysis (or body) which is the central part of the bone lying between the two extremities.
As for the proximal end of the femur, it is formed by:
- the head of the femur located in the acetabulum: it is the articular cavity of the coxal bone which makes it possible to form the hip;
- the neck of the femur which connects the head and the diaphysis;
- the trochanters (bony reliefs) which are at the union of the neck and the diaphysis.
The coxa valga designates a deformation of the upper part of the femur. This deformation is related to the modification of the angle of inclination between the neck and the body of the femur. More specifically, it is characterized by a excessive opening from the corner cervico-diaphyseal. This is the angle formed by the neck of the femur and the diaphysis.
Due to the deformation of the axis of the femoral neck, the femoral head will rest on a small surface and will increase the pressures at the level of the articular cartilage.
It should be noted that this angle is normally between 120° and 135° in adults. When it reaches 140°, we speak of a case of coxa valga.
What are the causes of coxa valga?
The coxa valga can have either a congenital or an acquired origin.
We speak of congenital origin if the deformation occurs during in utero development or at birth, by specific maneuvers called “Barlow and Ortolani maneuver”. In this case, there is instability in the hip. This instability can lead to congenital hip dislocation.
We speak of a coxa valga of acquired origin when it is secondary to a fracture of the neck of the femur.
How does coxa valga manifest?
At first this angulation excessive femoral neck is asymptomatic. As the deformity progresses, the effect of the stresses caused by the femoral head leads to advanced wear at the joint. This is no longer in the right place.
The main symptom of coxa valga is lameness (lameness). In the long term, excessive stress can cause groin pain and other joints such as the knee or ankle. It is a mechanical pain. In other words, it is not inflammatory. It is especially felt during movements including mobilization of the hip (especially during walking).
A restriction in certain movements can also be seen. The patient may experience great difficulty in achieving certain positions and certain gestures such as turning the knee or even crossing the legs.
In some cases, complications are encountered that lead to permanent stiffness. This is the case of a coxitis (osteo-articular infection).
Over a prolonged period, the coxa valga can also cause other osteoarthritic pathologies of the hip.
What about the diagnosis?
Le diagnostic of the coxa valga is based primarily on a clinical examination. The patient is observed and questioned about the location and intensity of the pain felt.
To confirm the diagnosis of this hip disorder, a coxometry must be performed. This is an examination that allows you to give different measurements on radiological images. These shots are taken from the front and in profile. The coxometry is used concretely to highlight the malformations of the hip as well as a beginning osteoarthritis.
To know everything about hip osteoarthritis, see the following article.
To do this, the health professional uses a coxometer. This tool looks like a graduated ruler combined with a protractor. It is on these shots that the angle measurements will be made.
On the AP view, the doctor measures the obliquity of the acetabular roof, the cervico-diaphyseal angle and the lateral coverage of the femoral head.
If necessary, an MRI and a bone scan can be prescribed.
How to treat this hip disorder?
Le traitement of this type of hip deformity is usually surgical. Regarding the choice of technique, it depends on the age of the patient and the condition of the joint.
Conservative treatment may be considered. It consists in modifying the architecture of the femoral neck to obtain a mechanically more favorable anatomy.
In case of excessive wear, to hope for any improvement via this treatment, it is necessary to favor the replacement of the joint by a total hip prosthesis.
The plantar orthosis relieves the discomfort caused by the deformation. It can be the inequality of the lower limbs, deviation of the pelvis or deviations of the lower limbs.
Osteosynthesis is an intervention consisting in forming a junction at the level of the weakened zone. It is offered to patients with a progressive form of coxa valga.
The osteotomy is a strictly extra-articular intervention, while being guided by a scope. It consists of cutting the bone in order to modify its axis. We aim for a better distribution of the various sudden pressures exerted at the level of the head of the femur and the acetabulum. It also restores the cervico-diaphyseal angle while putting the joint back in place.
This is the most suitable method for young patients with no signs of joint damage or osteoarthritis.
Fitting a hip prosthesis
Proper alignment of the femoral head in its cavity and joint congruence can be improved by wearing a hip prosthesis. This is the only possible treatment for cartilage wear.
To know everything about the hip prosthesis, see the following article.
Depending on the state of the joint, the hip prosthesis can be total or partial. The time required for consolidation is around 45 days.
Rehabilitation should be done as soon as possible after the operation in a hospital setting. Then, it must be continued in town or in a rehabilitation center when the patient cannot return home.
Early mobilization is a key factor in a favorable evolution. It maintains and improves muscle function and joint mobility. Its goal is to allow the patient to resume his activities of everyday life as quickly as possible.
Rehabilitation is continued after the patient is discharged. the physiotherapist explains the things not to do and shows the exercises to do at home, between rehabilitation sessions.
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