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Genu varum

Genu varum (Blount's Disease) is a deformity marked by medial angulation of the leg in relation to the thigh, an outward bowing of the legs. It is also known as bandy-leg, bowleg, bow-leg, and tibia vara. Usually there is an outward curvature of both femur and tibia, with at times an interior bend of the latter bone. more...

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At birth all children are more or less bandy-legged. The child lies on its nurse's knee with the soles of the feet facing one another; the tibia and femora are curved outwards; and, if the limbs are extended, although the ankles are in contact, there is a distinct space between the knee-joints. During the first year of life a gradual change takes place. The knee-joints approach one another; the femora slope downwards and inwards towards the knee joints; the tibia become straight; and the sole of the foot faces almost directly downwards.

While these changes are occurring, the bones, which at first consist principally of cartilage, are gradually becoming ossified, and in a normal child by the time it begins to walk the lower limbs are prepared, both by their general direction and by the rigidity of the bones which form them, to support the weight of the body. If, however, the child attempts either as the result of imitation or from encouragement to walk before the normal bandy condition had passed off, the result will necessarily be either an arrest in the development of the limbs or an increase of the bandy condition.

If the child is weakly, either with rickets or suffering from any ailment that prevents the due ossification of the bones, or is improperly fed, the bandy condition may remain persistent. Thus the chief cause of this deformity is rickets. The remaining causes are occupation, especially that of a jockey, and traumatism, the condition being very likely to supervene after accidents involving the condyles of the femur. In the rickety form the most important thing is to treat the constitutional disease, at the same time instructing the mother never to place the child on its feet. In many cases this is quite sufficient in itself to effect a cure, but matters can be hastened somewhat by applying splints. When in older patients the deformity arises either from traumatism or occupation, the only treatment is surgery.

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CONTRIBUTION OF NAVIGATION SYSTEMS TO ASSESSMENT OF FEMORAL ROTATION DURING TOTAL KNEE ARTHROPLASTY
From Journal of Bone and Joint Surgery, 1/1/04 by Saragaglia, D

Purpose: Over recent years, several authors have estimated that the distal femur presents an epiphyseal torsion which can he measured intraoperatively or on the preoperative scan.This measurement does not however take into account the dynamic mechanical axis, particularly the mechanical axis at 90° flexion when walking. We used a computer-assisted navigation system (Orthopilot®) to attempt to measure femoral rotation by dynamic gonometry in extension and 90° flexion before and after implantation of a total knee arthroplasty.

Material and methods: We recorded the preoperative (Rx) and intraoperative (Orthopilot) HKA in extension and in 90 flexion before and after implantation of 50 total knee prostheses (Search®. Aesculup. AG. Tuttlingen) and again postoperatively (Rx).The series included 19 knees with genu valgum (mean HKA 187.36±5.4:, range 18°-203°), 30 knees with genu varum (HKA ` 169.2±4.11. range 160°-176°). and one normal axis knee. Aerate: The radiographie values obtained preoperatively were confirmed by Orthopilot. respectively 186.68±5.25° and 169.76±3.84° in extension. At 90° flexion. HKA was 178.63±5.7° before implantation tor genu valgum giving a significant varus due to lateral opening during flexion, and 171.6±4.15° for genu varum. showing persistence of varus. After implantation of the total knee prosthesis, the values were as follows. For the genu varum: HKA in extension 180.57±0.82° and HKA in 90° flexion 176.86±2.55° giving a mean residual varus of 3.16±2.86° (from 4-8° varus) without external rotation of the femoral implant. For gen u valgum, HKA in extension was I79.60±0.92° and HKA in 90 flexion was 176.1±3.23 .giving a mean residual varus of 3.26±2.86° ((MO varus), recalling that in the event of genu valgum we impose external rotation due to the frequent hypoplasia of the lateral condyle.

Discussion: Orthopilot-assisted implantation of total knee prostheses provides new information concerning dynamic gonometry. particularly the varus or valgus in flexion, which corresponds to measuring natural external or internal rotation. Measuring epiphyseal torsion of the distal lemur with classical methods does not take into account the global rotation of the femur which is often an external rotation (up to 8 for genu varum). Systematic implantation of the femoral component in external rotation raises the risk of increasing considerably the varus forced to the implant during flexion.

D. Saragaglia. C. Chaussard. H. Pichon. D. Berne, M. Chaker

Service de Chirurgie Onhopedique et

Traumatologie du Sport, Hopital Sud, BP 185,

38045 Grenoble cedex 09, France

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