From the Guidelines
The recommended treatment approach for patients with Genu Varum (bowleggedness) is to emphasize weight-bearing exercise, maintenance of joint range, and maximizing strength and endurance, with surgical intervention considered only after medical treatment has been maximized for at least 12 months, and preferably performed by a surgeon with expertise in metabolic bone diseases 1.
Treatment Considerations
When considering treatment for Genu Varum, several factors must be taken into account, including the age of the patient, the severity of the deformity, and the presence of any underlying medical conditions.
- For children, guided growth techniques may be considered, which involve surgically correcting the deformity at the physis before significant diaphyseal deformity develops 1.
- In adolescents or adults with persistent deformity, surgical intervention such as osteotomy may be necessary to correct the deformity and improve functional outcomes 1.
- Physiotherapy is also recommended following surgery or in case of decreased range of movement, muscle weakness, fatigue, instability, or physical deconditioning 1.
Surgical Intervention
Surgical intervention for Genu Varum should be considered carefully, taking into account the potential risks and benefits.
- Osteotomy is a surgical procedure that involves cutting and realigning the bone to correct the deformity, and can be performed using either internal or external fixation techniques 1.
- The decision to perform surgery should be based on the severity of the deformity, the presence of symptoms, and the potential for improvement in functional outcomes 1.
- Regular clinical and functional assessments should be made after surgery, including radiography, to monitor the patient's progress and adjust treatment as needed 1.
From the Research
Treatment Approaches for Genu Varum
The treatment approach for patients with Genu Varum (bowleggedness) varies depending on the patient's age, stage of disease, and deformity.
- Physiologic bowing in children has a favorable natural history, but pathologic conditions such as idiopathic tibia vara require treatment strategies that vary with the patient's age and stage of disease 2.
- For young active patients with a progressively symptomatic varus knee and mild to moderate secondary osteoarthritis, valgus osteotomy of the proximal tibia remains the treatment of choice 3.
- High tibial osteotomy (HTO) is commonly used for genu varum deformity in young and active patients, but corrective valgus osteotomy may lead to an oblique joint line in cases of associated femur varum or absence of tibia vara 4.
- To avoid this drawback, an accurate and reproducible radiological protocol including at least a standing AP long-leg X-ray is suggested to measure the hip-knee-ankle (HKA) angle, medial distal femoral mechanical angle (MDFMA), and medial proximal tibial mechanical angle (MPTMA) 4.
- Computer-navigation of the osteotomies is the best choice to achieve the preoperative goal, and the choice of osteotomy (HTO, double level osteotomy (DLO), or distal femoral osteotomy (DFO)) depends on the patient's specific condition 4.
- The optimal postoperative tibio-femoral axial alignment is obtained between 3 degrees and 5 degrees valgus, and the analysis of a series of 193 cases reviewed after an average 8 year follow-up illustrates the criteria of good results 5.
- Lateral femoral closing wedge osteotomy is also a viable option for correcting genu varum of femoral or mixed origin, especially in cases where an associated tibial valgisation osteotomy is required 6.
Key Considerations
- Restoration of the mechanical axis of the limb is the principal goal of treatment 2.
- The particular type of internal fixation is of secondary importance 2.
- Standing radiographs of the entire lower limbs are necessary for surgical planning, as the deformity can sometimes affect the distal femur rather than the proximal tibia 2.
- The height of the medial tibio-femoral space is a statistically important factor in determining the success of the osteotomy 5.