The Journal of Bone and Joint Surgery (American). 2006;88:380-386.
doi:10.2106/JBJS.C.01518
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Femoral Deformity in Tibia Vara

J. Eric Gordon, MD1, David J. King, MD2, Scott J. Luhmann, MD1, Matthew B. Dobbs, MD1 and Perry L. Schoenecker, MD1

1 St. Louis Shriners Hospital for Children, 2001 South Lindbergh Boulevard, St. Louis, MO 63131. E-mail address for J.E. Gordon: gordone{at}msnotes.wustl.edu
2 Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110

Investigation performed at Washington University School of Medicine, St. Louis Shriners Hospital for Children, and St. Louis Children's Hospital, St. Louis, Missouri

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Previous studies have suggested that compensatory valgus deformity of the femur is common in patients with tibia vara, or Blount disease. The availability and routine use of standing long-cassette radiographs of the lower extremities to assess angular deformities has allowed quantitative evaluation of this hypothesis.

Methods: The cases of all patients with tibia vara, two years of age or older, seen at our institution prior to treatment, over a thirteen-year period, were reviewed. Seventy-three patients with a total of 109 involved lower limbs were identified and were classified as having either infantile tibia vara (thirty-seven patients with fifty-six involved limbs) or late-onset tibia vara (thirty-six patients with fifty-three involved limbs). Standardized standing radiographs of the lower extremity were examined to assess the deformity at the distal part of the femur and the proximal part of the tibia by measuring the lateral distal femoral angle and the medial proximal tibial angle.

Results: The distal part of the femur in the children with infantile tibia vara either was normal or had mild varus deformity, with a mean lateral distal femoral angle of 97° (range, 82° to 129°). The mean medial proximal tibial angle in these children was 72° (range, 32° to 84°). Older children with infantile tibia vara were noted to have little distal femoral deformity, with no more than 4° of valgus compared with either normal values or the contralateral, normal limb. Children with late-onset tibia vara had a mean lateral distal femoral angle of 93° (range, 82° to 110°) and a mean medial proximal tibial angle of 73° (range, 52° to 84°). On the average, the varus deformity of the distal part of the femur constituted 30% (6° of 20°) of the genu varum deformity in these patients.

Conclusions: Patients with infantile tibia vara most commonly had normal alignment of the distal parts of the femora; substantial valgus deformity was not observed. Distal femoral varus constituted a substantial portion of the genu varum in children with late-onset disease. When correction of late-onset tibia vara is planned, the surgeon should be aware of the possibility that distal femoral varus is a substantial component of the deformity.


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