Knee osteoarthritis (OA)
What is it?
Axial deviations of the knee can be divided into two broad categories depending on the direction of deviation: valgus (X-shaped knees) and varus (braced knees). There are also idiopathic forms (for which no cause is identified) and forms secondary to various pathologies.
A certain degree of varus or valgus of the knee is considered to be physiological at a developmental age. In infants, the knee is usually presented with a varus deviation; later, up to the age of 6 or 7 years, the knee is usually valgus, and then undergoes spontaneous correction as it grows.
However, axial deviations that persist even in the later stages of growth merit further investigation by an orthopaedic specialist.
Which are the symptoms?
Axial deviation of the knee, if not severe, is a benign condition that does not cause much discomfort. However, in the long term, it can lead to changes in the walking dynamics, alignment of the spinal column and pain symptoms as well as possible functional limitations during daily life. Deviations of the knee can also lead to a vicious circle with the involvement of other adjacent joints.
- pain
- functional limitation
- gait disturbance
- changes in the spinal column
How is it diagnosed?
The basis for recognising axial deformities is the clinical examination, which must be complete in order to exclude secondary forms. The examination is first performed with the patient in the orthostatic position in order to monitor the axis of the lower limb under load both when standing with the feet shoulder-width apart and when walking. It is also important to determine the presence of any dysmetria or coexistence of foot axis deviation and femoral neck variation. It is also important to investigate muscle trophism and any ligamentous laxity. The clinical examination is accompanied by an X-ray of the loaded lower limbs.
How is it treated?
Axial deformities detected at developmental age can be treated conservatively or surgically, depending on their extent. Conservative treatment consists of encouraging postural adjustments in order not to worsen the condition, such as maintaining a correct sitting position or correcting minor defects in foot deviation using insoles or pads.
From the surgical point of view, paediatric patients can be treated with methods using residual growth potential to gradually correct the degree of deviation. This is achieved by temporarily fusing the proximal tibial and/or distal femoral growth cartilage (medially or laterally, depending on the direction of deviation) using special plates (eight-plates). Alternative and more invasive methods such as osteotomy with plates or external fixators (Ilizarov or hexapodalis) may be used, if the degree of deviation is very severe or in cases where the patient has stopped growing.
Where do we treat it?
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