Is surgery always indicated in rachitic coronal knee deformities? Our experience in 198 knees

Abstract

Introduction: Defective mineralization of osteoid matrix prior to physeal closure causes rickets. Poor calcification of the cartilage matrix in the zone of provisional calcification causes flattened skull, rachitic rosary, bowed legs, coxa vara and brittle bones. The recent literature has seen an increase in the incidence of the disease in both developing and developed nations. We evaluated behaviour of lower limb deformities due to nutritional rickets in 117 patients. Materials and methods: A prospective study was conducted from January 2009 to December 2011 for clinical and radiological evaluation of knee deformities in nutritional rickets. A total of 117 patients with 198 coronal plane knee deformities between 2 years and 12 years age of rickets were enrolled in this study. Results: In our study, there were 65 genu varum and 133 genu valgum deformities. Seven genu varum (10.7%) and 37 genu valgum (28%) deformities were regarded as failure. Fifty eight genu varum got corrected completely obtaining an average of 5 of valgum in an average of 6.3 months. The average rate of spontaneous correction was 1.9 a month. Ninety six valgum got corrected obtaining an average of 4.7 valgum in an average of 13.3 months. The average rate of spontaneous correction was 0.92 a month. Conclusion: Most of the rachitic deformities get corrected with age. Genu varum is having better chances and a faster rate of correction as compared with genu valgum. Early surgery may be indicated in late presenting cases. We believe varum above 4 years and 18 of valgum above 9 years usually do not correct and may require surgical intervention.

Latitude, urbanization, age, and sex as risk factors for vitamin D deficiency disease in the Roman Empire

“…The association between rickets and other diseases may mean that mortality bias is important. Deformities from rickets tend to reduce in severity and frequency with age due to growth and remodeling (Hess, ; Prakash et al, ), and many deformities from disease in infancy may potentially have been erased by growth. In addition, deformities occurring later in the growth process may be fairly minor due to slower growth in older children (Cesur et al, ).…”

“…Because rickets increases vulnerability to other diseases, including life‐threatening infections (Snoddy et al, ), it may lead to early mortality. Although some may persist into adulthood, many bone deformities due to childhood rickets are gradually removed during growth and remodeling (Hess, ; Prakash, Mehtani, Sud, & Reddy, ). These observations led us to anticipate that the frequency of rickets would decline with age in the subadult cohort.…”

A practical approach to diagnose and treat rickets

“…Thus, for at-risk infants, 400-1000 IU/day and from 1 year onwards, 600-1000 IU/day along with adequate calcium intake as per the age group is recommended [27,32].…”

Predictors of Spontaneous Remodelling of Angular Knee Deformities in Children with Healed Nutritional Rickets: A Prospective Cohort Study Protocol

“…Most active bone lesions in children with NR tend to heal spontaneously with or without medical treatment [7]. Evidence from numerous unpublished data and less published data suggest that a considerable percentage of limb deformities in children with healed NR tend to remodel over time [8]. Nevertheless, the predictors of good prognosis in terms of patient-and deformity-related variables are largely unknown.…”

“…Nevertheless, the predictors of good prognosis in terms of patient-and deformity-related variables are largely unknown. In other words, the patient and deformity characteristics that are associated with a favorable response namely spontaneous deformity remodelling are not clearly specified in the literature [8]. This is because the main bulk of publications on children with NR address prevention [9,10], non-skeletal presenting manifestations [11], medical treatment [7,12,13], underlying patho-aetiological factors [14], genetic susceptibility [15], identification of potentıal risk factors [16], orthopedic surgery management [17], animal experimentation [18] and epidemiological and public health aspects of the disease [19][20][21].…”