_Diagnosis._--Pain in the hip and a limp in walking suggest _hip-joint disease_, but while in coxa vara the movements are chiefly restricted in the direction of abduction, in hip disease they are restricted or absent in all directions. From _congenital dislocation of the hip_ the diagnosis can usually be made by the history, the examination of the joint and of its movements; and by the Trendelenburg test (p. 252). In _sacro-iliac disease_, the pain and tenderness are over the sacro-iliac joint and the movements at the hip are free in all directions. Valuable evidence is obtained from skiagrams.
_Treatment._--In the early stages, especially if there is pain and tenderness, the patient must lie up and extension is applied in the abducted position of the limb; after a fortnight or so recourse is had to massage and exercises and the patient is allowed up for a little each day, attention being paid to flat-foot, which is a common accompaniment. When deformity is the prominent feature and interferes with locomotion it must be corrected. The bloodless method is to be preferred; under general anæsthesia, the shortened adductors are stretched or divided, and forcible movements are carried out in all directions, until the limb can be brought into an attitude of marked abduction and internal rotation. A plaster-case is then applied, from the pelvis to the middle of the calf, the knee being slightly flexed for greater comfort; in a week or so the patient is able to go about, and in a couple of months a second plaster-case is applied, this time leaving the knee free. After another six weeks or so a moulded splint is used, which can be removed at bedtime. The traumatic forms can nearly always be corrected by this bloodless method. In advanced cases the deformity can only be corrected by open operation, which consists in dividing the femur obliquely downwards and medially through the great trochanter, and, the adductor muscles having been ruptured or divided, the limb is put up in the abducted position along with, if required, powerful weight extension.
[Illustration: FIG. 133.--Coxa Vara, showing adduction curvature of neck of femur associated with arthritis of the hip and knee.]