Varus Flexion Deformity

Varus flexion deformity means that a joint is bent in two ways at the same time.
“Varus” means the lower part of the leg (or bone) points inward, so the limb looks bow-shaped. In the knee, the body weight line passes to the inner (medial) side of the joint, which puts more load on the inner compartment. Flexion deformity  (or flexion contracture) means the joint cannot fully straighten. The knee, for example, cannot reach the normal 0° extension and stays partly bent all the time, both when the person tries to move it and when the doctor moves it.

Elbow valgus deformity (often called cubitus valgus) means the forearm points outwards more than normal when your arm is straight and your palm faces forward. A small outward angle (carrying angle) is normal, but in valgus deformity this angle is clearly larger, so the elbow looks “bent outwards.” It may be present from birth, or it may develop after poorly healed childhood elbow fractures, growth plate injuries, bone diseases such as rickets, or previous surgery. In some people it is only a cosmetic issue, but in others it can cause pain, joint instability, and gradual stretching of the ulnar nerve on the inner side of the elbow, leading to tingling and weakness in the ring and little fingers (tardy ulnar nerve palsy).

Varus flexion deformity of the knee means your knee is bowed outward (varus) and also stuck in a bent position (flexion contracture), so you cannot fully straighten it. It usually happens with long-standing knee osteoarthritis or other joint damage, where the inner (medial) side of the knee wears out more, soft tissues at the back become tight, and the leg slowly drifts into a bent, bow-leg shape.

This condition can cause pain, limping, difficulty standing upright, and big limits in daily life. Treatment is usually step-by-step: start with lifestyle changes and therapy, use medicines when needed, and consider surgery if the deformity and pain stay severe. Guidelines for knee osteoarthritis recommend a multimodal plan that mixes non-drug care, medicines, and sometimes operations.

So, varus flexion deformity of the knee is a mixed deformity. The knee is bow-legged (varus) and also fixed in a partly bent position (flexion deformity). This combined deformity increases pressure on the inner side of the knee, reduces the contact area of the joint surfaces, and makes walking, standing, and daily work harder.

Varus flexion deformity is most often described in the knee with long-standing osteoarthritis or after injury, but the same idea (inward angulation plus fixed bending) can be used for other joints, such as the elbow or ankle.

Other Names

Doctors and therapists may use different names for varus flexion deformity of the knee. These terms are very similar in meaning:

• Varus knee with flexion deformity

• Varus flexion contracture of the knee

• Genu varum with fixed flexion deformity

• Bow-leg deformity with flexion contracture

• Varus osteoarthritic knee with flexion contracture

• Medial compartment osteoarthritis with varus and flexion deformity

All of these describe a knee that is bow-legged (varus) and cannot fully straighten (flexion deformity), often due to degenerative joint disease.

Types of varus flexion deformity

Mild, moderate, and severe deformity
Doctors often classify varus flexion deformity by how many degrees of varus angle and flexion contracture are present. Mild deformity means only a small inward angle and a few degrees of fixed bending; severe deformity means a large bowing and a big flexion contracture that strongly limits function.

Flexible (reducible) vs fixed deformity
A flexible or reducible deformity improves when the patient relaxes, lies down, or when the doctor gently corrects it by hand. A fixed deformity does not correct even with strong stretching or under anesthesia, which means the bone shape and joint surfaces have changed, not only the soft tissues.

Soft-tissue–dominant vs bony deformity
In some people, the main problem is tight muscles, capsules, and ligaments at the back and inner side of the knee. In others, the main problem is bone wear or mal-aligned bone healing. Doctors separate soft-tissue–dominant deformity from bony deformity because treatment plans are different.

Primary degenerative vs post-traumatic deformity
When the deformity comes slowly with age and wear-and-tear osteoarthritis, it is called primary degenerative. When it comes after fractures, ligament injuries, or infection, it is called post-traumatic or post-infective deformity.

Types of Varus Flexion Deformity

Here are simple “types” based on how the deformity behaves and what mainly causes it.

• Mild varus flexion deformity
  The leg is only slightly bowed, and the knee lacks a small amount of extension (for example, missing 5–10° from full straight). Daily activities are possible but may cause discomfort or stiffness. This is common in early osteoarthritis.

• Moderate varus flexion deformity
  The bow-leg appearance is clear, and the knee is stuck in a more noticeable bent position (for example, 10–20° flexion loss). Walking, climbing stairs, and standing for long periods become more difficult. Pain and limp are more obvious.

• Severe varus flexion deformity
  The knee is strongly bowed inward and can be fixed in large flexion (more than 20°). The person may not be able to stand upright or walk far. This stage is usually seen in advanced osteoarthritis or after multiple injuries or surgeries.

• Flexible (partly correctable) varus flexion deformity
  When the doctor gently moves the leg, part of the deformity can be corrected. This suggests that soft tissues (muscles, capsules, ligaments) are tight but not completely fixed, and physiotherapy may help.

• Fixed (non-correctable) varus flexion deformity
  Even with strong passive movement, the knee stays in the same bowed and bent position. This usually means long-standing bone changes, joint destruction, and thick contractures, often requiring surgery such as osteotomy or total knee replacement.

Causes of Varus Flexion Deformity

Each cause below describes how it can lead to both varus and flexion deformity of the knee.

1. Primary knee osteoarthritis (medial compartment)
   Long-term wear of cartilage on the inner side of the knee makes that side narrower. The tibia then tilts inward (varus), and pain and inflammation cause muscles and joint capsule to tighten, leading to a fixed flexion deformity.

2. Post-traumatic malunion of fractures around the knee
   If a fracture of the femur or tibia heals in a crooked position, the bone axis may lean inward and create varus. Scarring around the knee and immobilization after injury can limit extension and create a flexion contracture.

3. Previous medial meniscectomy (removal of medial meniscus)
   Removing the medial meniscus reduces shock absorption on the inner side of the knee. This increases pressure there, speeds up cartilage loss, and promotes varus alignment and secondary flexion deformity.

4. Anterior cruciate ligament (ACL) or posteromedial ligament injury
   Chronic instability after ligament injury changes joint kinematics. Abnormal loading of the medial compartment and persistent inflammation can lead to varus malalignment and limited extension.

5. Inflammatory arthritis (for example rheumatoid arthritis)
   Long-term synovitis damages cartilage and bone, especially in weight-bearing areas. Progressive destruction can collapse the medial compartment, causing varus, while pain and swelling encourage a flexed resting position.

6. Blount disease (tibia vara) in childhood
   In this growth disorder, the top of the tibia grows unevenly, creating strong varus deformity in children. Over time, abnormal alignment and joint changes may also cause a flexion contracture in the knee.

7. Rickets and other metabolic bone diseases
   Soft and weak bones in childhood can bend under body weight, especially at the knees, causing genu varum. Later, degenerative changes and muscle imbalance may add a flexion deformity.

8. Long-term joint immobilization (cast, brace, or bed rest)
   Keeping the knee bent for weeks or months makes the muscles and joint capsule shorten. This leads to a flexion contracture. If weight-bearing is unbalanced, bone remodeling can also favor varus alignment.

9. Post-infectious arthritis (after septic arthritis or tuberculosis of the knee)
   Infection can destroy cartilage and bone and cause scarring. Healing in a damaged and shortened position can leave the knee both bowed and flexed.

10. Neuromuscular disorders (for example spasticity or muscle weakness)
    In conditions that change muscle tone, some muscles may constantly pull the knee into flexion, while others are weak. This imbalance can gradually cause deformity and abnormal alignment such as varus.

11. Obesity and heavy mechanical loading
    Extra body weight increases load on the medial compartment of the knee. Over time, this can accelerate cartilage loss and bone change on the inner side and promote varus with secondary flexion deformity.

12. Repetitive squatting, kneeling, or heavy lifting jobs
    Frequent deep knee flexion and high loads can speed up wear of the medial joint compartment. The joint may gradually become varus and then fixed in partial flexion due to pain and tight tissues.

13. Osteonecrosis (avascular necrosis) of femoral condyle or tibial plateau
    When blood supply to part of the bone is lost, the bone can collapse. If this happens on the medial side, the joint line tilts inward and creates varus, often with painful flexion deformity.

14. Paget’s disease or other deforming bone disorders
    These conditions cause abnormal bone remodeling and thickening. Deformity around the knee can include bowing and altered joint surfaces, leading to varus and limited extension.

15. After high tibial osteotomy (HTO) or other realignment surgery that fails
    If a corrective osteotomy heals in the wrong position, or if the correction gradually “falls back,” recurrent malalignment may appear as varus and be accompanied by a flexion deformity.

16. Residual deformity after total knee arthroplasty (TKA)
    If a knee replacement does not fully correct pre-existing varus and flexion contracture, or if soft tissue balancing is incomplete, a residual varus flexion deformity can remain.

17. Combined femoral and tibial deformity
    Sometimes both the femur and tibia are deformed. Their combined effect can greatly increase varus angle, and long-standing malalignment then promotes flexion deformity.

18. Ligament imbalance and laxity (for example medial collateral ligament stretching)
    If the lateral side of the knee is relatively tight and the medial side is stretched, the joint can shift into varus. Tight posterior structures may also resist full extension and add flexion deformity.

19. Degenerative changes in aging femur (lateral bowing)
    Studies show that age-related curvature of the femoral shaft can encourage varus-type osteoarthritis. As OA progresses, pain and contracture lead to a combined varus flexion deformity.

20. Uncorrected childhood genu varum persisting into adulthood
    Some people have bow-legs from childhood that are never fully corrected. Over many years, this abnormal alignment can turn into painful medial compartment OA with secondary flexion deformity.

Symptoms of Varus Flexion Deformity

1. Visible bow-leg appearance
   When standing, the knees are far apart while the ankles may be closer together. This “bow-legged” look is a classic sign of varus malalignment of the knee.

2. Knee cannot fully straighten
   The person feels that the knee always stays slightly bent. Even when lying down and trying hard to straighten the leg, a small gap remains under the knee. This shows flexion deformity.

3. Pain on the inner (medial) side of the knee
   Because most of the body weight passes through the inside half of the joint in varus deformity, pain here is common, especially when standing or walking.

4. Morning stiffness and stiffness after rest
   The knee may feel stiff after waking up or after sitting for a long time. It may take several minutes of gentle movement before the joint feels looser.

5. Swelling or fullness around the knee
   Inflammation in osteoarthritis and other joint diseases can cause fluid build-up (effusion). The knee may look puffy, and clothes may feel tight at the joint.

6. Limping while walking
   Because the knee cannot fully straighten and is painful, the person may shift weight quickly off that leg. This causes a limp and uneven walking pattern.

7. Difficulty climbing stairs or walking downhill
   Going up or down stairs puts extra force on the knee joint. With varus flexion deformity, these activities can be painful and feel unstable, so the person may use a rail or take one step at a time.

8. Reduced walking distance and fatigue
   Because walking is painful and inefficient, the person may not be able to walk as far as before. The thigh and calf muscles may tire easily due to altered mechanics.

9. Grinding, clicking, or cracking sounds (crepitus)
   Rough joint surfaces and uneven cartilage wear can make noises when the knee moves. These sounds may be felt as vibration or heard during bending and straightening.

10. Feeling of instability or “giving way”
    Some people feel that the knee might buckle, especially on uneven ground. This can be due to ligament imbalance and weak muscles trying to control a deformed joint.

11. Progressive worsening of the deformity
    Over months or years, the bow-leg and flexion deformity can gradually increase as cartilage and bone continue to wear and contractures get tighter.

12. Pain in hip, ankle, or lower back
    Because the leg axis is altered, other joints must adapt. This can lead to secondary pain in the hip, ankle, or spine due to abnormal posture and gait.

13. Difficulty squatting, sitting cross-legged, or kneeling
    These positions require controlled flexion and extension. With a fixed flexion deformity and pain, many daily activities, cultural sitting habits, or prayers become difficult.

14. Reduced confidence in walking on uneven surfaces
    On rough ground, the combination of deformity, pain, and instability increases the fear of falling. People may limit outdoor activity, which can affect fitness and mood.

15. Reduced quality of life and independence
    Over time, difficulty with walking, stairs, and self-care tasks can limit independence. People may avoid social activities and feel frustrated or low in mood.

Diagnostic Tests for Varus Flexion Deformity

Below are important tests grouped into Physical Exam, Manual Tests, Lab and Pathological Tests, Electrodiagnostic Tests, and Imaging Tests.

Physical Exam Tests

1. Observation of limb alignment while standing
   The doctor watches the person stand with feet together. They look for bow-leg alignment, knee spacing, and general posture. This simple test often clearly shows varus deformity of the knee.

2. Gait (walking) analysis
   The clinician watches the person walk across the room. They check for limping, knee flexion during stance, stride length, and trunk lean. This helps judge how the deformity affects movement and balance.

3. Measurement of knee range of motion with a goniometer
   A small measuring device (goniometer) is used to measure how far the knee can bend and straighten. Lack of full extension in degrees tells how big the flexion deformity is.

4. Palpation of joint lines and surrounding tissues
   The doctor gently presses along the inner and outer sides of the knee joint and around the patella. Areas of tenderness, warmth, and swelling help to locate active disease and guide further tests.

5. Assessment of fixed deformity in different positions
   The knee is examined while the patient lies on the bed. The examiner lifts the heel and attempts to press the knee fully down. Any persistent gap or angle shows a fixed flexion component.

6. Neurovascular examination of the leg and foot
   Pulses, skin color, temperature, and sensation are checked. Long-standing deformity, surgery, or rapid correction can affect nerves and vessels, so this assessment is important for safety.

Manual Orthopedic Tests

7. Varus stress test at 0° and 30° flexion
   With the patient lying down, the examiner applies inward force to the lower leg. This tests the stability of the lateral collateral ligament and helps assess how much of the varus deformity is due to soft-tissue laxity.

8. Valgus stress test for comparison
   The opposite direction (valgus stress) is also tested to compare medial and lateral ligament strength. This helps to understand overall coronal balance and guides surgical planning if needed.

9. Lachman test and anterior drawer test
   These tests check the ACL by pulling the tibia forward relative to the femur. ACL deficiency can change joint kinematics and contribute to abnormal loading and deformity.

10. McMurray or other meniscal provocation tests
    The knee is bent and rotated to pinch the meniscus. Pain or clicking suggests meniscal damage, especially of the medial meniscus, which is common in varus osteoarthritic knees.

11. Assessment of hamstring and gastrocnemius tightness
    The examiner stretches the hamstring and calf muscles. Tight posterior muscles can hold the knee in flexion and make it harder to fully extend, contributing to the flexion deformity.

Lab and Pathological Tests

12. Complete blood count (CBC) and inflammatory markers (ESR, CRP)
    These blood tests help to look for inflammation or infection. Raised markers may suggest inflammatory arthritis or persistent low-grade infection around the joint.

13. Autoimmune markers (rheumatoid factor, anti-CCP, ANA)
    These tests help detect autoimmune diseases such as rheumatoid arthritis or connective tissue disease, which can cause severe joint damage and deformity.

14. Metabolic bone profile (calcium, phosphate, vitamin D, alkaline phosphatase)
    This group of tests checks for rickets, osteomalacia, and other metabolic bone diseases that can cause bowing and deformity of long bones.

15. Synovial fluid analysis from knee aspiration
    If there is a lot of swelling, fluid can be drawn from the joint with a needle. Looking at the fluid for cells, crystals, or bacteria helps distinguish osteoarthritis, gout, infection, or inflammatory arthritis.

Electrodiagnostic Tests

16. Nerve conduction studies (NCS)
    These tests measure how fast signals travel along the nerves in the leg. They may be used when there are signs of nerve involvement, such as weakness or numbness, especially after surgery or severe deformity.

17. Electromyography (EMG) of lower-limb muscles
    EMG looks at the electrical activity of muscles. It helps to identify neuromuscular causes of contractures, muscle imbalance, or nerve damage that may affect knee posture and deformity.

Imaging Tests

18. Weight-bearing anteroposterior (AP) and lateral knee X-rays
    Standard standing X-rays show joint space narrowing, osteophytes, bone sclerosis, and alignment of the knee. Medial joint space loss with bowing is typical in varus osteoarthritis.

19. Full-length hip–knee–ankle (HKA) radiograph
    This long-leg X-ray measures the mechanical axis and exact varus or valgus angle from hip to ankle. It is very useful for surgical planning and for quantifying the degree of varus malalignment.

20. Magnetic resonance imaging (MRI) of the knee
    MRI shows cartilage, menisci, ligaments, and bone marrow in detail. It can reveal hidden meniscal tears, osteonecrosis, marrow edema, and other soft-tissue or bone changes that contribute to deformity.

Non-pharmacological treatments for varus flexion deformity

1. Patient education and self-management
   Learning what varus flexion deformity is, why it happens, and how your daily habits affect it is the first “treatment.” Clear education about joint protection, pacing activities, weight control, and realistic goals helps you take active control of your condition and improves long-term outcomes in knee osteoarthritis.

2. Weight loss and body-weight control
   Extra body weight increases load on the medial (inner) side of the knee and speeds up cartilage wear, which worsens varus deformity and flexion contracture. Even a small weight loss (5–10% of body weight) can lower pain and improve walking. A balanced diet plus regular low-impact exercise is usually recommended.

3. Activity modification
   You are usually advised to avoid high-impact activities such as running, jumping, squatting with heavy weights, or walking long distances on hard ground. Instead, you focus on short, frequent activity bouts, rest breaks, and choosing softer surfaces. This reduces repeated stress on the degenerated medial compartment and helps slow progression of deformity.

4. Supervised physiotherapy
   A physiotherapist designs a program to improve knee extension, reduce flexion contracture, strengthen weak muscles, and retrain gait. Therapy often includes stretching, strengthening, balance work, and functional tasks such as sit-to-stand. In flexion deformity, regular, gently progressed therapy is a key conservative treatment.

5. Home exercise program
   Exercises at home help to maintain gains made in the clinic. These usually include heel-prop or towel-under-heel positions to gently stretch the back of the knee, plus straight-leg raises, mini-squats within a safe range, and hip strengthening. Daily practice helps prevent the knee from “tightening up” again.

6. Hamstring and calf stretching
   In flexion deformity, the hamstrings and calf muscles often become shortened and tight. Slow, sustained stretches in lying or sitting positions, held for 20–30 seconds and repeated several times, can improve knee extension range. The therapist adjusts stretch intensity to avoid pain or micro-injury.

7. Quadriceps and hip muscle strengthening
   Weak quadriceps make it harder to support the knee in near-straight positions, so the leg “prefers” to stay bent. Strengthening exercises (like straight-leg raises, short-arc quads, step-ups, and hip abductor exercises) improve stability, reduce pain, and may reduce the tendency to walk in a flexed posture.

8. Bracing (unloader knee brace)
   A valgus “unloader” brace shifts part of the body weight from the worn medial compartment to the outer side of the knee. This can lessen pain and sometimes reduce progression of varus alignment. Braces are often combined with exercise and weight loss to improve comfort during walking.

9. Lateral wedge insoles and shoe modifications
   Lateral heel or sole wedges slightly tilt the foot to reduce load on the inner knee, which can help in mild to moderate varus deformity. Supportive shoes with shock-absorbing soles can also reduce impact forces and make walking easier.

10. Walking aids (cane or walker)
    Using a cane in the opposite hand can reduce load on the affected knee and improve balance. A walker or crutches may be used during flare-ups or early after surgery. Proper height and training are important so the aid supports rather than strains the body.

11. Heat and cold therapy
    Warm packs or showers can relax tight muscles and reduce stiffness, especially before exercises. Cold packs can calm swelling and pain after activity. These simple home treatments make it easier and less painful to keep moving, which is essential for managing flexion deformity.

12. Aquatic (water-based) therapy
    Exercising in a warm pool allows you to move the knee with less weight through it because water supports part of your body. This reduces pain, encourages fuller motion, and helps strengthen muscles in a low-impact way. It is useful for people who cannot tolerate land exercises well.

13. Transcutaneous electrical nerve stimulation (TENS)
    TENS uses mild electrical currents through skin pads to help reduce pain signals. It does not correct the deformity, but it can make movement and exercise more comfortable, which indirectly improves function and extension over time. Evidence is mixed but some patients find benefit.

14. Manual therapy and joint mobilization
    Physiotherapists may use manual techniques such as gentle joint glides, soft-tissue massage, and patellar mobilization. These approaches aim to reduce stiffness, improve joint nutrition, and allow better extension. They are usually done together with active exercises to maintain new range.

15. Night or extension splints
    In selected patients, a night-time knee splint or serial casting in a gradually more extended position can help reduce fixed flexion deformity. The idea is to provide a prolonged, gentle stretch to the tight tissues at the back of the knee. This must be supervised by a specialist to avoid pressure sores or nerve problems.

16. Neuromuscular and balance training
    Varus alignment changes how forces move through the knee and can affect balance. Exercises like single-leg stands, step practice, and balance board drills retrain muscles and nerves to control the joint better, reducing falls and improving confidence when walking or turning.

17. Spasticity management (in neurological causes)
    Some flexion deformities are linked to neurological conditions like cerebral palsy or stroke, where muscle spasticity keeps the knee bent. Treatment may include stretching, splinting, botulinum toxin injections, and special physiotherapy programs to reduce muscle over-activity and improve extension.

18. Pain coping skills and psychological support
    Chronic pain and disability can lead to anxiety, low mood, and fear of movement. Cognitive-behavioural strategies, relaxation training, and sometimes counselling help people stay active and follow rehabilitation plans, which is essential for long-term knee health.

19. Workplace and daily-task ergonomics
    Adjusting working height, using chairs with proper seat height, avoiding long kneeling or squatting, and planning rest breaks can reduce stress on the knee. Simple changes in how you climb stairs, sit, or lift things can have a large effect on pain and function across the day.

20. Fall-prevention and home safety
    Because bent, painful knees raise fall risk, doctors often suggest grab bars, non-slip mats, good lighting, and removal of loose rugs. Combined with strength and balance training, this helps prevent injuries that could worsen the deformity or cause fractures.

Drug treatments for varus flexion deformity

These medicines mainly treat pain and inflammation or the underlying arthritis that causes the deformity. Never start, stop, or adjust these drugs without your doctor, especially if you have heart, kidney, liver, stomach, or bleeding problems.

1. Paracetamol (acetaminophen) – simple pain reliever
   Paracetamol is often a first-line drug for mild osteoarthritis pain because it has fewer stomach and heart risks than NSAIDs at usual doses. It reduces pain signals in the brain but does not strongly reduce inflammation or change joint shape. Over-use can harm the liver, so daily dose limits are important.

2. Naproxen (oral NSAID)
   Naproxen is a non-steroidal anti-inflammatory drug that reduces pain and stiffness in osteoarthritis by blocking COX enzymes and lowering prostaglandin production. FDA-approved labels show benefit in knee osteoarthritis at divided daily doses, but they also warn about stomach ulcers, kidney problems, and increased cardiovascular risk, especially with long-term or high-dose use.

3. Ibuprofen (oral NSAID)
   Ibuprofen works in a similar way to naproxen, reducing inflammatory mediators and easing pain and swelling. It is often used at the lowest effective dose for the shortest time. FDA labels emphasise risks like stomach bleeding, kidney strain, and cardiovascular events, especially in older adults or those with risk factors.

4. Diclofenac (oral NSAID)
   Diclofenac is a potent NSAID used for osteoarthritis pain. It improves pain and function but has relatively higher cardiovascular and gastrointestinal risk in some studies, so many guidelines prefer safer NSAID profiles or topical forms. It should be used with careful monitoring and only when benefits clearly outweigh risks.

5. Topical diclofenac gel
   For knee osteoarthritis, applying diclofenac gel directly on the skin over the joint can reduce pain with lower blood levels than oral NSAIDs. FDA-approved topical diclofenac products have shown pain relief in OA with a lower risk of systemic side effects, although local skin irritation can occur.

6. Celecoxib (COX-2 selective NSAID)
   Celecoxib is a COX-2-selective NSAID approved for relief of signs and symptoms of osteoarthritis. FDA labels describe typical adult doses (for example around 200 mg per day in one or two doses) and warn about increased risk of heart attack, stroke, and blood clots, as well as kidney and stomach issues, although stomach risk may be lower than some non-selective NSAIDs.

7. Meloxicam (preferential COX-2 NSAID)
   Meloxicam is another NSAID with some COX-2 selectivity, used once daily for osteoarthritis pain. It improves pain and stiffness but carries the same boxed warnings for cardiovascular and gastrointestinal events as other NSAIDs. It is often used when once-daily dosing is helpful for adherence.

8. Combination naproxen + esomeprazole (for NSAID users at ulcer risk)
   Products such as naproxen combined with the proton-pump inhibitor esomeprazole are FDA-approved for patients needing naproxen for osteoarthritis but also at higher risk of NSAID-associated stomach ulcers. The esomeprazole part reduces stomach acid and lowers ulcer risk, while naproxen provides pain control.

9. Combination amlodipine + celecoxib (for patients with hypertension + OA)
   A fixed combination containing amlodipine (a blood-pressure medicine) and celecoxib is approved for patients who need both drugs. It is not specific for deformity but can simplify treatment in people with both hypertension and osteoarthritis, reducing pill burden while carrying the usual NSAID warnings.

10. Intra-articular corticosteroid injections (e.g., triamcinolone)
    Corticosteroid injections into the knee reduce inflammation and pain for weeks to months in some people with osteoarthritis, especially during flares. They can make physiotherapy easier by lowering pain, but repeated injections may have cartilage-thinning and infection risks, so frequency is usually limited.

11. Intra-articular hyaluronic acid (viscosupplementation)
    Hyaluronic acid injections aim to improve joint lubrication and shock absorption. Evidence is mixed, and some guidelines do not routinely recommend them, but selected patients may report symptom relief. They are not proven to correct deformity, and they are usually considered only after simpler measures.

12. Duloxetine (serotonin-noradrenaline reuptake inhibitor)
    Duloxetine is an antidepressant that also treats chronic musculoskeletal and knee osteoarthritis pain. It works by changing pain signalling in the brain and spinal cord, particularly useful when pain has neuropathic or central features. Side effects may include nausea, sleep disturbance, and blood-pressure changes.

13. Tramadol (weak opioid analgesic)
    Tramadol may be used short-term for moderate to severe pain when other options fail or are not tolerated. It acts on opioid receptors and also affects serotonin and noradrenaline pathways. Because of risks of dependence, drowsiness, constipation, and respiratory depression, guidelines recommend using the lowest dose for the shortest period and avoiding routine long-term use.

14. Short-course stronger opioids (last resort)
    In very severe pain while waiting for surgery, doctors may briefly use stronger opioids. This is usually a last resort because benefits are limited and risks of addiction and overdose are high. They do not treat the deformity itself and are avoided whenever possible.

15. Disease-modifying antirheumatic drugs (e.g., methotrexate) in inflammatory arthritis
    If the varus flexion deformity is driven by rheumatoid arthritis or other inflammatory joint disease, DMARDs such as methotrexate are used to control the underlying disease. By reducing joint inflammation and damage, they can slow the worsening of deformity. These medicines require close blood-test monitoring and specialist supervision.

16. Biologic agents for inflammatory arthritis
    Biologics (like TNF-alpha inhibitors or IL-6 inhibitors) are powerful drugs used when standard DMARDs are not enough. They greatly reduce inflammation and can slow joint destruction, which indirectly reduces risk of severe deformities. Because they alter the immune system, they raise infection risk and must be used only under rheumatology care.

17. Topical capsaicin cream
    Capsaicin cream reduces pain by depleting substance P, a neurotransmitter involved in pain signalling in small nerves. It can give modest relief in knee osteoarthritis when applied several times daily, though some people feel burning at the skin site. It does not change deformity but can make activity more tolerable.

18. Low-dose antidepressants for chronic pain (e.g., amitriptyline)
    Tricyclic antidepressants at low doses may help chronic musculoskeletal pain and improve sleep. They modulate pain pathways and can be useful when pain is widespread or long-lasting. Side effects include drowsiness, dry mouth, and dizziness, so they must be used carefully, especially in older adults.

19. Topical NSAID patches or plasters
    In some countries, NSAID patches applied to the knee give slow, local delivery of anti-inflammatory medicine. They are used when oral NSAIDs are risky or not tolerated. Skin irritation or allergy can occur, and their effect may be modest but still helpful as part of a multimodal pain plan.

20. Short-term muscle relaxants (in spasm-related pain)
    If muscle spasm around the knee is intense, short-term muscle relaxants may be used. They calm overactive muscles and can make stretching and physiotherapy easier. However, side effects like drowsiness and falls risk limit long-term use, especially in older adults.

Dietary molecular supplements

Evidence for supplements is usually modest. They should not replace standard treatments and should be discussed with your doctor to avoid interactions.

1. Omega-3 fatty acids (fish oil)
   Omega-3 fatty acids from fish oil have anti-inflammatory effects by modifying eicosanoid and cytokine production. They may slightly reduce joint pain and morning stiffness, especially in inflammatory arthritis. Typical doses are in the gram range per day, but exact amounts must be matched to your overall health and medicines like blood thinners.

2. Vitamin D
   Vitamin D supports bone and muscle health. Low vitamin D is common in people with osteoarthritis and may be associated with worse pain and function. Correcting deficiency using medically supervised doses can improve muscle strength and balance, which indirectly reduces strain on the knee and fall risk.

3. Glucosamine sulfate
   Glucosamine is a building block of cartilage and is widely promoted for joint health. Trials show mixed results, but some people report reduced pain and improved function after several months of daily use. It is usually taken in capsule or powder form, and may affect blood sugar in diabetics, so monitoring is important.

4. Chondroitin sulfate
   Chondroitin is another cartilage component often combined with glucosamine. Some studies suggest small improvements in pain and function in knee osteoarthritis; others find little difference from placebo. It appears generally safe, but benefits are modest and take time to appear.

5. Collagen peptides
   Hydrolysed collagen supplements may support cartilage and bone metabolism by providing amino acids and stimulating collagen synthesis. Small trials report improvements in joint pain and function, especially combined with exercise. They are usually taken as powders dissolved in drinks once per day.

6. Curcumin (turmeric extract)
   Curcumin has anti-inflammatory and antioxidant properties that may reduce joint pain by modulating NF-κB and cytokine pathways. Standardised extracts are often taken with piperine or formulated for better absorption. It can interact with blood thinners and may upset the stomach in some people.

7. Boswellia serrata extract
   Boswellia contains boswellic acids that inhibit 5-lipoxygenase and other inflammatory pathways. Some trials have shown reduced pain and improved walking distance in knee osteoarthritis. It is usually taken in capsule form; digestive upset and rare liver effects are possible.

8. Ginger extract
   Ginger has mild anti-inflammatory and analgesic effects and may slightly reduce knee pain and stiffness. It is usually taken as capsules or concentrated extracts. At high doses, it can cause stomach upset or interact with blood-thinning medicines.

9. S-adenosylmethionine (SAMe)
   SAMe participates in methylation reactions and cartilage metabolism. Some studies suggest it can reduce osteoarthritis pain and improve function, with efficacy similar to some NSAIDs but fewer side effects. However, it is more expensive and not suitable for everyone, especially people with bipolar disorder.

10. Vitamin K2 plus calcium (when deficient)
    Vitamin K2 helps regulate calcium deposition in bone. Together with calcium, and when monitored by a doctor, it may support bone strength and reduce fracture risk. Strong bones are important when joint shape is abnormal, because collapse or fractures can worsen deformity.

Regenerative / immune-related and stem-cell-type therapies

At present, no stem cell drug is fully approved specifically to correct varus flexion deformity of the knee. Most approaches are experimental, offered in research or specialised centres. It is very important to be cautious and avoid unregulated clinics.

1. Platelet-rich plasma (PRP) injections
   PRP is made from your own blood, concentrated to contain more platelets and growth factors. It is injected into the knee to try to reduce pain and support tissue repair. Some studies show better pain relief than placebo in OA; others show limited benefit. It does not reliably correct deformity, and protocols are not standardised.

2. Autologous mesenchymal stromal cell injections (experimental)
   These cells, taken from bone marrow or fat, are processed and injected into the knee with the hope of modulating inflammation and supporting cartilage repair. Early studies suggest possible symptom improvements, but long-term safety, best dose, and real structural benefits are still being researched, and regulatory status differs between countries.

3. Bone marrow aspirate concentrate (BMAC)
   BMAC contains a mix of stem-like cells and growth factors from your own bone marrow. It is injected into the knee or used with surgical procedures like high tibial osteotomy. Evidence is still limited, and it should only be done in regulated settings as part of a comprehensive treatment plan.

4. Biologic augmentation with high tibial osteotomy
   Some surgeons combine HTO (realignment surgery) with cartilage repair techniques or biologic agents such as PRP or cell-based products. The main “regenerative” effect comes from correcting the mechanical axis, which improves load distribution and allows cartilage to function better. The biologic additions are still under study.

5. General immune-supportive care (vaccination, infection control)
   Good immune health—up-to-date vaccines, treating chronic infections, and managing systemic diseases—does not directly correct deformity but helps the body tolerate surgery and heal after operations. It also reduces the risk that biologic drugs (for inflammatory arthritis) will lead to serious infections.

6. Research-only gene and cell therapies
   Some clinical trials are exploring gene therapy and advanced cell products for cartilage repair in osteoarthritis. Right now, these are experimental and not routine care. Patients interested in such options should only join properly approved trials after detailed discussions with their specialists.

Surgeries used for varus flexion deformity

1. High tibial osteotomy (HTO)
   HTO is a bone-cutting operation around the upper tibia to realign the leg so body weight passes more through the healthier part of the knee. In medial compartment OA with varus deformity, opening wedge HTO can reduce pain, improve function, and delay the need for total knee replacement. It is usually used in younger, active patients.

2. Distal femoral osteotomy (when deformity is mainly in femur)
   If the varus deformity comes mainly from the lower femur rather than the tibia, a distal femoral osteotomy may be done. The surgeon reshapes and realigns the bone to restore a more normal mechanical axis and improve load distribution. This is less common but important in selected patients.

3. Posterior soft-tissue and capsular release
   In severe fixed flexion deformity, tight structures at the back of the knee—hamstrings, posterior capsule—may be surgically released to allow full extension. This can be done alone in certain cases or combined with osteotomy or replacement. Recent studies show stepwise posterior capsular release can correct flexion contracture during total knee arthroplasty.

4. Ilizarov or external-fixator gradual correction
   For very severe or complex deformities, an external frame (Ilizarov or similar) can gradually straighten the knee and correct varus and flexion over weeks. The frame is adjusted a little each day to slowly stretch soft tissues and reshape bone, then removed once the alignment is satisfactory. This approach is specialised and used in selected difficult cases.

5. Total knee arthroplasty (knee replacement)
   In advanced osteoarthritis with severe pain, structural damage, and fixed varus flexion deformity, total knee replacement is often the final treatment. The surgeon removes damaged bone and cartilage, corrects alignment, releases tight tissues, and implants artificial components. If done well, it can greatly reduce pain and restore more normal leg alignment and extension.

Prevention and slowing progression

1. Keep a healthy body weight to reduce load on the medial knee.

2. Stay physically active with low-impact exercises like walking, cycling, or swimming.

3. Treat knee injuries early, especially ligament or meniscus tears, to avoid long-term imbalance.

4. Use good footwear and insoles if your doctor or therapist recommends them.

5. Follow physiotherapy programs to keep muscles strong and the knee as straight as possible.

6. Control systemic diseases such as rheumatoid arthritis, diabetes, and obesity.

7. Avoid repetitive heavy kneeling or squatting at work if possible; use kneepads and job modifications.

8. Maintain good bone health with enough vitamin D, calcium, and fall-prevention measures.

9. Stop smoking, which harms bone and soft-tissue healing and worsens outcomes after surgery.

10. Attend regular follow-ups with your doctor so changes in alignment or function are caught early.

When to see a doctor

You should see a doctor (usually an orthopedic surgeon or rheumatologist) if:

• Knee pain lasts more than a few weeks, especially on the inner side of the knee.

• You notice your leg looking more bow-legged or you cannot fully straighten your knee.

• Pain or stiffness limits walking, climbing stairs, or standing from a chair.

• You have night pain, swelling, or a feeling that the knee is “giving way” or locking.

• There is sudden redness, heat, or fever, which could mean infection.

• You have significant weight loss, severe morning stiffness, or involvement of many joints, suggesting inflammatory or systemic disease.

Early assessment with X-rays and possibly MRI helps to plan the right mix of non-operative treatment and to decide if and when surgery might be needed.

What to eat and what to avoid

1. Eat: Plenty of colourful vegetables and fruits
   These provide vitamins, minerals, and antioxidants that support tissue repair and overall health.

2. Eat: Lean protein (fish, skinless poultry, beans, lentils)
   Protein helps maintain muscle mass around the knee, which supports the joint and improves function.

3. Eat: Healthy fats (olive oil, nuts, seeds, oily fish)
   These contain monounsaturated and omega-3 fats that may reduce inflammation.

4. Eat: Whole grains (brown rice, oats, whole-wheat bread)
   Whole grains help with weight control by keeping you fuller longer and stabilising blood sugar.

5. Eat: Low-fat dairy or fortified alternatives
   These provide calcium and vitamin D important for bone strength.

6. Avoid or limit: Sugary drinks and sweets
   High sugar intake promotes weight gain and may increase systemic inflammation.

7. Avoid or limit: Deep-fried and fast foods
   These foods are rich in unhealthy fats and calories, which can worsen obesity-related knee stress.

8. Avoid or limit: Very salty processed foods
   Excess salt can worsen blood pressure and fluid retention, which is important if you take certain medicines.

9. Avoid or limit: Heavy alcohol use
   This can weaken bone, interfere with medicines, and increase fall risk.

10. Avoid or limit: Large portions and late-night snacking
    Keeping meal portions moderate supports healthy weight, which reduces strain on the knee.

Frequently asked questions (FAQs)

1. Can varus flexion deformity improve without surgery?
   Mild cases can often improve in symptoms and function with weight loss, physiotherapy, bracing, and medicines, but once bone alignment is clearly changed, complete straightening is difficult without surgery. Non-operative care still plays a big role in pain control and daily function.

2. Does every person with varus knee need a knee replacement?
   No. Many people manage for years with non-operative care or with joint-preserving surgery like high tibial osteotomy. Knee replacement is considered when pain is severe, conservative treatments no longer help, and X-rays show advanced joint damage.

3. Is knee bracing safe to use long-term?
   Most braces are safe when properly fitted and checked regularly. They may cause skin irritation or discomfort at first. Long-term success depends on wearing them during key activities and combining bracing with exercise and weight management.

4. How long does physiotherapy take to show results?
   Many people notice some improvement in pain and movement within a few weeks, but meaningful changes in strength, gait, and extension usually take months of consistent exercise, both in the clinic and at home.

5. Are NSAIDs safe if I have heart disease or kidney problems?
   NSAIDs can increase risks of heart attack, stroke, kidney injury, and stomach bleeding, especially in people with existing heart or kidney disease. FDA labels emphasise using the lowest effective dose for the shortest time and often avoiding NSAIDs altogether in high-risk patients. Your own doctor must decide what is safe for you.

6. Will supplements alone fix my deformity?
   No. Supplements may give small pain relief or support general health, but they cannot straighten a bow-leg or reverse structural damage. They are optional add-ons to, not replacements for, physiotherapy, weight control, and medical or surgical care.

7. What is the success rate of high tibial osteotomy?
   Modern studies show good pain relief and function for many years in properly selected people with varus knee osteoarthritis treated by HTO, especially younger and more active patients. Success depends on correct indication, precise alignment correction, and good rehabilitation.

8. Can a flexion deformity come back after surgery?
   Yes, especially if the underlying disease is active or if rehabilitation is not followed. Recurrence is more likely in very severe deformities or when soft tissues remain tight. Careful surgery and devoted post-operative physiotherapy reduce this risk.

9. Is it safe for teenagers or young adults to have these surgeries?
   In young people, doctors try first to use growth-friendly and joint-preserving techniques such as soft-tissue releases or guided growth and osteotomies. Total knee replacement is usually delayed as much as possible because implants have limited life and revision surgery is complex.

10. Can exercise make my deformity worse?
    High-impact or poorly chosen exercise can worsen pain and possibly speed wear, but well-planned low-impact strengthening and stretching almost always help. A physiotherapist can design a safe program that protects your joint while keeping you strong and mobile.

11. Is knee replacement my only option if I cannot straighten my knee at all?
    Not always. In some cases, gradual stretching, splints, or external-fixator techniques may correct severe flexion deformity without immediate replacement. However, if the joint is badly damaged and painful, total knee arthroplasty often offers the best chance of long-term relief and function.

12. How long does a total knee replacement last in varus deformity?
    With proper alignment correction and implant positioning, many modern knee replacements last 15–20 years or more. Severe uncorrected varus increases wear and failure, so accurate correction at surgery is essential.

13. Are stem cell injections a proven cure?
    No. Stem cell and similar biologic therapies are still being researched. Some small studies show symptom improvements, but long-term safety, best protocol, and real structural benefit are not yet clear. At present, they should only be considered in approved clinical trials or regulated centres.

14. What happens if I do nothing?
    Without treatment, varus flexion deformity often slowly worsens. Pain, stiffness, and walking problems usually increase, and muscles become weaker. Falls and secondary problems in the hip, back, and opposite leg can develop. Even simple non-drug measures like weight control and basic exercises can slow this decline.

15. Who should coordinate my care?
    Usually an orthopedic surgeon, often together with a rheumatologist and physiotherapist, coordinates care. In complex cases, a multidisciplinary team including nutritionists, pain specialists, and psychologists can give the best outcome. Regular communication between you and this team is vital.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: February 10, 2025.