Background: Significant limb length discrepancy (LLD) after total hip arthroplasty (THA) is associated with limb, unremitting pain, neurological complications, and recurrent dislocations and has been a major cause of patient dissatisfaction and litigation against operating surgeon. The authors present a prospective study involving a double-stitch technique to prevent postoperative LLD after THA. Materials and Methods: Fifty patients undergoing primary THA over a period of 2 years were included in the study and were divided into two groups of 25 each. In Group I, double-stitch technique was used for intraoperative adjustment of preoperative radiological LLD, whereas in Group II, palpation and comparison of level of patella was used for assessment of LLD. Postoperative LLD and hip outcome scores were obtained and compared. Results: Postoperative radiological LLD (mean ± standard deviation) was 2.72 ± 2.07 mm (range −5 mm to +6 mm) in Group I and +4.28 ± 7.2 mm (range −15 mm to +12 mm) in Group II. Nine patients in Group I and 2 patients in Group II had no true clinical leg lengths discrepancy postoperatively. Postoperative radiological LLD within 5 mm could be achieved in 24 patients in Group I and in 9 patients in Group II. Conclusion: The study indicates that double-stitch technique is a simple and effective method in reducing postoperative LLD following THA.
Introduction: To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition. Material and Methods: Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed. Results: The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients. Conclusion: Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.
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