A low-volume surgeon is an independent risk factor for leg
length discrepancy after primary total hip arthroplasty: a case-control
study

Kishimoto, Yuji; Suda, Hiroko; Kishi, Takahiro; Takahashi, Toshiaki

doi:10.1007/s00264-019-04435-6

Cited by 15 publications

(11 citation statements)

References 33 publications

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“…These results are highly consistent with several earlier studies [20]. A previous study demonstrated that the accurate reconstruction of biomechanical parameters related to the limb discrepancy after THAs is critical to ensure a long-term success [21].…”

Section: Discussionsupporting

confidence: 92%

Anterolateral Approach Might Be Superior to Posterolateral Approach in Controlling Lower Limb Discrepancy for Special Total Hip Arthroplasty Patients

Xiong

Liu

et al. 2021

Preprint

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Objectives: Variable approaches for total hip arthroplasty (THA) are promoted but investigations of associations between the approaches and the postoperative lower limb discrepancy (LLD) are limited. We intended to compare the efficacy between the anterolateral approach (ALA) and posterolateral approach (PLA) in controlling of postoperative LLD. Methods: Two retrospective cohorts were established including patients undergone unilateral primary THA. Preoperative and latest follow-up radiographs were compared and evaluated. Two hundred and sixty patients (140 females and 126 males; aged 46.70 ± 13.62 years) were recruited with around 20 months follow-up postoperatively. Results: Univariate analysis identified lower postoperative LLD, lower postoperative acetabular offset and lower hospital costs in the ALA group than in the PLA group (p＜0.01), however, the femoral and global offset and length of stay (LOS) are comparable between (p > 0.05). Multivariable liner regression revealed that PLA, preoperative LLD, developmental dysplasia of the hip and aseptic avascular necrosis are major contributors to the postoperative LLD (p<0.05). Conclusions: This study illustrates that the ALA might be superior to the PLA in controlling the postoperative LLD among some of the THA patients. Both ALA and PLA are comparable in regard to femoral and offset and LOS.

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Section: Discussionsupporting

confidence: 92%

Anterolateral Approach Might Be Superior to Posterolateral Approach in Controlling Lower Limb Discrepancy for Special Total Hip Arthroplasty Patients

Xiong

Liu

et al. 2021

Preprint

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“…Surgeon’s experience is also a confounding factor in maintaining leg length in THA. Kishimoto et al [ 34 ] found out that 80% of patients operated by high-volume surgeons had a LLD < 5 mm compared to 40% of patients operated by low-volume surgeons. Low-volume surgeons are a risk factor for increased postoperative LLD with an odds ratio of 8.26 [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Kishimoto et al [ 34 ] found out that 80% of patients operated by high-volume surgeons had a LLD < 5 mm compared to 40% of patients operated by low-volume surgeons. Low-volume surgeons are a risk factor for increased postoperative LLD with an odds ratio of 8.26 [ 34 ]. We evaluated LLD and reconstruction of HO according to surgeon’s experience by evaluating differences between consultants and residents.…”

Section: Discussionmentioning

confidence: 99%

The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning

et al. 2021

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Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.

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“…The effect of unequal lower limb length after total hip arthroplasty LLD can affect the daily life of patients in varying degrees and signi cantly reduce the patient's postoperative quality of life [2][3][4][5]. With the development of THA surgery technology, LLD has been signi cantly decreased but not completely eliminated [6][7][8]. So far, there is no nal conclusion on the range of LLD that patients can tolerate.…”

Section: Discussionmentioning

confidence: 99%

“…Severe LLD can lead to gait disorders, lower back pain, hip dislocation, sciatica, prosthesis loosening and even early revision problems [2][3][4][5]. At present, there have been many methods to control LLD [6,7] but most of them have the disadvantages such as cumbersome to use, need additional equipment, increase operation time or cost, low accuracy, and et al This paper introduced a new method (the 'Y' line technique) to control LLD by measuring the central height of the acetabulum and femoral head of the healthy hip on preoperative Xray and adjusting the prosthesis height according to the preoperative measurement intraoperatively. Good results have been obtained and the factors affecting the accuracy of this method were also analysed.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

Jin¹,

Sun²,

Duan³

et al. 2021

Preprint

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Objective: To introduce a surgical technique (the ‘Y’ line technique) which is to control the leg length discrepancy (LLD) after total hip arthroplasty.Methods: A total of 350 patients were selected; 134 patients who were used the ‘Y’ line technique to control lower limb length were included in Group A and 166 patients treated with free hand methods to control lower limb length were included in Group B. 50 patients who were taken standard anteroposterior X-ray of bilateral hips preoperatively and used the ‘Y’ line technique during the operation were included in Group C. Results: The postoperative LLD of the three groups was statistically significant (p < 0.001). There were significant differences statistically in comparison between any two groups (P<0.01). Severe unequal length rates of the lower extremities (LLD > 10 mm) were 5.97% (8/134) in Group A, 14.3% (24/166) in Group B and 0% (0/50) in Group C – the difference was statistically significant (p < 0.001). There were significant differences between Group A and Group B, Group B and Group C (P < 0.05), but there was no significant difference between Group A and Group C (P = 0.078).Conclusion: The ‘Y’ line technique, which does not increase the operation time, can effectively reduce postoperative LLD. Insufficient internal rotation of the healthy lower extremity and the low projection position in the preoperative anteroposterior X-ray of bilateral hips were important factors affecting the accuracy of the ‘Y’ line technique.

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A low-volume surgeon is an independent risk factor for leg length discrepancy after primary total hip arthroplasty: a case-control study

Cited by 15 publications

References 33 publications

Anterolateral Approach Might Be Superior to Posterolateral Approach in Controlling Lower Limb Discrepancy for Special Total Hip Arthroplasty Patients

Anterolateral Approach Might Be Superior to Posterolateral Approach in Controlling Lower Limb Discrepancy for Special Total Hip Arthroplasty Patients

The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning

The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

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