Hip surgeons and leg length inequality after primary hip replacement

Abstract

This study reports the results of 2 separate surveys of British Hip Society (BHS) members relating to leg length inequality (LLI) after primary total hip replacement (THR). Survey 1: Investigates the members' opinions on the effect of LLI on the outcome of THR and explores the acceptable limits of LLI. Survey 2: Reports on the intraoperative techniques currently used by BHS members to minimise LLI after THR. Results - Survey 1: 97% of all surgeons completing the survey believed that LLI can affect the outcome of THR. Results - Survey 2: All surgeons reported using at least 1 intraoperative technique for assessing leg length with a median of 5 techniques. Over 50% of surgeons use 2 or more tests. Conclusion - Survey 1: 89% of surgeons agreed that 15 mm of LLI after primary uncomplicated THR was always acceptable. 90% of surgeons felt that LLI more than 22.74 mm was never acceptable. Conclusion - Survey 2: Despite the multiple published papers on various methods of assessing leg length intraoperatively, the problem of LLI post THR persists. This study highlights the need for further research to develop a simple intraoperative technique with high accuracy and reproducibility.

Reliability of a simple fluoroscopic image to assess leg length discrepancy during direct anterior approach total hip arthroplasty

“…To minimize LLD after THA, multiple techniques have been developed for intra-operative assessment of leg length. In a survey conducted by the British Hip Society, surgeons reported utilizing a median of five techniques during THA to estimate LLD[ 5 ].…”

“…Use of a specialized traction table facilitates this procedure but may also increase reliance on fluoroscopically based assessment of LLD[ 6 , 7 ]. Reported techniques to assess LLD intra-operatively with fluoroscopy during DAA THA include printed or virtual image overlays, concurrent imaging of a radio-opaque linear marker, and computer assisted image analysis techniques to correct for image distortion[ 5 , 8 ]. These previously reported fluoroscopic techniques can add time, complexity, radiation exposure, or significant cost to the procedure.…”

Limb Length Inequality in Patients After Primary Total Hip Arthroplasty: Analysis of Radiological Assessment and Influencing Risk Factors Based on a District General Hospital Experience of 338 Cases

“…These factors include congenital dysplasia, growth plate problems, previous hip surgery, fractures, or infections [ 5 ]. Surgeons also use preoperative electronic templates to help determine the center of rotation, select implant size, and position and guide the femoral osteotomy level [ 6 ].…”

“…Intraoperative measures mainly depend on assessing soft tissue tension and limb length using different fixed reference points [ 6 ]. However, robust evidence for the beneficial effects of each of these measures on LLI is still lacking.…”

“…The survey results did not provide concrete values for acceptable cut-off ranges for the LLI. However, this was an unprecedented study that attempted to produce a consensus on the matter [ 6 ].…”