Influence of Leg Length Discrepancy on Clinical Results after Total Hip Arthroplasty - A Prospective Clinical Trial

Abstract

The effect of leg length differences on early clinical outcome after total hip arthroplasty remains uncertain. We performed a prospective study on 94 patients who were evaluated preoperatively and one year after surgery for clinical leg length differences, which were then compared with radiological measurements. The effect of leg length differences on walking ability, limp, pain and patient satisfaction was studied. The mean clinical leg length difference after operation was 0.05 cm (-1.5 to 1.5, SD 0.5). Clinical and radiological measurements correlated poorly (ω =0.36 pre- and ω =0.186 postoperatively). Patients with a shorter operated leg on clinical assessment were more prone to limping (p<0.05), and patients with a longer leg had more pain compared to patients with equal leg lengths (p<0.05). Walking ability, Harris Hip Score and patient satisfaction were only marginally affected by leg length differences. Virtually equal leg length was achieved for most patients but small differences had a negative influence in relation to limping and pain. Patients should be counselled pre-operatively about possible leg length differences and associated symptoms.

Application of intraoperative limb-length measurement by a new osteotomy device in hemiarthroplasty for treating femoral neck fracture

“…The accurate angle and height of osteotomy in hip arthroplasty is hard to control, which leads to limb discrepancy. Limb-length discrepancy (LLD) exceeding 10 mm after hip arthroplasty, raising legal or neurological issues, is reported in the literature [2, 10]. In order to achieve better control of the angle and height of osteotomy during hip arthorplasty, many surgeons developed various limb length measurement devices.…”

“…Limb-length discrepancy (LLD) is a common complaint after hip arthroplasty and can be a cause of patient dissatisfaction and litigation [1, 2]. Williamson [3] reported that 27% of patients required heel lifts after hip arthroplasty to improve quality of gait.…”

An intraoperative device to restore femoral offset in total hip arthroplasty

“…They believed that LLD was most commonly caused by over-lengthening of the prosthetic head-neck distance. The accuracy of femoral offset measurement using preoperative plain radiographs is affected by the rotation of the femur and pelvic tilt [18],[19]. Surgeons, in the past, have used methods or devices like pins, rulers, and calipers for intraoperative measurement of leg length discrepancy [8],[10],[20],[21].…”

The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: A Prospective Cohort Study

“…Benedetti et al [12] showed that LLD in the range of 1-20 mm did not impair the symmetry of time-distance parameters and of hip kinematics and kinetics during gait and stairs walking. Plaass et al [16] reported negative marginal effect of LLD after THA with more pain in patients with lengthening and more limping in patients with shortening. Perception of LLD after THA is reported in one third of operated patients and affected patients reported lower functional outcome [5].…”

“…Perception of LLD after THA is reported in one third of operated patients and affected patients reported lower functional outcome [5]. Unfortunately, most of the above-mentioned studies had limitations such as retrospective design [7,10,12], inadequate sample size [10,12,15], lack of preoperative function and quality of life [11,12,16,17] and heterogenous material where different types of osteoarthritis and even bilateral osteoarthritis mixed and evaluated together [10,16]. Konyves and Bannister [17] found that lengthening after LLD was associated with lower functional outcome up to 12 months postoperatively.…”