Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

Abstract

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening

“…The present study shows an outcome which is similar to those of the aforementioned studies, with satisfying radiological and functional results at a reasonable complication rate [21,22]. Nonetheless, to our knowledge this is the first study describing subsequent retrograde lengthening of the ipsilateral femur after THA with or without SSO as a treatment regimen for unilateral high hip dislocation with relevant LLD.…”

“…All three patients achieved leg length equalisation and showed a satisfying functional outcome [21]. Zak et al and Thakral et al each described two successful cases of subsequent intramedullary femoral lengthening after THA -however, lengthening was performed at the contralateral femur [18,22].…”

“…Retrograde femoral lengthening nails can be used for correction of residual LLD after THA [20]. However, data on lengthening procedures performed in femora after THA is scarce [21,22].…”