L-shaped caliper for limb length measurement during total hip arthroplasty

Shiramizu, Kei; Naito, Masatoshi; Shitama, Takashi; Nakamura, Yoshinari; Shitama, Hiroshi

doi:10.1302/0301-620x.86b7.14587

Cited by 63 publications

(62 citation statements)

References 7 publications

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“…The surgeon must use this information to determine the femoral osteotomy level. Various methods of measuring limb length change during surgery include comparing the dimensions of the resected bone with the dimensions replaced by the prosthesis [12,57,58], comparing the distance between the center of the trial head and the lesser trochanter [30,43], the use of mechanical jigs and measuring calipers [6,22,37,44], or the use of reference pins driven into the pelvis [3,21,31]. Some surgeons advocate the use of computer-assisted methods [33,41,55].…”

Section: Resultsmentioning

confidence: 99%

Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty

Meermans

Malik

Witt

et al. 2011

Clinical Orthopaedics &Amp; Related Research

149

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Background Pelvic radiographs are helpful in assessing limb-length discrepancy (LLD) before and after THA but are subject to variation. Different methods are used to determine LLDs. As a pelvic reference, both ischial tuberosities and the teardrops are used, and as a femoral reference, the lesser trochanter and center of the femoral head are used. Questions/purposes We validated the different methods for preoperative radiographic measurement of LLDs and evaluated their reliability. Patients and Methods LLDs were measured on full-leg radiographs for 52 patients (29 men, 23 women) with osteoarthritis (OA) of the hip and compared with different methods for measuring LLDs on AP radiographs of the pelvis. Results The true LLD varied from À8.0 to 9.1 mm. When the biischial line was used as a pelvic reference, the LLD measured on AP pelvis radiographs was different from the true LLD. No difference was found when the interteardrop line was used as a pelvic reference. There was substantial interobserver agreement when the lesser trochanter was used as a femoral reference (kappa = 0.66-0.70) and excellent interobserver and intraobserver agreement for all other measurements (kappa = 0.84-0.93). Conclusions Our data show use of the biischial line as a pelvic reference should be discouraged and the interteardrop line is a better alternative. The center of the femoral head is a more reliable femoral landmark compared with the lesser trochanter. Level of Evidence Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty

Meermans

Malik

Witt

et al. 2011

Clinical Orthopaedics &Amp; Related Research

149

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“…To this end, a number of techniques have been proposed to assess limb length intra-operatively with varying results [27,30,31]. Surgeons are always looking for any new technical improvements that will help achieve a more 'normalised' new hip with equal leg lengths and optimal joint function [1,19,22].…”

Section: Introductionmentioning

confidence: 99%

Does computer-assisted surgery benefit leg length restoration in total hip replacement? Navigation versus conventional freehand

Manzotti

Cerveri

Momi

et al. 2009

International Orthopaedics (SICOT)

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Leg length discrepancy following total hip replacement (THR) can contribute to poor hip function. Abnormal gait, pain, neurological disturbance and patient dissatisfaction have all been described as a result of leg length inequality after THR. The purpose of this study was to determine whether the use of computer navigation in THR can improve limb length restoration and early clinical outcomes. We performed a matched-pair study comparing 48 computer-assisted THR with 48 THRs performed using a traditional freehand alignment method. The same implant with a straight non-modular femoral stem was used in all cases. The navigation system used allowed the surgeon to monitor both acetabular cup placement and all the phases of femoral stem implantation including rasping. Patients were matched for age, sex, arthritis level, pre-operative diagnosis and pre-operative leg length discrepancy. At a minimum follow-up of six months, limb length discrepancy was measured using digital radiographs and a standardised protocol. The number of patients with a residual discrepancy of 10 mm or more and/or a postoperative over-lengthening were measured. The clinical outcome was evaluated using both the Harris Hip Score and the normalised Western Ontario and McMaster Universities (WOMAC) Arthritis Index. Restoration of limb length was significantly better in the computerassisted THR group. The number of patients with a residual limb length discrepancy greater than 10 mm and/or a post-operative over-lengthening was significantly lower. No significant difference in the Harris Hip Score or normalised WOMAC Arthritis Index was seen between the two groups. The surgical time was significantly longer in the computer-assisted THR group. No post-operative dislocations were seen.

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“…The most frequent complications are limping, lumbar pain, neurological damage, patient dissatisfaction, and the necessity to use contralateral shoe lifts for correction. Such complications, in some cases, can lead to the need for surgical revision [2][3][4][5]. A recent inquiry reported LLD as the second most cited cause of medical malpractice litigation among American Association of Hip and Knee Surgeons [6].…”

Section: Introductionmentioning

confidence: 99%

To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty?

Benedetti

Catani

Benedetti

et al. 2009

International Orthopaedics (SICOT)

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The aim of this study was to evaluate the effects of limb lengthening up to 20 mm after THA on symmetry of hip kinematics and kinetics during common activities of daily living. Twenty patients (age range 49-80 years) operated on with Link Lubinus II THA, with lateral access and a mean follow-up of 16 months, were assessed by gait analysis during level walking, stair ascending and descending. The time-distance, hip kinetics and kinematics values were statistically compared between the operated side and the non-operated side in order to assess symmetry. The 12-item Questionnaire was used to assess satisfaction and personal perception of limb lengthening. Mean value of limb lengthening after THA was 11 mm (SD 6). Minor abnormalities were found in the kinematics and kinetics of the operated and non-operated hips during level walking and stair climbing. The score of the questionnaire corresponded to a high level of satisfaction after THA and only two patients complained of limping independent from the amount of discrepancy. From this study we can conclude that a leg length inequality in the range of 1-20 mm does not impair the symmetry of time-distance parameters and of hip kinematics and kinetics during gait and stairs walking. Although objective, gait analysis data did not correspond to patient's perception of discrepancy, which is subjective and irrespective of the amount of lengthening. There is biomechanical evidence that a limb lengthening of up to two centimetres after THA in general does not need to be corrected by means of a contralateral shoe lift. Individual decisions to the contrary need to be justified.

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L-shaped caliper for limb length measurement during total hip arthroplasty

Cited by 63 publications

References 7 publications

Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty

Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty

Does computer-assisted surgery benefit leg length restoration in total hip replacement? Navigation versus conventional freehand

To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty?

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