Leg length discrepancy after total hip arthroplasty: comparison of 3 intraoperative measurement methods

Abstract

We conclude that the use of an intraoperative measurement device can reduce the leg length discrepancy, with best results when using the trochanteric/joint ratio device.

<p>A simple method to minimize leg length discrepancy in hip hemiarthroplasty</p>

“…There are several ways to avoid LLD after hip replacement: (1) fix Kirschner wires on bones to serve as references points, and measure the distance before and after installation of the prosthesis by a ruler or similar device,5,16,18 (2) use a navigation system during the operation,4,5,15,19 (3) direct manual comparison of the positions of bilateral patellas or heels in surgery,9,20 (4) similar to our method, measure the distance between the center of the femoral head and the top of lesser trochanter of the fractured side before femoral neck osteotomy and after the prosthesis implantation,21,22 (5) template measuring on X-ray film before operation to confirm the osteotomy position according to the lesser trochanter or the fracture line,14 and (6) compare the tip of the greater trochanter and the femoral head center during operation 14…”

“…The accuracy of the manual comparison of the position of bilateral patellas and heels is not high, which depends on the patient’s position and surgical drapes 9. This method could result in 27% of patients with LLD >10 mm 20. Maybe preoperative template measurement should be recommended, but its accuracy depends on the correct magnification of the X-ray film28 and the surgeon’s experience 29.…”

Letter to the Editor, “Who Restores Hip Biomechanics More Effectively After a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopedic Residents”

“…Leg length has been shown to play a role in hip stability as well as patient satisfaction postoperatively [4,5] and is more difficult to accurately restore when total hip arthroplasty is performed for fractures vs osteoarthritis such that this research is meaningful and informative. Measuring leg length and femoral offset for hip arthroplasty is challenging on plain film imaging as hip rotation and flexion can influence the landmarks leading to platforms and algorithms designed to capture this intraoperatively [6][7][8][9].…”

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

“…However, such methods are inaccurate due to the in uence of body position and types of anaesthesia [11]. An intraoperative device [12] navigation system [13,14] and intraoperative uoroscopy [15][16][17][18] could reduce LLD, but more surgical equipment or procedures were needed, which increased the cost and/or operation time and might increase the risk of infection. The control of LLD by solely relying on the preoperative measurement of the template was still unreliable [19], but if it was combined with the intraoperative measurement of the height of the femoral head prosthesis, LLD could be more effectively reduced [20].…”