Limb length discrepancy after total hip arthroplasty: a systematic review

Pathak, Pradeep Kumar; Gupta, Rakesh; Meena, Hari Singh; Fiske, Rajendra

doi:10.18203/issn.2455-4510.intjresorthop20183670

Cited by 5 publications

(5 citation statements)

References 44 publications

(92 reference statements)

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“…In planning revision surgery to design customised implants, the patients are CT scanned in supine position [ 16 ] and the true functional LL cannot be evaluated. Pelvic measurements of VFO constitute a surrogate for LL [ 23 ], but that can lead to significant limitations not taking into account any causes of LLD which do not involve the hip [ 24 ]; including abnormal pelvic orientation, bone length inequality, fixed flexion and asymmetrical femoral and tibial torsion [ 25 ]. LDBR, EOS, offers upright imaging and 3D reconstruction of the lower limbs to accurately measure LL with low radiation exposure and with negligible magnification errors [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of acetabular defects greater than Paprosky type 3B: the importance of functional imaging

Laura

Henckel

Gal

et al. 2021

BMC Musculoskelet Disord

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Background 3D Surgical planning has become a key tool in complex hip revision surgery. The restoration of centre of rotation (CoR) of the hips and leg length (LL) are key factors in achieving good clinical outcome. Pelvic imaging is the gold standard for planning and assessment of LL. We aimed to better understand if 3D planning is effective at equalising LL when large acetabular defects are present. Materials and methods This was a prospective case study of 25 patients. We report the analysis of pre-operative LL status and planned LL restoration measured on CT, in relation to the achieved LL measured post-operatively in functional, weight bearing position. Our primary objective was the assessment of restoration of CoR as well as the anatomical and functional LL using biplanar full-length standing low-dose radiographs; our secondary objective was to evaluate the clinical outcome. Results Pre-operative intra-pelvic discrepancy between right and left leg was a mean of 28 mm (SD 17.99, min = 3, max = 60 mm). Post-operatively, the difference between right and left vertical femoral offset (VFO), or CoR discrepancy, was of 7.4 mm on average, significantly different from the functional LL discrepancy (median = 15 mm), p = 0.0024. Anatomical LLD was a median of 15 mm. In one case there was transient foot drop, one dislocation occurred 6 months post-operatively and was treated by closed reduction, none of the patients had had revision surgery at the time of writing. Mean oxford hip score at latest follow up was 32.1/48. Discussion This is the first study to investigate limb length discrepancy in functional position after reconstruction of large acetabular defects. We observed that VFO is not an optimal surrogate for LL when there is significant bone loss leading to length inequality, fixed flexion of the knee and abduction deformity. Conclusions Although challenging, LLD and gait abnormalities can be greatly improved with the aid of an accurate surgical planning. Surgeons and engineers should consider the integration of EOS imaging in surgical planning of reconstruction of large acetabular defects.

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Section: Discussionmentioning

confidence: 99%

“…Methods of correcting LLD include 2D or 3D pre-operative planning using X-Rays or CTs, intraoperative identification of anatomical landmarks and navigation techniques [ 24 ]. Computer-assisted navigation techniques rely on the usage of intraoperative landmarks.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of acetabular defects greater than Paprosky type 3B: the importance of functional imaging

Laura

Henckel

Gal

et al. 2021

BMC Musculoskelet Disord

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“…A limit of 1 mm was chosen in order to prevent penetration. A leg length discrepancy of 10 mm was stated as a critical threshold [ 64 ]. A more conservative 8 mm was chosen here.…”

Section: Methodsmentioning

confidence: 99%

The Patient-Specific Combined Target Zone for Morpho-Functional Planning of Total Hip Arthroplasty

Habor

Fischer

Tokunaga³

et al. 2021

JPM

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Background Relevant criteria for total hip arthroplasty (THA) planning have been introduced in the literature which include the hip range of motion, bony coverage, anterior cup overhang, leg length discrepancy, edge loading risk, and wear. The optimal implant design and alignment depends on the patient’s anatomy and patient-specific functional parameters such as the pelvic tilt. The approaches proposed in literature often consider one or more criteria for THA planning. but to the best of our knowledge none of them follow an integrated approach including all criteria for the definition of a patient-specific combined target zone (PSCTZ). Questions/purposes (1) How can we calculate suitable THA implant and implantation parameters for a specific patient considering all relevant criteria? (2) Are the resulting target zones in the range of conventional safe zones? (3) Do patients who fulfil these combined criteria have a better outcome score? Methods A method is presented that calculates individual target zones based on the morphology, range of motion and load acting on the hip joint and merges them into the PSCTZ. In a retrospective analysis of 198 THA patients, it was calculated whether the patients were inside or outside the Lewinnek safe zone, Dorr combined anteversion range and PSCTZ. The postoperative Harris Hip Scores (HHS) between insiders and outsiders were compared. Results 11 patients were inside the PSCTZ. Patients inside and outside the PSCTZ showed no significant difference in the HHS. However, a significant higher HHS was observed for the insiders of two of the three sub-target zones incorporated in the PSCTZ. By combining the sub-target zones in the PSCTZ, all PSCTZ insiders except one had an HHS higher than 90. Conclusions The results might suggest that, for a prosthesis implanted in the PSCTZ a low outcome score of the patient is less likely than using the conventional safe zones by Lewinnek and Dorr. For future studies, a larger cohort of patients inside the PSCTZ is needed which can only be achieved if the cases are planned prospectively with the method introduced in this paper. Clinical Relevance The method presented in this paper could help the surgeon combining multiple different criteria during THA planning and find the suitable implant design and alignment for a specific patient.

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“…In patients with severe osteoarthritis, severe joint space loss, and a flattened femoral head, standardized data of proximal femoral anatomy based on the local population might be useful, especially when the contralateral side is also affected [ 10 , 11 ]. Furthermore, the limited availability of prosthesis designs across different contexts may limit the options to reproduce native hip anatomy [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Do Cementless Stems Match Any Hip? A Description of Anthropometric Measurements of the Proximal Femur in Colombia

Canencio Salgado,

Martínez-Villaba,

Bautista

et al. 2024

Arthroplasty Today

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Limb length discrepancy after total hip arthroplasty: a systematic review

Cited by 5 publications

References 44 publications

Reconstruction of acetabular defects greater than Paprosky type 3B: the importance of functional imaging

Reconstruction of acetabular defects greater than Paprosky type 3B: the importance of functional imaging

The Patient-Specific Combined Target Zone for Morpho-Functional Planning of Total Hip Arthroplasty

Do Cementless Stems Match Any Hip? A Description of Anthropometric Measurements of the Proximal Femur in Colombia

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