“…Second, we considered the R-LLD only on the frontal hip radiographs. It has been reported that the lengths of the left and right femurs differ based on the degree of subluxation in patients with DHO, and it may be preferable to evaluate the total length of the lower limbs [ 22 ]. Third, we have not directly examined the effectiveness of shoe lifts for LLD.…”
Background
We aimed to examine the inconsistency between radiographic leg length discrepancy (R-LLD) and perceived LLD (P-LLD) in patients with dysplastic hip osteoarthritis and to evaluate the factors that can cause such inconsistency.
Methods
We conducted a retrospective study on 120 patients. An inconsistent LLD was defined as a condition in which the P-LLD was shorter than the R-LLD by > 5 mm. We compared relevant data on the general characteristics of the patients and the radiological findings between consistent (group E, 92 cases [76.7%]) and inconsistent LLDs (group S, 28 cases [23.3%]).
Results
The number of patients with a history of hip surgery on the affected side and the Japanese Orthopedic Association classification pain scores were significantly higher in group S than in group E (32.1% vs. 10.8%, respectively; P = 0.015, and 21.7 ± 7.0 vs. 17.5 ± 8.2, respectively; P = 0.036). The pelvic oblique angle and length of the R-LLD were significantly higher in group S than in group E (2.9 ± 2.5° vs. 0.3 ± 2.3°, respectively; P < 0.01, and 17.2 ± 8.9 mm vs. 6.3 ± 8.4 mm, respectively; P < 0.01). Multivariate logistic analysis revealed that the pelvic oblique angle (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.28–2.52; P < 0.01) and length of the R-LLD (OR: 2.75, 95% CI: 1.24–6.12; P = 0.013) were independent risk factors of inconsistent LLD.
Conclusion
The pelvic oblique angle and a long R-LLD were independent risk factors of inconsistent LLD in patients with dysplastic hip osteoarthritis. Therefore, hip surgeons should consider P-LLD rather than R-LLD to understand the need for conservative intervention.
“…Second, we considered the R-LLD only on the frontal hip radiographs. It has been reported that the lengths of the left and right femurs differ based on the degree of subluxation in patients with DHO, and it may be preferable to evaluate the total length of the lower limbs [ 22 ]. Third, we have not directly examined the effectiveness of shoe lifts for LLD.…”
Background
We aimed to examine the inconsistency between radiographic leg length discrepancy (R-LLD) and perceived LLD (P-LLD) in patients with dysplastic hip osteoarthritis and to evaluate the factors that can cause such inconsistency.
Methods
We conducted a retrospective study on 120 patients. An inconsistent LLD was defined as a condition in which the P-LLD was shorter than the R-LLD by > 5 mm. We compared relevant data on the general characteristics of the patients and the radiological findings between consistent (group E, 92 cases [76.7%]) and inconsistent LLDs (group S, 28 cases [23.3%]).
Results
The number of patients with a history of hip surgery on the affected side and the Japanese Orthopedic Association classification pain scores were significantly higher in group S than in group E (32.1% vs. 10.8%, respectively; P = 0.015, and 21.7 ± 7.0 vs. 17.5 ± 8.2, respectively; P = 0.036). The pelvic oblique angle and length of the R-LLD were significantly higher in group S than in group E (2.9 ± 2.5° vs. 0.3 ± 2.3°, respectively; P < 0.01, and 17.2 ± 8.9 mm vs. 6.3 ± 8.4 mm, respectively; P < 0.01). Multivariate logistic analysis revealed that the pelvic oblique angle (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.28–2.52; P < 0.01) and length of the R-LLD (OR: 2.75, 95% CI: 1.24–6.12; P = 0.013) were independent risk factors of inconsistent LLD.
Conclusion
The pelvic oblique angle and a long R-LLD were independent risk factors of inconsistent LLD in patients with dysplastic hip osteoarthritis. Therefore, hip surgeons should consider P-LLD rather than R-LLD to understand the need for conservative intervention.
“…The mean Charlson Comorbidity Index (CCI) score was 1.45, indicating mild comorbidity, while the majority of patients had an ASA rating of 3 (n = 109, 64%). The Mini-Mental State Examination (MMSE) mean was 24.43, falling within the normal range (24)(25)(26)(27)(28)(29)(30). The mean baseline IADL was 6.11 out of a possible 8, indicating high function.…”
Section: Methodsmentioning
confidence: 99%
“…LLD of patients with partial or total hip replacements or cannulated screws was determined by measuring from each lesser trochanter to a trans-ischial line drawn to intersect both ischial tuberosities (Figure 1). 24 When 1 or both lesser trochanters were absent, the greater trochanters were used. The prosthetic head diameter as confirmed by the surgical notes was used to scale the measurements.Figure 1.LLD in patients with partial/total hip replacements or cancellous screws was measured as the difference in distance from the less trochanters to a trans-ischial line.…”
Introduction A negative correlation exists between functional outcomes and leg length discrepancy (LLD) following hip fracture repair. We have assessed the effects of LLD following hip fracture repair in elderly patients on 3-meter walking time, standing time, activities of daily living (ADL), and instrumental activities of daily living (IADL). Methods One hundred sixty-nine patients enrolled in the STRIDE trial were identified with femoral neck, intertrochanteric, and subtrochanteric fractures that were treated with partial hip replacement, total hip replacement, cannulated screws, or intramedullary nail. Baseline patient characteristics recorded included age, sex, body mass index Charlson comorbidity index (CCI) score. ADL, IADL, grip strength, sit-to-stand time, 3-meter walking time and return to ambulation status were measured at 1 year after surgery. LLD was measured on final follow-up radiographs by either the sliding screw telescoping distance or the difference from a trans-ischial line to the lesser trochanters, and was analyzed as a continuous variable using regression analysis. Results Eighty eight patients (52%) had LLD <5 mm, 55 (33%) between 5-10 mm and 26 subjects (15%) >10 mm. Age, sex, BMI, Charlson score, and ambulation status had no significant impact on LLD occurrence. Type of procedure and fracture type did not correlate with severity of LLD. Having a larger LLD was not found to have a significant impact on post-operative ADL ( P = .60), IADL ( P = .08), sit-to-stand time ( P = .90), grip strength ( P = .14) and return to former ambulation status ( P = .60), but did have a statistically significant impact on 3-meter walking time ( P = .006). Discussion LLD after hip fracture was associated with reduced gait speed but did not affect many parameters associated with recovery. Continued efforts to restore leg length after hip fracture repair are likely to be beneficial.
“…Radiography of bilateral lower limbs is considered a standard approach to measuring LLD ( 1 , 7 , 8 ). Pediatric radiologists used to manually measure the LLD on radiographs from the upper edge of the femoral head to the distal tibia; however, while cognitively simple, this task is labor-intensive.…”
Background: Deep learning (DL) has been suggested for the automated measurement of leg length discrepancy (LLD) on radiographs, which could free up time for pediatric radiologists to focus on valueadding duties. The purpose of our study was to develop a unified solution using DL for both automated LLD measurements and comprehensive assessments in a large and comprehensive radiographic dataset covering children at all stages, from infancy to adolescence, and with a wide range of diagnoses.
Methods:The bilateral femurs and tibias were segmented by a cascaded convolutional neural network (CNN), referred to as LLDNet. Each LLDNet was conducted through use of residual blocks to learn more abundant features, a residual convolutional block attention module (Res-CBAM) to integrate both spatial and channel attention mechanisms, and an attention gate structure to alleviate the semantic gap. The leg length was calculated by localizing anatomical landmarks and computing the distances between them. A comprehensive assessment based on 9 indices (5 similarity indices and 4 stability indices) and the paired Wilcoxon signed-rank test was undertaken to demonstrate the superiority of the cascaded LLDNet for segmenting pediatric legs through comparison with alternative DL models, including ResUNet, TransUNet, and the single LLDNet. Furthermore, the consistency between the ground truth and the DL-calculated measurements of leg length was also comprehensively evaluated, based on 5 indices and a Bland-Altman analysis. The sensitivity and specificity of LLD >5 mm were also calculated.Results: A total of 976 children were identified (0-19 years old; male/female 522/454; 520 children between 0 and 2 years, 456 children older than 2 years, 4 children excluded). Experiments demonstrated that the proposed cascaded LLDNet achieved the best pediatric leg segmentation in both similarity indices (0.5-1% increase; P<0.05) and stability indices (13-47% percentage decrease; P<0.05) compared with the alternative DL methods. A high consistency of LLD measurements between DL and the ground truth was also observed using Bland-Altman analysis [Pearson correlation coefficient (PCC) =0.94; mean bias =0.003 cm]. The sensitivity and specificity established for LLD >5 mm were 0.792 and 0.962, respectively, while those for LLD >10 mm were 0.938 and 0.992, respectively.
Conclusions:The cascaded LLDNet was able to achieve promising pediatric leg segmentation and LLD measurement on radiography. A comprehensive assessment in terms of similarity, stability, and measurement consistency is essential in computer-aided LLD measurement of pediatric patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
