Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Abstract

persistent pain around the greater trochanter is a common complication after total hip arthroplasty. Restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. The purpose of this study was to evaluate postoperative differences of these parameters after THA and to analyze their association to greater trochanteric pain syndrome. Furthermore, we aimed to evaluate the clinical relevance of trochanteric pain syndrome compared to patient reported outcome measures. 3D-CT scans of 90 patients were analyzed after minimalinvasive total hip arthroplasty and leg length, femoral and acetabular offset differences were measured. Clinical evaluation was performed three years after THA regarding the presence of trochanteric pain syndrome and using outcome measures. Furthermore, the patients' expectation were evaluated. Patients with trochanteric pain syndrome showed a higher absolute discrepancy of combined leg length, femoral and acetabular offset restoration compared to the non-operated contralateral side with 11.8 ± 6.0 mm than patients without symptoms in the trochanteric region with 7.8 ± 5.3 mm (p = 0.01). Patients with an absolute deviation of the combined parameters of more than 5 mm complained more frequently about trochanteric symptoms (29.2%, 19/65) than patients with a biomechanical restoration within 5 mm compared to the non-affected contralateral side (8.0%, 2/25, p = 0.03). Clinical outcome measured three years after THA was significantly lower in patients with trochanteric symptoms than without trochanteric pain (p < 0.03). Similarly, fulfillment of patient expectations as measured by THR-Survey was lower in the patients with trochanteric pain (p < 0.005). An exact combined restoration of leg length, acetabular and femoral offset reduces significantly postoperative trochanteric pain syndrome and improves the clinical outcome of the patients.

The association of postoperative global femoral offset with total hip arthroplasty outcomes

“…We speculated that when FO with or without GFO was too short compared to the non-surgical side, the abductor muscle strength, walking distance, and speed decreased; consequently, patients may experience pain related to fatigue of the muscle around the hip joint 2 , 19 . In contrast, in the case of FO with or without GFO made too long, pain at the lateral aspect of the hip joint, known as “greater trochanteric pain syndrome”, may occur 20 .…”

Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years

“…HO and leg length reconstruction postoperatively is crucial for an additive effect on clinical outcomes [ 20 ]. Restoration of leg length and offset correlate reduced trochanteric pain syndrome postoperatively [ 45 ]. A postoperative unbalanced offset between legs was associated with hip abductor muscle weakness and may increase gait asymmetry in the sagittal plane [ 21 ].…”

The modern state of femoral, acetabular, and global offsets in total hip arthroplasty: a narrative review

“…Clement et al ( 22 ) expressed a similar idea, stating that: ‘the exact anatomic parameters of the femoral and acetabular components that relate to the optimal outcome of patients undergoing a THA remain to be identified’. In the study of Worlicek et al ( 43 ), for instance, the discrepancy of a single parameter such as leg length, femoral offset, or acetabular offset did not differentiate patient pain, but rather a specific combination significantly reduced postoperative pain and improved clinical outcomes. Advanced statistical analysis may someday unveil these ideal relationships of THA.…”

“…One such study identified target limb length for each patient based on patient perception and severity of the disease, equaling offset to the contralateral limb ( 42 ). This allowed surgeons to accurately achieve target offset length to within 5 mm for patients with unilateral hip osteoarthritis with excellent clinical outcomes ( 42 , 43 ). Even still, this method is limited to comparing the contralateral side pre- and postoperatively to determine a length that should not change and can thus be a basis for another.…”