Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

Abstract

The application of distraction osteogenesis through the use of magnet-operated, remote-controlled intramedullary lengthening continues to provide new opportunities for accurate limb equalization. While limb-length discrepancy and deformity can be addressed by total hip arthroplasty alone, the magnitude of correction is limited by the soft-tissue envelope and complications such as sciatic nerve palsy. This 3-patient case series presents the combination of staged ipsilateral total hip arthroplasty and retrograde intramedullary femoral nail lengthening for the correction of both deformity and limb-length discrepancy. Our results report leg-length equalization, independent ambulation without assistive devices, and excellent bone and functional outcomes without complications, demonstrating that this combined technique can be used to achieve targeted lengthening and deformity correction.

Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

“…Physical examination is of outstanding importance to rule out other causes of deformity and LLD [ 21 , 22 ]. In minor LLD cases with minimal symptoms, patients may benefit from conservative treatment.…”

“…Various approaches are described to correct LLD after surgeries around the hip. Length correction by THA is, however, limited to 4 cm, as acute correction can cause nerve palsy [ 21 ]. Two-stage THA with primary extensive soft tissue release and skeletal traction, followed by THA, can be an option in highly selected patients [ 23 ].…”

“…To our knowledge, only a few studies have addressed this topic. Harkin et al published three hip dysplasia cases treated by THA and retrograde intramedullary femoral lengthening in a staged procedure [ 21 ]. They reported excellent outcomes regarding bone healing, leg length equality, and patient comfort [ 21 ].…”

“…Harkin et al published three hip dysplasia cases treated by THA and retrograde intramedullary femoral lengthening in a staged procedure [ 21 ]. They reported excellent outcomes regarding bone healing, leg length equality, and patient comfort [ 21 ]. We stated the same satisfactory results, except a nail breakage after missing bone healing one year after surgery.…”

Hip-Sparing Equalization Procedures for Leg-Length Discrepancy after Total Hip Arthroplasty: A Retrospective Case Series

“…The hip-sparing techniques with internal lengthening implants function as second-stage reconstruction after THA in patients with significant LLD before THA. This process was recently reported in a multicenter study by Harkin et al [10], who described three cases of hip dysplasia in patients who underwent a two-stage reconstruction: THA followed by ipsilateral lengthening with a retrograde femoral Precice lengthening nail. All three patients reported independent ambulation without assistive devices and had excellent bone and functional outcomes without complications.…”