Total hip arthroplasty: leg length inequality impairs functional outcomes and patient satisfaction

Abstract

BackgroundLeg length inequality (LLI) was identified as a problem of total hip arthroplasty soon after its introduction. Leg lengthening is the most common form of LLI. Possible consequences are limping, neuronal dysfunction and aseptic component loosening. LLI can result in an increased strain both on the contralateral hip joint and on the abductor muscles. We assessed the influence of leg lengthening and shortening on walking capacity, hip pain, limping and patient satisfaction at 2-year follow-up.Methods478 cases with postoperative lengthening and 275 with shortening were identified, and matched with three controls each. Rigorous adjustment for potential differences in baseline patient characteristics was performed by propensity-score matching of covariates. The arbitrarily defined desired outcomes were a walking capacity >60 minutes, no hip pain, no limping, and excellent patient satisfaction. Differences in not achieving the desired outcomes between the groups were expressed as odds ratios.ResultsIn the lengthened case group, the odds ratio for not being able to walk for an hour was 1.70 (95% CI 1.28-2.26) for cases compared to controls, and the odds ratio for having hip pain at follow-up was 1.13 (95% CI 0.78-1.64). The odds ratio for limping was 2.08 (95% CI 1.55-2.80). The odds ratio for not achieving excellent patient satisfaction was 1.67 (95% CI 1.23-2.28). In the shortening case group, the odds ratio for not being able to walk for an hour was 1.23 (95% CI 0.84-1.81), and the odds ratio for having hip pain at follow-up was 1.60 (95% CI 1.05-2.44). The odds ratio for limping for cases was 2.61 (95% CI 1.78-3.21). The odds ratio for not achieving excellent patient satisfaction was 2.15 (95% CI 1.44-3.21).ConclusionsWalking capacity, limping and patient satisfaction were all significantly associated with leg lengthening, whereas pain alleviation was not. In contrast, hip pain, limping and patient satisfaction were all significantly associated with leg shortening, whereas walking capacity was not.

The Importance of Additional Mid Swing Toe Clearance for Amputees

“…A large study on patients having undergone hip arthroplasty (n=753) shows that leg length discrepancy reduces satisfaction and functional outcome after hip arthroplasty. 47 Reducing risks of falls reduces the degree of disability of amputees by improving their mobility and hence improves their quality of life. 48…”

The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: A Prospective Cohort Study

“…Farmer et al [28] found that treatment of hip pain after THA in patients with LLD was more difficult than in those who had no LLD. Röder et al [30] reported a negative effect of leg lengthening after THA on walking capacity, limping and patient satisfaction and of leg shortening, on hip pain, limping and patient satisfaction. Therefore, the shortening of the operated leg in this study population did not seem to compromise the prosthetic stability.…”

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