Double-Stitch Technique: A Simple and Effective Method to Minimize Limb Length Discrepancy after Total Hip Arthroplasty

Abstract

Background: Significant limb length discrepancy (LLD) after total hip arthroplasty (THA) is associated with limb, unremitting pain, neurological complications, and recurrent dislocations and has been a major cause of patient dissatisfaction and litigation against operating surgeon. The authors present a prospective study involving a double-stitch technique to prevent postoperative LLD after THA. Materials and Methods: Fifty patients undergoing primary THA over a period of 2 years were included in the study and were divided into two groups of 25 each. In Group I, double-stitch technique was used for intraoperative adjustment of preoperative radiological LLD, whereas in Group II, palpation and comparison of level of patella was used for assessment of LLD. Postoperative LLD and hip outcome scores were obtained and compared. Results: Postoperative radiological LLD (mean ± standard deviation) was 2.72 ± 2.07 mm (range −5 mm to +6 mm) in Group I and +4.28 ± 7.2 mm (range −15 mm to +12 mm) in Group II. Nine patients in Group I and 2 patients in Group II had no true clinical leg lengths discrepancy postoperatively. Postoperative radiological LLD within 5 mm could be achieved in 24 patients in Group I and in 9 patients in Group II. Conclusion: The study indicates that double-stitch technique is a simple and effective method in reducing postoperative LLD following THA.

Accuracy of the Horizontal Calibrator in Correcting Leg Length and Restoring Femoral Offset in Total Hip Arthroplasty

“…How to minimize LLD while maintaining hip stability is a common challenge. Many studies (11,13,14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) have been published to describe techniques for LLD management. Freehand techniques are widely used, including intraoperative clinical assessment of soft tissue tension and comparison with contralateral leg position.…”

“…Nevertheless, this method is far from the center of acetabular rotation, which increases measurement error and additional trauma. Gupta and Papadopoulos et al ( 12 , 17 ) described a double-stitch technology, that is, tie a knot with silk thread on the skin about 10 cm from the proximal end of the great trochanter, and then draw the other end with vascular forceps to make a diathermic mark on the most lateral edge of the great trochanter. They performed 60 THAs using this technique and showed a mean postoperative LLD of 1.58 mm (range −8 mm to 7 mm).…”

“…Although there are many devices designed according to this idea at the present such as: Double-Stitch Technique (17), L-shaped caliper (18), LOOD device (14), calipers dual pin retractor (19), they also have obvious disadvantages, such as susceptibility to changes in limb position, complex operation, poor measurement accuracy, inconsistent anchor points, muscle contracture, and soft tissue effects (1,3,4). This article proposes a simple method that compensates for the shortcomings of previous measuring devices (12,13,16,17,(19)(20)(21)(22)(23) and combines the advantages of different measuring instruments (14,18,(24)(25)(26)(27)(28)(29)(30) to provide more accurate limb length and recovery of OD. This technique involves careful preoperative planning combined with the intraoperative use of the Horizontal Calibrator plus a double reverse "U" pad.…”

“…Although there are many devices designed according to this idea at the present such as: Double-Stitch Technique ( 17 ), L-shaped caliper ( 18 ), LOOD device ( 14 ), calipers dual pin retractor ( 19 ), they also have obvious disadvantages, such as susceptibility to changes in limb position, complex operation, poor measurement accuracy, inconsistent anchor points, muscle contracture, and soft tissue effects ( 1 , 3 , 4 ). This article proposes a simple method that compensates for the shortcomings of previous measuring devices ( 12 , 13 , 16 , 17 , 19 – 23 ) and combines the advantages of different measuring instruments ( 14 , 18 , 24 – 30 ) to provide more accurate limb length and recovery of OD. This technique involves careful preoperative planning combined with the intraoperative use of the Horizontal Calibrator plus a double reverse “U” pad.…”

The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

“…The most common used free hand methods to reduce LLD after THA are palpating the two knees, palpating iliotibial tract tension and the Shuck Test. However, such methods are inaccurate due to the in uence of body position and types of anaesthesia [11]. An intraoperative device [12] navigation system [13,14] and intraoperative uoroscopy [15][16][17][18] could reduce LLD, but more surgical equipment or procedures were needed, which increased the cost and/or operation time and might increase the risk of infection.…”