Femoral Shortening by a Step-cut Osteotomy for Leg-length Discrepancy in Adults

The effect on low back pain of shortening osteotomy for leg length inequality

“…Most authors consider 20 to 25 mm as the lower level [1,7,11,13]. We agree that a discrepancy of less than 20 mm should be corrected with a shoe raise and discussion of operation should start at this point.…”

“…Some consider that a discrepancy of as little as 5 m m can have clinical significance [2,10], while others think that shortening of less than 20 to 25 mm has mainly cosmetic implications [6,9,11], but it seems well established that chronic low back pain occurs more frequently in subjects with LLI greater than 10 mm [2,4,10]. In order to test the effect of equalising leg length the use of a raise on the shoe has been recommended [7,13]. If this brings relief a permanent shoe raise as an alternative to operation should be discussed with the patient.…”

“…However, there are no reports which focus on the effect on low back pain after a shortening osteotomy. Johansson and Barrington examined 14 patients treated by femoral shortening and 8 of these had low back pain as a presenting symptom; the effect on the back pain was not specified but all the patients were satisfied with the result [7]. Winquist et al reported that 22 out of 40 patients treated by femoral shortening had presented with back pain, but the postoperative result with regard to the back pain was not given [13].…”

“…Slight leg length inequality m a y be easily corrected with a raise on the shoe, but operation is an option for patients with inequality o f more than 20 to 25 m m [1,7,11,13]. In skeletally mature patients of normal height a shortening procedure is the m e t h o d o f choice in most cases.…”