Limb length discrepancy after total knee arthroplasty may contribute to suboptimal functional results

Hinarejos, Pedro; Sánchez-Soler, Juan; Leal-Blanquet, Joan; Torres-Claramunt, Raúl; Monllau, Juan Carlos

doi:10.1007/s00590-020-02683-6

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…A few studies have reported that radiographic LLD and perceived LLD existed in the preoperative period in unilateral OA knee [ 18 – 20 ]. These two parameters improved after TKA.…”

Section: Discussionmentioning

confidence: 99%

“…These two parameters improved after TKA. The authors of these studies suggested that the patients should be informed of the existence of such LLD in the preoperative period [ 18 – 20 ]. We tried to look for the existence of similar preoperative LLD in our patients who had bilateral disease.…”

Section: Discussionmentioning

confidence: 99%

“…The preoperative LLD and perceived LLD in TKA have recently gained more importance [ 18 – 20 ]. However, many studies have not evaluated these aspects.…”

Section: Introductionmentioning

confidence: 99%

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Impact of limb length discrepancy on functional outcome in total knee arthroplasty patients: a prospective cohort study

et al. 2022

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Background Limb length alteration following total knee arthroplasty (TKA) has been under-reported. Few studies have shown a significant association between limb length discrepancy (LLD) and poor functional outcome. This prospective study evaluated the impact of radiographic and perceived LLD on functional outcome in TKA. The variables affecting LLD were also evaluated. Methods The preoperative and postoperative limb lengths of TKA patients (112 knees, 81 patients, KL grade ≥ 3) were measured in full-length digital radiographs. The Hip-Knee-Ankle (HKA) angles were also measured. The functional outcome (Western Ontario and McMaster Universities Arthritis Index) and perception about LLD were evaluated after six months. Results The mean preoperative radiographic LLD in the unilateral and bilateral TKA groups was 0.75 cm ± 0.60 cm and 0.58 cm ± 0.52 cm (P = 0.197), respectively. Similarly, postoperative LLD was 0.76 cm ± 0.85 cm in the unilateral group and was 0.59 cm ± 0.92 cm (P = 0.402) in the bilateral group. Only 19.7% of patients had postoperative radiographic LLD of ≥ 10 mm, and 80.2% of patients had LLD of < 10 mm. The functional outcome was significantly affected when LLD exceeded 10 mm (correlation coefficient 0.54, P < 0.001). Linear regression analysis revealed no significant effects of age, sex, height, weight, BMI, preoperative LLD and difference in deformity between the limbs on postoperative LLD. 34.5% of patients perceived LLD in the preoperative period, which decreased to 3.7% in the postoperative period. Perceived LLD did not correlate to radiographic LLD and functional outcome. Conclusions There is no significant difference in radiographic LLD between unilateral and bilateral TKA. The functional outcome is adversely affected by radiographic LLD of ≥ 10 mm. Age, sex, BMI, preoperative LLD and difference in deformity angle do not affect the LLD. About one-third of patients perceive LLD in the preoperative period, which improves significantly after TKA. Levels of evidence II.

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“…A few studies have reported that radiographic LLD and perceived LLD existed in the preoperative period in unilateral OA knee [ 18 – 20 ]. These two parameters improved after TKA.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of limb length discrepancy on functional outcome in total knee arthroplasty patients: a prospective cohort study

et al. 2022

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“…Some studies have focused on radiological results to predict clinical outcomes and satisfaction after knee replacement [ 2 - 4 ], especially those aiming to compare robotic-assisted surgery and conventional surgery [ 5 , 6 ]. Nevertheless, these studies focus mainly on anteroposterior views, sometimes lateral views, but less frequently on the axial view of the patella or the rotation of the femoral component.…”

Section: Introductionmentioning

confidence: 99%

Concordance in Radiological Parameters of Different Knee Views After Total Knee Arthroplasty

Barahona¹,

Guzmán²,

Bustos³

et al. 2023

Cureus

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“…Some patients may suffer from leg length discrepancy caused by leg length change after operation, which can reduce the patient’s satisfaction with the operation. In addition, post-operative leg length discrepancy may result in many unwanted effects, such as poor recovery, limping, acceleration of contralateral knee osteoarthritis, and lower back pain [ 2 – 4 ]. As the total knee arthroplasty (TKA) is the most common operation for end-stage knee osteoarthritis, most of the research have been focused on the leg length change after TKA.…”

Section: Introductionmentioning

confidence: 99%

How much the leg length has changed after the MOUKA through measurement of the full length radiographs? Beware of splicing error

Xie

Jiao

Yao

et al. 2023

BMC Musculoskelet Disord

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Background Leg length change after knee arthroplasty is one of the most concerned problems for patients and doctors. However, as there was only one literture focused on the leg length change after unicompartmental knee arthroplasty, we aimed to clarify the leg length change after medial mobile-bearing unicompartmental knee arthroplasty (MOUKA) using a novel double calibration method. Methods We enrolled patients who underwent MOUKA and had taken full-length radiographs in a standing position prior to and at 3 months after the operation. We eliminated the magnification by a calibrator and corrected the longitudinal splicing error by measuring the femur and tibia lengths before and after operation. Perceived leg length change was collected 3 months after operation. Bearing thickness, preoperative joint line convergence angle, preoperative and postoperative varus angles, flexion contracture and Oxford knee score (OKS) were also collected. Results From June 2021 to February 2022, 87 patients were enrolled.76 (87.4%) of them showed an increase with an average of 0.32 cm (range from -0.30 cm to 1.05 cm) in leg length change. The lengthening was strongly correlated with the degree of varus deformity and its correction value (r = 0.81&0.92, P < 0.01). Only 4 (4.6%) patients perceived leg length lengthening after operation. There was no difference in OKS between the patients who had an increase in leg length and those who had a decrease (P = 0.99). Conclusions Majority of patients only experienced a slight increase in leg length after MOUKA, and such an increase did not affect patients’ perception and short-term function.

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Limb length discrepancy after total knee arthroplasty may contribute to suboptimal functional results

Cited by 11 publications

References 20 publications

Impact of limb length discrepancy on functional outcome in total knee arthroplasty patients: a prospective cohort study

Impact of limb length discrepancy on functional outcome in total knee arthroplasty patients: a prospective cohort study

Concordance in Radiological Parameters of Different Knee Views After Total Knee Arthroplasty

How much the leg length has changed after the MOUKA through measurement of the full length radiographs? Beware of splicing error

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