Limb length discrepancy after total knee arthroplasty: A systematic review and meta-analysis

Trıpathy, Sujit Kumar; Pradhan, Sangram K.; Varghese, Paulson; Purudappa, Prabhudev Prasad; Velagada, Sandeep; Goyal, Tarun; Panda, Bijnya Birajita; Vanyambadi, Jagadeesh

doi:10.12998/wjcc.v9.i2.357

Cited by 8 publications

(15 citation statements)

References 20 publications

(37 reference statements)

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“…The incidence of limb lengthening after TKA in the literature varies between 44% and 83.3% [ 5 ]. The studies by Lang et al .…”

Section: Discussionmentioning

confidence: 99%

“…The reason for more limb length alteration after valgus knee TKA is still not apparent, but consistently, all studies reported a higher limb lengthening in the valgus-deformed knee compared to varus deformity [ 5 , 21 , 23 ]. Probably, the inflammatory nature of the disease in the valgus knee allows for more stretching of the ligaments during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advancements in surgical techniques, implant design and better rehabilitation protocol, 15–20% of patients remain dissatisfied after total knee arthroplasty (TKA) [ 1 , 2 ]. Although multiple factors are associated with poor functional outcome and dissatisfaction, limb length discrepancy (LLD) is a major concern that has been inadequately studied [ 3 – 5 ]. Unlike THA, the principle of TKA involves soft tissue balancing after appropriate bone resection to equalize the flexion-extension gap, and hence limb length alteration is unavoidable [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although multiple factors are associated with poor functional outcome and dissatisfaction, limb length discrepancy (LLD) is a major concern that has been inadequately studied [ 3 – 5 ]. Unlike THA, the principle of TKA involves soft tissue balancing after appropriate bone resection to equalize the flexion-extension gap, and hence limb length alteration is unavoidable [ 5 , 6 ]. Limb length discrepancy has been shown to increase the incidences of back pain, radiculopathy, gait disorders and general dissatisfaction [ 7 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Only a few studies in the literature evaluated LLD after TKA [ 5 , 6 , 10 , 14 , 15 , 17 – 23 ]. While the western literature reported minimal LLD (< 5.5 mm) that has no clinical relevance [ 6 , 18 – 21 , 23 ], others have reported substantial limb length discrepancy (≥ 10 mm) following unilateral TKA [ 10 , 14 , 15 , 17 ].…”

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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“…The incidence of limb lengthening after TKA in the literature varies between 44% and 83.3% [ 5 ]. The studies by Lang et al .…”

Section: Discussionmentioning

confidence: 99%