Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram

Kjellberg, Martin; Al-Amiry, Bariq; Englund, Erling; Sjödén, Göran O.; Sayed-Noor, Arkan S.

doi:10.1007/s00256-011-1166-7

Cited by 81 publications

(53 citation statements)

References 24 publications

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“…Three patients in the freehand group and four in the C-arm group were excluded for having poor quality imaging that limited accuracy of limb length measurements. The measurements were obtained by drawing a line between the bottom of the teardrop bilaterally and measuring, perpendicularly, the distance between this line and the most prominent portion of the lesser tuberosity [10,14] were compared using Fisher's exact test or chisquare, as appropriate. Freehand and C-arm groups were compared with respect to the principles of the Lewinnek safe zone (abduction, 30°-45°; version, 5°-25°) [11] using the Ztest for two binary independent proportions.…”

Section: Patientsmentioning

confidence: 99%

Does Fluoroscopy Improve Acetabular Component Placement in Total Hip Arthroplasty?

Beamer

Morgan

Barr

et al. 2014

Clin Orthop Relat Res

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Background The success of THA largely depends on correct placement of the individual components. Traditionally, these have been placed freehand using anatomic landmarks, but studies have shown poor accuracy with this method. Questions/purposes Specifically, we asked (1) does using fluoroscopy lead to more accurate and greater likelihood of cup placement with the Lewinnek safe zone than does freehand cup placement; (2) is there a learning curve associated with the use of fluoroscopy for cup placement; (3) does the use of fluoroscopy increase operative time; and (4) is there a difference in leg length discrepancy between freehand and fluoroscopic techniques? Methods This series consisted of 109 consecutive patients undergoing primary THA, conversion of a previous hip surgery to THA, and revision THA during a 24-month period. No patients were excluded from analysis during this time. The first 52 patients had cups placed freehand, and then the next 57 patients had acetabular components placed using fluoroscopy; the analysis began with the first patient treated using fluoroscopy, to include our initial experience with the technique. The abduction, version, and limb length discrepancy were measured on 6-week postoperative pelvic radiographs obtained with the patient in the supine position. Operative time, sex, age, BMI, diagnosis, operative side, and femoral head size were recorded as possible confounders. Results Cups inserted freehand were placed in the ideal range of abduction (30°-45°) and anteversion (5°-25°) 44% of the time. With fluoroscopy, placement in the Lewinnek safe zone for both measures significantly increased to 65%. The odds of placing the cup in the Lewinnek safe zone for abduction and version were 2.3 times greater with the use of fluoroscopy (95% CI, 1.2-5.0; p = 0.03). Patients undergoing primary THAs (32 freehand, 35 C-arm) had cup placement in the safe zone for abduction and version 44% of the time freehand and 57% of the time with fluoroscopy, which failed to reach statistical significance. There was no difference in operative time, patient age, sex, operative side, diagnosis, limb length discrepancy, or femoral head size between the two groups. Conclusions The use of fluoroscopy to directly observe pelvic position and acetabular component placement increased the success of placement in the Lewinnek safe zone in this cohort of patients having complex and primary THAs. This is a simple, low-cost, and quick method for increasing successful acetabular component alignment. The study population included a large proportion of patients

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Section: Patientsmentioning

confidence: 99%

Does Fluoroscopy Improve Acetabular Component Placement in Total Hip Arthroplasty?

Beamer

Morgan

Barr

et al. 2014

Clin Orthop Relat Res

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“…The LLD was defined as the difference in the perpendicular distance in millimeters between a line passing through the lower edge of the teardrop points to the corresponding tip of the lesser trochanter. The ICC for this method was also satisfactory [18].…”

Section: Confounding Variablesmentioning

confidence: 73%

Factors related to low back pain in patients with hip osteoarthritis

Tanaka

Matsumoto²,

Fujii

et al. 2015

BMR

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“…To account for possible dropouts, we recruited about 10% more participants, leading to 27 patients in each group. in the robotic milling group and 12 points (range, [5][6][7][8][9][10][11][12][13][14][15] in the manual rasping group, respectively. No significant differences were found between the two groups with respect to the postoperative Harris hip scores and WOMAC scores (p ¼ 0.512 and P ¼ 0.301, respectively) ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…The bi-ischial line was used if tear drop deformity was severe. [15] For femoral stem alignment, an outlier was defined as above varus 3 or valgus 3 , and for leg length discrepancy, an outlier was defined as 410 mm. Femoral subsidence of44 mm, a change in the varus angle of42 , or a complete radiolucent line was considered to indicate stem loosening.…”

Section: Methodsmentioning

confidence: 99%

Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study

Lim

Park

et al. 2015

Computer Aided Surgery

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Background: Recently, two topical issues in total hip arthroplasty (THA) have been robot-assisted surgery and use of a short stem. The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospective, randomized design. Methods: We randomized 54 patients into two groups, either robotic milling group or manual rasping group. The patients were assessed clinically and radiographically at 8 weeks, 5 months, 12 months, and 24 months. Results: Robotic milling group had a significantly longer operation time, requiring on average 8.9 min for registration and 11.2 min for milling. On the other hand, robotic milling group showed superior results in terms of stem alignment and leg length equality. Two intraoperative femoral fractures occurred only in manual rasping group. Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups. No complications including stem loosening, infection, nerve palsy, or dislocation were encountered in either group during the follow-up period. Conclusions: The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment, improve leg length equality, and help reduce the risk of intraoperative femoral fracture as compared with manual rasping. However, the clinical outcome scores did not differ between the two groups at the time of short-term follow-up. Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA.

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Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram

Abstract: Despite the excellent interobserver reliability and intraobserver reproducibility of LLD measurement on radiographs, clinicians should be aware of its limited accuracy when compared to CT-scanogram.

Cited by 81 publications

References 24 publications

Does Fluoroscopy Improve Acetabular Component Placement in Total Hip Arthroplasty?

Does Fluoroscopy Improve Acetabular Component Placement in Total Hip Arthroplasty?

Factors related to low back pain in patients with hip osteoarthritis

Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study

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