Patients’ Perception of Leg Length Discrepancy Post Total Hip Arthroplasty

Abstract

Perception of a leg length discrepancy post total hip arthroplasty (THA) is one of the most common sources of patient dissatisfaction and can have a direct influence on the considered success of the operation.This research examined postoperative perception of imposed limb discrepancies in a group of THA patients compared to a group of participants with no previous hip surgery. Two subgroups of THA patients were involved: those who did not perceive a difference in limb length following THA and those that did.Discrepancies were imposed in 2.5 mm increments. For discrepancies ≥5 mm, a significant number of participants were aware of a difference (74%). There was no significant difference in perception of imposed discrepancies between THA patients and participants with no previous hip surgery. THA patients who perceived a difference in their limb lengths postoperatively had significantly worse pain and oxford scores when compared to THA patients who perceived their limb lengths to be equal. Knowing the boundaries between LLDs that go undetected and those that patients are aware of could guide surgeons when evaluating the balance between correct soft tissue tension and the resulting unequal leg length. From these findings, discrepancies >5 mm are likely to be perceived. Whether this perception would lead directly to a negative outcome score and patient dissatisfaction is more complex to project and likely to be patient specific. Intraoperative methods to aid the controlled positioning of implanted components could help maintain and restore leg length to within an acceptable amount that patients cannot perceive.

A Smart Tool for Intraoperative Leg Length Targeting in Total Hip Arthroplasty: A Retrospective Cohort Study

“…Femoral abduction as minor as 5 degrees has been noted to induce leg length errors of up to 8 mm [19]. Additionally, a recent study found that 74% of THA patients with a LLD of greater than 5 mm perceived that difference post-operatively, with the majority of those patients reporting significantly worse pain and Oxford scores, as compared with patients who were unaware of a LLD and/or those with a LLD less than 5 mm [39]. …”

Intellijoint HIP^®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty

“…Traditional freehand methods are associated with LLDs of between 4 and 7 mm,34–36 discrepancies that are clinically significant, as postsurgical data indicate that patients can perceive an LLD of as little as 5 mm, and such a discrepancy can be associated with increased pain and decreased Oxford scores 37. Mechanical devices such as outriggers or calipers improve outcomes but still fall below the standard for success.…”

Leg Length Discrepancy after Total Hip Arthroplasty Using the Modified Anterolateral Approach for Stable Hip

“…Sykes et al [9] reported that for discrepancies ≥ 5 mm, a significant number of participants were aware of the difference. They also noted that the patients who underwent THA who perceived a difference in their limb lengths postoperatively had significantly worse pain and Oxford scores compared with those who perceived their limb lengths to be equal [9].…”

“…Sykes et al [9] reported that for discrepancies ≥ 5 mm, a significant number of participants were aware of the difference. They also noted that the patients who underwent THA who perceived a difference in their limb lengths postoperatively had significantly worse pain and Oxford scores compared with those who perceived their limb lengths to be equal [9]. Mahmood et al [10] reported that patients whose limbs lengthened by > 9 mm after THA had higher incidence of shoe lift use, residual hip pain, limb length discrepancy awareness, and use of walking aids [10].…”