Perioperative management of leg-length discrepancy in total hip arthroplasty: a review

Gheewala, Rohan A.; Young, Joseph R.; Mori, Benjamin Villacres; Lakra, Akshay; DiCaprio, Matthew R.

doi:10.1007/s00402-022-04759-w

Cited by 11 publications

(8 citation statements)

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“…Finally, we did not analyze the risk of impingement or dislocation in this retrospective study, but only the rate of abnormal SPM. Instability and impingement are associated with other factors, including implant positions, combined anteversion, leg length, and offset, [27][28][29] and should be anticipated before surgery. The purpose was only to understand the implication of a low PI in patients with abnormal spinopelvic mobility.…”

Section: Discussionmentioning

confidence: 99%

Low pelvic incidence with low lordosis and distal apex of lumbar lordosis associated with higher rates of abnormal spinopelvic mobility in patients undergoing THA

Aubert,

Gerard,

Auberger

et al. 2023

Bone Jt Open

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AimsThe risk factors for abnormal spinopelvic mobility (SPM), defined as an anterior rotation of the spinopelvic tilt (∆SPT) ≥ 20° in a flexed-seated position, have been described. The implication of pelvic incidence (PI) is unclear, and the concept of lumbar lordosis (LL) based on anatomical limits may be erroneous. The distribution of LL, including a unusual shape in patients with a high lordosis, a low pelvic incidence, and an anteverted pelvis seems more relevant.MethodsThe clinical data of 311 consecutive patients who underwent total hip arthroplasty was retrospectively analyzed. We analyzed the different types of lumbar shapes that can present in patients to identify their potential associations with abnormal pelvic mobility, and we analyzed the potential risk factors associated with a ∆SPT ≥ 20° in the overall population.ResultsΔSPT ≥ 20° rates were 28.3%, 11.8%, and 14.3% for patients whose spine shape was low PI/low lordosis (group 1), low PI anteverted (group 2), and high PI/high lordosis (group 3), respectively (p = 0.034). There was no association between ΔSPT ≥ 20° and PI ≤ 41° (odds ratio (OR) 2.01 (95% confidence interval (CI)0.88 to 4.62), p = 0.136). In the multivariate analysis, the following independent predictors of ΔSPT ≥ 20° were identified: SPT ≤ -10° (OR 3.49 (95% CI 1.59 to 7.66), p = 0.002), IP-LL ≥ 20 (OR 4.38 (95% CI 1.16 to 16.48), p = 0.029), and group 1 (OR 2.47 (95% CI 1.19; to 5.09), p = 0.0148).ConclusionIf the PI value alone is not indicative of SPM, patients with a low PI, low lordosis and a lumbar apex at L4-L5 or below will have higher rates of abnormal SPM than patients with a low PI anteverted and high lordosis.Cite this article: Bone Jt Open 2023;4(9):668–675.

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Section: Discussionmentioning

confidence: 99%

Low pelvic incidence with low lordosis and distal apex of lumbar lordosis associated with higher rates of abnormal spinopelvic mobility in patients undergoing THA

Aubert,

Gerard,

Auberger

et al. 2023

Bone Jt Open

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“…LLD was defined as the difference in the distance between a line connecting the two anterior superior iliac spines and a line connecting the tips of the lesser trochanters (Fig. 3 D) 22 . LLD within 10 mm was considered acceptable 23 .…”

Section: Methodsmentioning

confidence: 99%

A new designed full process coverage robot-assisted total hip arthroplasty: a multicentre randomized clinical trial

Lu,

Zhang,

et al. 2024

International Journal of Surgery

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Objective: To compare the effect of a new complete robot-assisted total hip arthroplasty (RA-THA) with that of the manual total hip arthroplasty (MTHA) and to verify the accuracy and safety of the former. Methods: Overall, 148 patients were enrolled from March 3, 2021 to December 28, 2021 in this study and classified into RA-THA (n=74 patients) and MTHA (n=74 patients) groups. The sex, age, operative side, body mass index (BMI), diagnosis, other basic information, operative time, acetabular prosthesis anteversion and inclination, femoral prosthesis anteversion and angulation, femoral prosthesis filling rate, leg length discrepancy (LLD), Harris hip score, and visual analog scale (VAS) score of the two groups were compared. Results: No significant differences were observed in the two groups regarding sex, age, operative side, BMI, diagnosis, Harris hip score, VAS score, acetabular inclination, acetabular prosthesis anteversion, femoral prosthesis anteversion, combined anteversion, and femoral prosthesis filling rate (P>0.05). The operative time was significantly longer in the RA-THA group than in the MTHA group (106.71±25.22 min vs. 79.42±16.16 min; t=7.30, P<0.05). The femoral angulation (1.78°±0.64°) and LLD (2.87±1.55 mm) in the RA-THA group were significantly lesser than those in the MTHA group (2.22°±1.11° and 5.81±6.27 mm, respectively; t=−2.95 and t=−3.88, P<0.05). Conclusion: The complete RA-THA has some advantages over the traditional procedure in restoring the lower limb length and controlling the femoral prosthesis angulation. Thus, this study verifies the accuracy and safety of the robot-assisted system.

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“…The goals of the surgery include restoration of the center of rotation, correct orientation of components, appropriate femoral offset, and equal leg length [ 1 ]. Among these key components of successful primary THA, leg length equalization still remains one of the most challenging targets [ 2 , 3 ]. Indeed, lengthening is a rather common occurrence after primary THA, with reported incidences ranging from 1% to 27% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Among these key components of successful primary THA, leg length equalization still remains one of the most challenging targets [ 2 , 3 ]. Indeed, lengthening is a rather common occurrence after primary THA, with reported incidences ranging from 1% to 27% [ 2 ]. Leg Length Discrepancy (LLD) is a prevalent source of post-THA dissatisfaction [ 4 ] with patient frequently reporting mechanical symptoms, such as gait disturbances [ 5 ], hip instability potentially resulting in dislocations, and premature component loosening [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

An Intraoperative Method to Minimize Leg Length Discrepancy in Anterior Minimally Invasive Total Hip Arthroplasty—A Prospective Study

Girolami,

Bevoni,

Artioli

et al. 2024

JPM

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While several intraoperative devices have been described in the literature for assessing leg length discrepancy (LLD), none have been utilized during total hip arthroplasty (THA) performed via the Anterior Minimally Invasive Surgery (AMIS) approach. The aim of this prospective study was to evaluate the efficacy and accuracy of a compass device in assessing leg length during THA performed using the AMIS technique. A prospective study was conducted involving 35 patients who consecutively underwent unilateral primary THA using the AMIS technique at our department from September 2017 to December 2018. LLD was measured by comparing preoperative and postoperative anteroposterior radiographs of the pelvis, independently assessed by two observers. The mean preoperative LLD was 3.6 (SD 3.9, range, 0.2–19.3) mm. The mean postoperative LLD was 2.5 (SD 3.0, range, 0–12.2) mm. A postoperative LLD of less than 5 mm was observed in 88.2% of cases, with 94.1% having values less than 10 mm. In conclusion, the compass device emerged as a valuable tool for ensuring precise limb length control in THA with the AMIS approach, offering both efficiency and cost-effectiveness in clinical practice.

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Perioperative management of leg-length discrepancy in total hip arthroplasty: a review

Cited by 11 publications

References 50 publications

Low pelvic incidence with low lordosis and distal apex of lumbar lordosis associated with higher rates of abnormal spinopelvic mobility in patients undergoing THA

Low pelvic incidence with low lordosis and distal apex of lumbar lordosis associated with higher rates of abnormal spinopelvic mobility in patients undergoing THA

A new designed full process coverage robot-assisted total hip arthroplasty: a multicentre randomized clinical trial

An Intraoperative Method to Minimize Leg Length Discrepancy in Anterior Minimally Invasive Total Hip Arthroplasty—A Prospective Study

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