Revision surgery for leg length inequality after primary hip replacement

McWilliams, Anthony; Lampropoulos, Anastasios; Stone, Martin

doi:10.1177/1120700017752568

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…The effect of unequal lower limb length after total hip arthroplasty LLD can affect the daily life of patients in varying degrees and signi cantly reduce the patient's postoperative quality of life [2][3][4][5]. With the development of THA surgery technology, LLD has been signi cantly decreased but not completely eliminated [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Leg length discrepancy (LLD) is a common complication after total hip arthroplasty (THA), and it is also the main reason why patients are dissatis ed with the operation [1]. Severe LLD can lead to gait disorders, lower back pain, hip dislocation, sciatica, prosthesis loosening and even early revision problems [2][3][4][5]. At present, there have been many methods to control LLD [6,7] but most of them have the disadvantages such as cumbersome to use, need additional equipment, increase operation time or cost, low accuracy, and et al This paper introduced a new method (the 'Y' line technique) to control LLD by measuring the central height of the acetabulum and femoral head of the healthy hip on preoperative Xray and adjusting the prosthesis height according to the preoperative measurement intraoperatively.…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

Jin¹,

Sun²,

Duan³

et al. 2021

Preprint

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Objective: To introduce a surgical technique (the ‘Y’ line technique) which is to control the leg length discrepancy (LLD) after total hip arthroplasty.Methods: A total of 350 patients were selected; 134 patients who were used the ‘Y’ line technique to control lower limb length were included in Group A and 166 patients treated with free hand methods to control lower limb length were included in Group B. 50 patients who were taken standard anteroposterior X-ray of bilateral hips preoperatively and used the ‘Y’ line technique during the operation were included in Group C. Results: The postoperative LLD of the three groups was statistically significant (p < 0.001). There were significant differences statistically in comparison between any two groups (P<0.01). Severe unequal length rates of the lower extremities (LLD > 10 mm) were 5.97% (8/134) in Group A, 14.3% (24/166) in Group B and 0% (0/50) in Group C – the difference was statistically significant (p < 0.001). There were significant differences between Group A and Group B, Group B and Group C (P < 0.05), but there was no significant difference between Group A and Group C (P = 0.078).Conclusion: The ‘Y’ line technique, which does not increase the operation time, can effectively reduce postoperative LLD. Insufficient internal rotation of the healthy lower extremity and the low projection position in the preoperative anteroposterior X-ray of bilateral hips were important factors affecting the accuracy of the ‘Y’ line technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

Jin¹,

Sun²,

Duan³

et al. 2021

Preprint

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“…Hip arthroplasty for displaced femoral neck fractures has achieved remarkable results in relieving pain and rapidly restoring hip function and has become the main treatment modality in elderly population (1,2). However, there exists the defect of leg length discrepancy (LLD) after hip arthroplasty, it can lead to serious complications, such as limping, back and leg pain, prosthesis loosening, and dislocation (3)(4)(5)(6)(7). In addition, the expectations of the patients might usually be high and LLD could be associated with patient dissatisfaction or even legal problems (8,9).…”

Section: Introductionmentioning

confidence: 99%

A novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) to prevent postoperative leg-length discrepancy for femoral neck fractures in hip arthroplasty

Zhang

Zheng²,

Liu³

et al. 2022

Front. Surg.

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ObjectiveTo determine whether the two lower extremities are of equal length after hip arthroplasty for femoral neck fractures, we developed a novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) in hip arthroplasty.MethodsPatients with femoral neck fractures requiring hip arthroplasty from July 2020 to March 2022 in the orthopedic department of Jinjiang Municipal Hospital, Fujian Province, China were recruited. Hip arthroplasty was performed using the proposed “shoulder-to-shoulder” method of manual positioning based on anatomical mark in 52 patients with femoral neck fractures who met the inclusion criteria. “Shoulder-to-shoulder” was achieved by alignment of the marked femoral “shoulder” and the “shoulder” of prosthesis stem. There were 16 male and 36 female patients, with 27 undergoing total hip arthroplasty (THA) and 25 undergoing hip hemiarthroplasty (HA). The fractures were categorized according to the Garden classification: type II, type III, and type IV in 5, 11, and 36 patients, respectively. The vertical distance from the apex of the medial margin of the femoral trochanter to the tear drop line on both sides which was regarded as the length of both limbs were compared via postoperative imaging, and the apex–shoulder distance on the ipsilateral side measured via postoperative imaging was compared with those measured intraoperatively.ResultsAll patients completed the surgery successfully. The measurement results for the lower extremities after THA were as follows: contralateral group, 43.87 ± 5.59 mm; ipsilateral group, 44.64 ± 5.43 mm. The measurement results for the lower extremities after HA were as follows: contralateral group, 45.18 ± 7.82 mm; ipsilateral group, 45.16 ± 6.43 mm. The measurement results for the lower extremities after all arthroplasties were as follows: contralateral group, 44.50 ± 6.72 mm; ipsilateral group, 44.89 ± 5.90 mm. The results for the apex–shoulder distance were as follows: postoperative imaging, 19.44 ± 3.54 mm; intraoperative apex–shoulder distance, 27.28 ± 2.84 mm. Statistical analysis results indicated no statistically significant difference in the postoperative bilateral lower extremity length after hip arthroplasty (P = 0.75), while a statistically significant difference was found between the intraoperative and postoperative imaging measurements of the apex–shoulder distance (P < 0.01).ConclusionThe novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) for femoral neck fractures in hip arthroplasty is simple and accurate, making it effective for preventing postoperative bilateral leg length discrepancy.

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“…LLI is present in around 40-70 % of the healthy population and can reach over 20 mm -this is present in around 0.1 % of the population (Subotnick, 1981). LLI is associated with a number of health problems, such as hip osteoarthritis, loosening of the total hip prosthesis, low back pain, stress, bone fracture, and changes in walking and running economy (Chan, 2018;McWilliams et al, 2018;Applebaum et al, 2021;Alfuth et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Anthropometric Profile of Leg Length Inequality and its Impact on Gait

et al. 2022

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Leg length inequality (LLI) affects gait -primarily pelvic and torso movements. LLI is present in around 40-70 % of the healthy population. Due to LLI's significant impact on the body, as well as the possible occurrence of a variety of associated health problems, the aim of this research is to determine whether there is a significant difference in pelvic movement in all three planes, depending on the degree of LLI. This study was conducted on a sample of 30 healthy subjects. The functional length of lower limbs was measured. When LLI was calculated, kinematic measures were taken of pelvic and lower limb movements during gait using 3D cameras and ©Vicon Motion Systems Ltd. UK. The obtained data on kinematic pelvic movement in all three planes during gait were compared with the reference values. The results show that there is no statistically significant difference in pelvic movement about the axes x, y, and z in cases of LLI of up to 18mm (p>0,05). There is a statistically highly significant positive correlation between the difference in functional leg length (r=0,575; p=0,008) and femur length (r=0,525; p=0,015) on one hand, and the difference in pelvic movement about the axis x on the other, compared to the reference values. In a healthy population with LLI from 0 to 18 mm, gait remains unaffected and an increase in LLI predominantly affects pelvic movement about the horizontal axis (x) -pelvic tilt, which exponentially increases with an increase in femur length discrepancy.

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Revision surgery for leg length inequality after primary hip replacement

Abstract: Revision surgery for LLI, while it may not resolve all of the pain that the patient presents with, it is a successful treatment for patients who do not respond to conservative management of their LLI.

Cited by 11 publications

References 27 publications

The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

A novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) to prevent postoperative leg-length discrepancy for femoral neck fractures in hip arthroplasty

Anthropometric Profile of Leg Length Inequality and its Impact on Gait

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