The Assessment of Limb Length Discrepancy Before Total Hip Arthroplasty

Tipton, Shane; Sutherland, John K.; Schwarzkopf, Ran

doi:10.1016/j.arth.2015.10.026

Cited by 39 publications

(28 citation statements)

References 18 publications

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“…Acetabular offset was defined as the distance from the medial border of the teardrop to the centre of rotation of the acetabulum parallel to Hilgenreiner’s line. Cup height was defined as the distance from the centre of rotation of the acetabulum to a line drawn parallel with each ischial tuberosity, as this has been recently demonstrated to be more reliable than the inter-teardrop line [ 22 ]. All measurements were made using digital radiographs [Kodac© picture archiving and communication system (PACS) on a liquid crystal display] and the graphic measuring tools available.…”

Section: Methodsmentioning

confidence: 99%

Total hip replacement: increasing femoral offset improves functional outcome

Clement

Patrick-Patel

MacDonald

et al. 2016

Arch Orthop Trauma Surg

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IntroductionThe aim of this study was to assess the independent effect of radiographic measures of implant position, relative to pre-operative anatomical assessment, on the functional outcome of total hip arthroplasty according to change in the Oxford hip score (OHS) 1 year post surgery.MethodsA prospective cohort study was preformed to assess whether improvement in functional outcome (change in OHS at 1 year) and the relationship with femoral offset and length, and acetabular offset and height. After a power calculation 359 patients were recruited to the study and radiographic measures were performed by blinded observers. Regression analysis was used to assess the independent effect of the four radiographic measurements after adjusting for confounding variables.ResultsThere was a significant (p < 0.001) decrease in acetabular offset [5.3 mm, 95 % confidence interval (CI) 4.4–6.2] and increase in femoral offset (6.1 mm, 95 % CI 5.4–6.8). Hence there was no significant change in overall offset. Femoral offset was the only radiographic measure to be achieved statistical significance (r = 0.198, 95 % CI 0.063–0.333, p = 0.004) in relation to clinical outcome, with increasing offset being associated with a greater improvement in the OHS. On combining femoral and acetabular offset increasing offset was associated with a greater improvement in the OHS (r = 0.10, 95 % CI 0.01–0.19, p = 0.04).ConclusionThis study supports the long-held biomechanical theory of medialisation of the acetabular component with compensatory increased femoral offset results in improved functional outcome.

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Section: Methodsmentioning

confidence: 99%

Total hip replacement: increasing femoral offset improves functional outcome

Clement

Patrick-Patel

MacDonald

et al. 2016

Arch Orthop Trauma Surg

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“…One of the strengths of this study is the accuracy and generalizability of the leg-length measurements. The raters used a previously validated method for measuring LLD 14,23,25 and displayed almost perfect interrater reliability between surgeons. Additionally, because preoperative hip-to-ankle radiographs are the standard of care for all patients with open physes at this institution, all patients undergoing ACL reconstruction who completed follow-up were included, reducing potential selection biases in the cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Only EOS imaging (EOS) or anterior-posterior (AP) calibrated radiographs were used to assess leg length. Apparent leg length was measured from the top of the femoral head to the center of the tibial plafond, 14,23,25 and LLD was calculated as the difference between the 2 measured leg lengths for each patient (Figure 1). Three raters (P.D.F., C.G., D.W.G.)…”

Section: Methodsmentioning

confidence: 99%

Use Caution When Assessing Preoperative Leg-Length Discrepancy in Pediatric Patients With Anterior Cruciate Ligament Injuries

et al. 2020

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Background: Pre- and postoperative standing hip-to-ankle radiographs are critical for monitoring potential postoperative growth arrest and resultant deformities after pediatric anterior cruciate ligament (ACL) reconstruction. Purpose: To determine the prevalence of apparent preoperative leg-length discrepancies (LLDs) that resolve at the first postoperative radiographic examination in patients undergoing ACL reconstruction in order to understand what proportion of the noted preoperative deformities may have been inaccurate. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of prospectively collected preoperative and first postoperative full-length hip-to-ankle radiographs was performed in a cohort of skeletally immature patients who had an acute ACL injury and underwent subsequent surgical reconstruction. Leg length measurements for both the injured and the uninjured legs were obtained for comparison. Results: A total of 112 patients (mean age, 12.7 ± 1.7 years) were included (79 boys and 33 girls). Leg-length measurement interrater reliability among 3 raters for 25 randomly chosen images was nearly perfect (intraclass correlation coefficient, 0.996; 95% CI, 0.994-0.998). At baseline, there was no apparent preoperative LLD (<5 mm) in 48% (n = 54) of participants, while 37% (n = 41) displayed a small apparent LLD (5 to <10 mm), 12% (n = 13) displayed a moderate apparent LLD (10 to <15 mm), and 4% (n = 4) displayed a large apparent LLD (≥15 mm). Of the patients with an apparent preoperative LLD, 66% (n = 38) of them tore their ACL on the leg measuring shorter. At first postoperative radiographs, 48% (n = 28) of patients with an apparent preoperative LLD showed resolution to no LLD: 46% (n = 19) of patients with a small apparent preoperative LLD, 54% (n = 7) of patients with a moderate apparent LLD, and 50% (n = 2) of patients with a large apparent LLD. Conclusion: A high percentage of patients (48%) with apparent preoperative LLDs showed resolution to no LLDs by their first postoperative imaging, indicating that preoperative hip-to-ankle radiographs display some false LLDs in patients with recent ACL tears who are unable to fully extend their injured leg and bear weight.

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“…These complications greatly affect the surgery satisfaction and the living quality of patients. DR images can clearly show the situation of both legs, suppling important clinical information for surgeries [5]. As the critical step for arthroplasty, imaging measurement plays an important role for preoperative assessment, accurate intraoperative osteotomy and osteotomy angel determination and for postoperative quality evaluation [6].…”

Section: Discussionmentioning

confidence: 99%

The Application of Improved Position for Lower Limb full Length DR Radiograph in Hip/Knee Arthroplasty

Hui-ge¹

2018

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Aim Compared with the traditional position, we tried to explore the application of improved position for lower limb DR radiograph in hip and knee arthroplasty. Method Retrospective analysis of the traditional and improved DR radiographs from 60 cases for hip and knee arthroplasty, by comparing the division angle, lower limb mechanical axis length, mechanical deviation between the lower limb mechanical axis and the center of the tibial plateau. Results (1) Preoperative data from twenty cases of improved and 15 cases of traditional lower limb DR radiographs showed the mechanical deviations between the lower limb mechanical axis and the center of the tibial plateau were 28.18, 4.71, 30.66, 11.92; postoperative data from fifty cases of improved and 33 cases of traditional DR radiographs showed the mechanical deviations between the lower limb mechanical axis and the center of the tibial plateau were 5.04, 11.03 (P < 0.05). (2) Improved position much more clearly showed the full length of the lower limb, compared with traditional position. (3) Values preoperative correction angle of 31 cases of improved and 19 cases of traditional position were 5.9°, 6.7° (P < 0.05). Conclusion DR radiographs of improved position can realistically show the preand post-operative status of hip and knee. The data of correction angle, lower limb mechanical axis length, mechanical deviations between the lower limb mechanical axis and the center of the tibial plateau can be more accurate. It is more convenient for the selection of operation procedure and for the assessment of surgery and rehabilitation.

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The Assessment of Limb Length Discrepancy Before Total Hip Arthroplasty

Cited by 39 publications

References 18 publications

Total hip replacement: increasing femoral offset improves functional outcome

Total hip replacement: increasing femoral offset improves functional outcome

Use Caution When Assessing Preoperative Leg-Length Discrepancy in Pediatric Patients With Anterior Cruciate Ligament Injuries

The Application of Improved Position for Lower Limb full Length DR Radiograph in Hip/Knee Arthroplasty

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