The Effect of Limb-Length Discrepancy on Gait*

Song, Kit M.; Halliday, Suzanne E.; Little, David

doi:10.2106/00004623-199711000-00011

Cited by 165 publications

(108 citation statements)

References 15 publications

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“…Third, the LLRS AIM Index does not differentiate between acquired and congenital deformities, although it can be used to evaluate both. Surgical correction for congenital deformities often is more difficult than for acquired deformities, with a higher complication rate [15,22]. Fourth, development of the score was performed primarily through consensus and expert opinion.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate assessment of the complexity of a limb deformity is essential for successful treatment [4,7,15,20,22,23]. During the past two decades, several classification systems have been established and disseminated for assessing and categorizing specific joints, limb segments, and disease states (Table 1) [1-3, 5, 6, 8, 10-14, 17-19, 24, 25].…”

Section: Introductionmentioning

confidence: 99%

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Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

McCarthy

Iobst

Rozbruch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains.Questions/Purposes We addressed two questions: (1) Does the LLRS AIM Index show construct validity by correlating with rankings of case complexity? (2) Does the LLRS AIM Index show sufficient interrater and intrarater reliabilities? Methods We had eight surgeons evaluate 10 fictionalized patients with various lower limb deformities. First, they ranked the cases from simplest to most complex, and then they rated the cases using the LLRS AIM Index. Two or more weeks later, they rated the cases again. We assessed reliability using the Kendall's W test. Results Raters were consistent in their rankings of case complexity (W = 0.33). Patient rankings also correlated with both sets of LLRS AIM ratings (r 2 = 0.25; r 2 = 0.23). The LLRS AIM Index showed interrater reliability with an intraclass correlation (ICC) of 0.97 for Trial 1 and 0.98 for Trial 2 and intrarater reliability with an ICC of 0.94. The LLRS AIM Index ratings also were highly consistent between the attending surgeons and surgeons-in-training (ICC = 0.91). Conclusions Our preliminarily observations suggest that the LLRS AIM Index reliably classifies the complexity of lower limb deformities in and between observers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

McCarthy

Iobst

Rozbruch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…The incidence of nerve palsy in the literature following total hip arthroplasty in DDH is 5-17% [2][3][4][5][6][7]. In order to avoid excessive nerve stretching, shortening of the proximal femoral metaphysis has been recommended [6][7][8] and sometimes combined with a trochanteric transfer.…”

Section: Discussionmentioning

confidence: 99%

“…In order to avoid excessive nerve stretching, shortening of the proximal femoral metaphysis has been recommended [6][7][8] and sometimes combined with a trochanteric transfer. However, this shortening and the subsequent leg length discrepancy may jeopardize the longevity of the prosthesis [6,7,9,10] and can adversely affect an otherwise excellent outcome of the THR [7,[11][12][13].…”

Section: Discussionmentioning

confidence: 99%

External fixator-assisted acute shortening with internal fixation for leg length discrepancy after total hip replacement

Kasis¹,

Stockley²,

Saleh³

2008

Strategies in Trauma and Limb Reconstruction

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We report a case of a 51-year-old lady, who underwent a femoral shortening using a fixator assisted blade plate after total hip replacement. The patient had a total hip replacement on the other side with previous revisions, which resulted in a leg length discrepancy. We used the above technique to control the shortening and preserve the mechanical and anatomical axis of the femur.Keywords External fixator Á Femoral shortening Á Total hip replacement Case reportA 35-year-old lady with a history of neglected developmental dysplasia (DDH) of the right hip presented with increasing hip pain, back pain and progressive knee deformity. She subsequently underwent conversion of the pseudoarthrosis to a total hip replacement. At the time of surgery, despite adductor tenotomy, it was difficult to relocate the trial prosthesis and a resection of the proximal femur was necessary. A straight stem prosthesis was cemented in the femur (Fig. 1).Ten years later the patient required a revision of the acetabular component as a consequence of aseptic loosening. The acetabular reconstruction was undertaken using a cemented socket and with impacted bone graft. The reconstruction lasted for 9 more years before a further revision was required. There was extensive bone loss in the acetabulum and the reconstruction was performed using a Burch Schneider support ring, mesh and again with impaction bone graft. The bone stock in the proximal femur was so poor that a proximal femoral allograft with an uncemented stem was used to reconstruct the proximal femur. A leg length discrepancy of 5 cm remained.Increasingly symptomatic osteoarthritis in the left hip necessitated a left primary arthroplasty to be performed 3 years later. Six months after the left THR (age 51), she presented with increasing back pain attributed to a 5-cm discrepancy in leg length (Fig. 2). Shortening of the left femur was done by performing an external fixator-assisted shortening through a supracondylar resection and internal stabilisation with a blade plate. Operative techniqueA limb reconstruction system (LRS) external fixator (Orthofix SRL, Italy) with four screws (150/50) was inserted in the sagittal plane under X-ray control perpendicular to the anatomical axis of the femur. Two screws were inserted above and two below the proposed level of femoral resection (Fig. 3). Through a lateral incision and subperiosteal approach a 4-cm segment of the distal femur was removed. The femur was then gradually shortened using the compression-distraction device on the fixator until bone contact at the edges of the osteotomy was achieved. With the fixator still in place, the newly shortened femur

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“…Although each patient should be considered individually, length differences over 2-2.5 cm are usually symptomatic and can lead to an unacceptable limp or backache [2,4,8,15,16]. A shortening procedure of the opposite side is an obvious choice for a straightforward leg length-difference of modest (2.5-5 cm) severity [8,15,17].…”

Section: Introductionmentioning

confidence: 99%

Lengthening osteotomy at the intertrochanteric level with simultaneous correction of angular deformities

Marti

Holder

Kloen

2001

International Orthopaedics (SICOT)

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Fixed multiplane deformities around the hip representing a combination of rotational, angular, and leg-length discrepancies are disabling for the patient and pose a challenge for the orthopaedic surgeon. We describe a joint-preserving, one-stage procedure to address these complex problems using an intertrochanteric osteotomy with a step-cut to allow for corrective lengthening, angulation, and rotation. We present our results in nine patients. The aim of this paper is to provide the orthopaedic surgeon with a detailed approach to treating these deformities with reproducible results.Résumé Les déformations fixées fixées au niveau de la hanche, interessant plusieurs plans avec une composante de modification de longueur sont invalidantes pour le patient et posent de difficiles problèmes au chirurgien. Nous décrivons une technique d'ostéotomie intertrochantérienne en un temps avec correction des angulations, des rotations et des différences de longueur. Nous présentons nos résultats chez neuf patients. Le but de cette présentation est de fournir une approche détaillée au chirurgien orthopédiste pour traiter ces déformations avec des résultats reproductibles.

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The Effect of Limb-Length Discrepancy on Gait*

Cited by 165 publications

References 15 publications

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

External fixator-assisted acute shortening with internal fixation for leg length discrepancy after total hip replacement

Lengthening osteotomy at the intertrochanteric level with simultaneous correction of angular deformities

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