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Int Orthop. 2020 Mar;44(3):437-443. doi: 10.1007/s00264-019-04411-0. Epub 2019 Oct 9.

Optimizing leg length correction in total hip arthroplasty.

Author information

1
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
2
Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan.
3
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan. tamonkabata@yahoo.co.jp.

Abstract

PURPOSE:

Residual feeling of leg length discrepancy (LLD) is a common cause of patient dissatisfaction following total hip arthroplasty (THA). The purpose of this study is to propose a method for determining an optimal leg length correction goal in THA.

METHODS:

We conducted a retrospective study of 132 patients to examine the radiographic LLD (R-LLD), perceived LLD (P-LLD), and whether or not the patient has an uncomfortable feeling about the leg length after THA.

RESULTS:

The residual discomfort rate in all patients was 9.1% (12/132 patients), and ten of these 12 patients felt uncomfortable due to a longer leg length. When R-LLD was within 7 mm, the rate was 6.8% (8/118 patients), which is nearly equal to the rate of 7.8% (5/64 patients) in cases in which R-LLD was within 2 mm. On the other hand, when R-LLD was 8 mm or more, the rate was 57.1% (4/7 patients).

CONCLUSIONS:

The results of our study show that 7 mm may be a reasonable threshold for reducing the residual discomfort. However, even with little or no R-LLD, some patients will continue to experience discomfort. We think that this is because of pre-operative differences between R-LLD and P-LLD in such cases. If the patient has a pelvic declination on the affected hip side and a lumbar scoliosis angle that is convex toward the affected hip side before surgery, the ideal length may be a little shorter than the radiographic isometry, since such patients are likely to feel a longer leg length than that shown radiographically.

KEYWORDS:

Perceived leg length discrepancy; Radiographic leg length discrepancy; Total hip arthroplasty

PMID:
31595310
DOI:
10.1007/s00264-019-04411-0

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