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Archives of Orthopaedic and Trauma Surgery

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11.01.2023 | Hip Arthroplasty

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

verfasst von: Rohan A. Gheewala, Joseph R. Young, Benjamin Villacres Mori, Akshay Lakra, Matthew R. DiCaprio

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 8/2023

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Abstract

Leg-length discrepancy (LLD) presents a significant management challenge to orthopedic surgeons and remains a leading cause of patient dissatisfaction and litigation after total hip arthroplasty (THA). Over or under-lengthening of the operative extremity has been shown to have inferior outcomes, such as dislocation, exacerbation of back pain and sciatica, and general dissatisfaction postoperatively. The management of LLD in the setting of THA is multifactorial, and must be taken into consideration in the pre-operative, intra-operative, and post-operative settings. In our review, we aim to summarize the best available practices and techniques for minimizing LLD through each of these phases of care. Pre-operatively, we provide an overview of the appropriate radiographic studies to be obtained and their interpretation, as well as considerations to be made when templating. Intra-operatively, we discuss several techniques for the assessment of limb length in real time, and post-operatively, we discuss both operative and non-operative management of LLD. By providing a summary of the best available practices and strategies for mitigating the impact of a perceived LLD in the setting of THA, we hope to maximize the potential for an excellent surgical and clinical outcome.

Okafor L, Chen AF (2019) Patient satisfaction and total hip arthroplasty: a review. Arthroplasty 1:6. https://doi.org/10.1186/s42836-019-0007-3CrossRefPubMedPubMedCentral

Ranawat CS, Rodriguez JA (1997) Functional leg-length inequality following total hip arthroplasty. J Arthroplast 12:359–364. https://doi.org/10.1016/S0883-5403(97)90190-XCrossRef

Haleem AM, Wiley KF, Kuchinad R, Rozbruch SR (2017) Total hip arthroplasty in patients with multifactorial perceived limb length discrepancy. J Arthroplast 32:3044–3051. https://doi.org/10.1016/j.arth.2017.04.036CrossRef

Pritchett JW (2004) Nerve injury and limb lengthening after hip replacement: treatment by shortening. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200401000-00027CrossRefPubMed

Clark CR, Huddleston HD, Schoch EP, Thomas BJ (2006) Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg 14:38–45. https://doi.org/10.5435/00124635-200601000-00007CrossRefPubMed

Konyves A, Bannister GC (2005) The importance of leg length discrepancy after total hip arthroplasty. 87:155–157. https://doi.org/10.1302/0301-620X.87B2.14878

Upadhyay A, York S, Macaulay W et al (2007) Medical malpractice in hip and knee arthroplasty. J Arthroplast 22:2-7.e4. https://doi.org/10.1016/J.ARTH.2007.05.003CrossRef

Hofmann AA, Skrzynski MC (2000) Leg-length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! Orthopedics 23:943–944CrossRefPubMed

Adams CT, O’Leary RE, Gheewala RA, Roberts JT (2021) Evolving patient perception of limb length discrepancy following total hip arthroplasty. J Arthroplasty 36:S374–S379. https://doi.org/10.1016/J.ARTH.2021.02.080CrossRefPubMed

10.

Edeen J, Sharkey PF, Alexander AH (1995) Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop (Belle Mead NJ) 24:347–351PubMed

11.

Parvizi JM, Sharkey PFM, Bissett GAB et al (2003) Surgical Treatment of Limb-Length Discrepancy Following Tota... In: Journal of Bone and Joint Surgery. https://journals.lww.com/jbjsjournal/Fulltext/2003/12000/Surgical_Treatment_of_Limb_Length_Discrepancy.7.aspx. Accessed 30 Jan 2022

12.

Röder C, Vogel R, Burri L et al (2012) Total hip arthroplasty: leg length inequality impairs functional outcomes and patient satisfaction. BMC Musculoskelet Disord. https://doi.org/10.1186/1471-2474-13-95CrossRefPubMedPubMedCentral

13.

Sabharwal S, Kumar A (2008) Methods for assessing leg length discrepancy. Clin Orthop Relat Res 466:2910. https://doi.org/10.1007/S11999-008-0524-9CrossRefPubMedPubMedCentral

14.

Jones HW, Harrison T, Clifton R, et al (2010) The relationship between abduction contracture and leg length discrepancy following total hip replacement. Orthopaed Proc 92-B:389. https://doi.org/10.1302/0301-620X.92BSUPP\_III.0920389

15.

Austin MS, Hozack WJ, Sharkey PF, Rothman RH (2003) Stability and leg length equality in total hip arthroplasty. J Arthroplast 18:88–90. https://doi.org/10.1054/ARTH.2003.50073CrossRef

16.

Jasty M, Webster W, Harris W (1996) Management of limb length inequality during total hip replacement. Clin Orthop Relat Res 165–71

17.

Desai AS, Dramis A, Board TN (2013) Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med 6:336–341. https://doi.org/10.1007/S12178-013-9180-0/FIGURES/1CrossRefPubMedPubMedCentral

18.

Beattie P, Isaacson K, Riddle DL, Rothstein JM (1990) Validity of derived measurements of leg-length differences obtained by use of a tape measure. Phys Ther 70:150–157. https://doi.org/10.1093/PTJ/70.3.150CrossRefPubMed

19.

Terry MA, Winell JJ, Green DW et al (2005) Measurement variance in limb length discrepancy: clinical and radiographic assessment of interobserver and intraobserver variability. J Pediatr Orthop 25:197–201. https://doi.org/10.1097/01.BPO.0000148496.97556.9FCrossRefPubMed

20.

Scheerlinck T (2010) Primary hip arthroplasty templating on standard radiographs. A stepwise approach. Acta Orthop Belg 76:432–442PubMed

21.

Vigdorchik JM, Sharma AK, Jerabek SA et al (2021) Templating for total hip arthroplasty in the modern age. J Am Acad Orthop Surg 29:e208–e216. https://doi.org/10.5435/JAAOS-D-20-00693CrossRefPubMed

22.

della Valle AG, Padgett DE, Salvati EA, (2005) Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg 13:455–462. https://doi.org/10.5435/00124635-200511000-00005CrossRefPubMed

23.

Lazennec JY, Rousseau MA, Rangel A et al (2011) Pelvis and total hip arthroplasty acetabular component orientations in sitting and standing positions: Measurements reproductibility with EOS imaging system versus conventional radiographies. Orthop Traumatol Surg Res 97:373–380. https://doi.org/10.1016/J.OTSR.2011.02.006CrossRefPubMed

24.

Luthringer TA, Vigdorchik JM (2019) A Preoperative Workup of a “Hip-Spine” total hip arthroplasty patient: a simplified approach to a complex problem. J Arthroplast 34:S57–S70. https://doi.org/10.1016/J.ARTH.2019.01.012CrossRef

25.

Sheha ED, Steinhaus ME, Kim HJ, et al (2018) Leg-length discrepancy, functional scoliosis, and low back pain. JBJS Rev 6:e6. https://doi.org/10.2106/JBJS.RVW.17.00148

26.

Biant LC, Bruce WJM, Assini JB et al (2009) Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem. J Arthroplast 24:27–32. https://doi.org/10.1016/j.arth.2007.12.016CrossRef

27.

Noble PC, Kamaric E, Sugano N et al (2003) Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res. https://doi.org/10.3097/01.blo.0000096819.67494.32CrossRefPubMed

28.

Reikerås O, Haaland JE, Lereim P (2010) Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res 468:1949–1955. https://doi.org/10.1007/s11999-009-1218-7CrossRefPubMedPubMedCentral

29.

Bono J v (2004) Digital templating in total hip arthroplasty. J Bone Joint Surg Am 86-A Suppl 2:118–22. https://doi.org/10.2106/00004623-200412002-00016

30.

Petretta R, Strelzow J, Ohly NE et al (2015) Acetate templating on digital images is more accurate than computer-based templating for total hip arthroplasty. Clin Orthop Relat Res 473:3752–3759. https://doi.org/10.1007/S11999-015-4321-YCrossRefPubMedPubMedCentral

31.

Iorio R, Siegel J, Specht LM et al (2009) A comparison of acetate vs digital templating for preoperative planning of total hip arthroplasty: is digital templating accurate and safe? J Arthroplast 24:175–179. https://doi.org/10.1016/J.ARTH.2007.11.019CrossRef

32.

Gamble P, de Beer J, Petruccelli D, Winemaker M (2010) The accuracy of digital templating in uncemented total hip arthroplasty. J Arthroplast 25:529–532. https://doi.org/10.1016/J.ARTH.2009.04.011CrossRef

33.

Valle AG, della, Slullitel G, Piccaluga F, Salvati EA, (2005) The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplast 20:51–58. https://doi.org/10.1016/j.arth.2004.04.016CrossRef

34.

Meermans G, Malik A, Witt J, Haddad F (2011) Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty. Clin Orthop Relat Res 469:1677. https://doi.org/10.1007/S11999-010-1588-XCrossRefPubMed

35.

Hofmann AA, Bolognesi M, Lahav A, Kurtin S (2008) Minimizing leg-length inequality in total hip arthroplasty: use of preoperative templating and an intraoperative x-ray. Am J Orthop (Belle Mead NJ) 37:18–23PubMed

36.

Song J-H, Kim Y-S, Kwon S-Y et al (2021) Usefulness of intraoperative C-arm image intensifier in reducing errors of acetabular component during primary total hip arthroplasty: an application of Widmer’s method. BMC Musculoskelet Disord 22:892. https://doi.org/10.1186/s12891-021-04791-8CrossRefPubMedPubMedCentral

37.

Ezzet KA, McCauley JC (2014) Use of intraoperative X-rays to optimize component position and leg length during total hip arthroplasty. J Arthroplast 29:580–585. https://doi.org/10.1016/j.arth.2013.08.003CrossRef

38.

McGEE HMJFRCS, SCOTT JHSFRCS, (1983) A simple method of obtaining equal leg length in total hip arthroplasty. Clin Orthoped Relat Res 194:269–270

39.

Woolson ST, Harris WH (1985) A method of intraoperative limb length measurement in total hip arthroplasty. Clin Orthop Relat Res 207–10

40.

Bose WJ (2000) Accurate limb-length equalization during total hip arthroplasty. Orthopedics 23:433–436PubMed

41.

Ranawat CS, Rao RR, Rodriguez JA, Bhende HS (2001) Correction of limb-length inequality during total hip arthroplasty. J Arthroplast 16:715–720. https://doi.org/10.1054/ARTH.2001.24442CrossRef

42.

Loughenbury FA, McWilliams AB, Stewart TD et al (2019) Hip surgeons and leg length inequality after primary hip replacement. Hip Int 29:102–108. https://doi.org/10.1177/1120700018777858CrossRefPubMed

43.

Singh V, Realyvasquez J, Simcox T et al (2021) Robotics versus navigation versus conventional total hip arthroplasty: does the use of technology yield superior outcomes? J Arthroplast 36:2801–2807. https://doi.org/10.1016/J.ARTH.2021.02.074CrossRef

44.

Ogawa K, Kabata T, Maeda T et al (2014) Accurate leg length measurement in total hip arthroplasty: a comparison of computer navigation and a simple manual measurement device. Clin Orthop Surg 6:153. https://doi.org/10.4055/CIOS.2014.6.2.153CrossRefPubMedPubMedCentral

45.

Manzotti A, Cerveri P, de Momi E et al (2011) Does computer-assisted surgery benefit leg length restoration in total hip replacement? Navigation versus conventional freehand. Int Orthop 35:19–24. https://doi.org/10.1007/s00264-009-0903-1CrossRefPubMed

46.

Kamara E, Robinson J, Bas MA et al (2017) Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty: is acetabular positioning improved in the learning curve? J Arthroplasty 32:125–130. https://doi.org/10.1016/J.ARTH.2016.06.039CrossRefPubMed

47.

Redmond JM, Gupta A, Hammarstedt JE et al (2015) The learning curve associated with robotic-assisted total hip arthroplasty. J Arthroplast 30:50–54. https://doi.org/10.1016/J.ARTH.2014.08.003CrossRef

48.

Ellapparadja P, Mahajan V, Deakin AH, Deep K (2015) Reproduction of hip offset and leg length in navigated total hip arthroplasty: how accurate are we? J Arthroplast 30:1002–1007. https://doi.org/10.1016/J.ARTH.2015.01.027CrossRef

49.

Taha TA, Bejcek C (2020) Robotic arm-assisted total hip arthroplasty to correct leg length discrepancy in a patient with spinopelvic obliquity. Arthroplast Today 6:784–791. https://doi.org/10.1016/J.ARTD.2020.07.010/ATTACHMENT/81530B7D-AAE1-463E-92FD-44CC1FF62CA3/MMC1.PDFCrossRefPubMedPubMedCentral

50.

Keršič M, Dolinar D, Antolič V, Mavčič B (2014) The impact of leg length discrepancy on clinical outcome of total hip arthroplasty: comparison of four measurement methods. J Arthroplast 29:137–141. https://doi.org/10.1016/J.ARTH.2013.04.004CrossRef

Titel: Perioperative management of leg-length discrepancy in total hip arthroplasty: a review
verfasst von: Rohan A. Gheewala
Joseph R. Young
Benjamin Villacres Mori
Akshay Lakra
Matthew R. DiCaprio
Publikationsdatum: 11.01.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 8/2023
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04759-w

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

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