Updated: 9/11/2018

THA Leg Length Discrepancy

Topic
Review Topic
0
0
Questions
2
0
0
Videos
1
https://upload.orthobullets.com/topic/12115/images/lld.jpg
 Introduction
  • Introduction
    • said to be most common reason for litigation following total hip arthroplasty
    • operative limb lengthening most common 
    • functional, but transient, limb-length differences are common
  • Etiology
    • contracture leads to pelvic obliquity
      • ABDuction contracture causes involved hemipelvis to be lower, creating apparent LONG leg
      • ADDuction contracture causes involved hemipelvis to be higher, creating apparent SHORT leg
    • weakness
      • weak abductors may provide the sensation of a long leg in the absence of true LLD 
      • usually resolve within 3-6 months post-operatively
    • prevention
      • pre-operative planning reduces incidence of post-operative discrepancies 
Presentation
  • Symptoms
    • patient may feel perceived LLD  despite anatomic equality
  • Physical exam
    • post-operative assessment of limb-length discrepancy
      • true limb length
        • measured from anterior superior iliac spine to medial malleolus
      • apparent limb length
        • determined by adding effect of soft-tissue contractures and pelvic obliquity  
        • difficult to truly measure
Imaging
  • Radiographs
    • recommended views
      • AP
    • findings
      • leg length discrepancy
      • increased neck length
      • increasing femoral offset will not increase limb length
Treatment
  • Nonoperative
    • shoe-lift
      • indications
        • shoe-lift adequate in most cases
        • wait 6 months until treatment to allow adequate relaxation of muscles
  • Operative
    • revisions THA - rare
      • indications
        • significant LLD that affect quality of life and has not resolved over 6 to 12 months.
        • concern for dislocation with revision surgery especially if attempting to shorten limb 
 

Please rate topic.

Average 3.9 of 8 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (2)

You have 100% on this question.
Just skip this one for now.

(OBQ10.160) All of the following intra-operative techniques may result in lengthening of the operative leg during total hip arthroplasty EXCEPT: Review Topic

QID: 3248
1

Increasing the femoral neck offset

88%

(1963/2221)

2

Increasing the femoral neck length

1%

(29/2221)

3

Incomplete insertion of a cemented femoral stem

1%

(24/2221)

4

Making a high femoral neck cut just below the femoral head

5%

(114/2221)

5

Bone grafting superior to the acetabulum to seat the cup more inferior

4%

(79/2221)

L 1

Select Answer to see Preferred Response

SUBMIT RESPONSE 1

You have 100% on this question.
Just skip this one for now.

(OBQ05.109) All of the following interventions help restore anatomic limb length following total hip arthroplasty EXCEPT: Review Topic

QID: 995
1

Preoperative templating

3%

(46/1816)

2

Use of an arthroplasty system incorporating variable neck lengths

3%

(59/1816)

3

Intraoperative assessment of limb length

5%

(90/1816)

4

Use of a modular arthroplasty system that allows variable femoral offset

86%

(1555/1816)

5

Clinical and radiographic preoperative assessment for limb length discrepancy

3%

(58/1816)

L 1

Select Answer to see Preferred Response

SUBMIT RESPONSE 4
VIDEOS & PODCASTS (1)
Topic COMMENTS (0)
Private Note