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
QUESTIONS 1 of 2 1 2 Previous Next (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 89% (1833/2071) 2 Increasing the femoral neck length 1% (28/2071) 3 Incomplete insertion of a cemented femoral stem 1% (23/2071) 4 Making a high femoral neck cut just below the femoral head 5% (102/2071) 5 Bone grafting superior to the acetabulum to seat the cup more inferior 4% (76/2071) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ05.109) All of the following interventions help restore anatomic limb length following total hip arthroplasty EXCEPT: Review Topic QID: 995 1 Preoperative templating 2% (43/1734) 2 Use of an arthroplasty system incorporating variable neck lengths 3% (54/1734) 3 Intraoperative assessment of limb length 5% (89/1734) 4 Use of a modular arthroplasty system that allows variable femoral offset 86% (1488/1734) 5 Clinical and radiographic preoperative assessment for limb length discrepancy 3% (52/1734) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 4