summary THA Leg Length Discrepancy is a common finding following THA that may be transient due to weakness of the abductors or permanent due to intentional limb lengthening. Diagnosis can be made clinically with comparison of the measurement from the anterior superior iliac spine to the medial malleolus. Pelvic radiographs can also be used to determine and compare limb lengths. Treatment is generally observation as most cases resolve with relaxation of the abductor muscles over time. Shoe-lifts may be indicated if leg length discrepancy persists after 6 months. Epidemiology Associated conditins 2nd most common reason for litigation following total hip arthroplasty (following nerve injury) Etiology Mechanism 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 3 1 2 3 Previous Next (OBQ10.160) All of the following intra-operative techniques may result in lengthening of the operative leg during total hip arthroplasty EXCEPT: QID: 3248 Type & Select Correct Answer 1 Increasing the femoral neck offset 88% (2703/3080) 2 Increasing the femoral neck length 1% (32/3080) 3 Incomplete insertion of a cemented femoral stem 1% (39/3080) 4 Making a high femoral neck cut just below the femoral head 5% (155/3080) 5 Bone grafting superior to the acetabulum to seat the cup more inferior 4% (137/3080) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ06.141) The preoperative pelvic radiograph of a 63-year-old female with osteoarthritis is shown in Figure A. She undergoes an uncomplicated total hip replacement. Six weeks post-operatively she complains that her right leg is longer than her left, and an AP pelvic radiograph is obtained which is shown in Figure B. Physical exam shows normal post-operative range of motion and strength in both hips. What is the most likely etiology for this patients gait impairment? QID: 327 FIGURES: A B Type & Select Correct Answer 1 Hip flexion contracture 3% (72/2515) 2 Excessive medialization of the acetabular component 1% (37/2515) 3 Patient's perceived leg length discrepancy 87% (2200/2515) 4 Hip adduction contracture 6% (153/2515) 5 Malpositioning of the femoral component 2% (45/2515) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ05.109) All of the following interventions help restore anatomic limb length following total hip arthroplasty EXCEPT: QID: 995 Type & Select Correct Answer 1 Preoperative templating 3% (61/2370) 2 Use of an arthroplasty system incorporating variable neck lengths 4% (91/2370) 3 Intraoperative assessment of limb length 5% (124/2370) 4 Use of a modular arthroplasty system that allows variable femoral offset 84% (1999/2370) 5 Clinical and radiographic preoperative assessment for limb length discrepancy 4% (85/2370) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (3) Podcasts (1) Login to View Community Videos Login to View Community Videos 2019 Orthopaedic Summit Evolving Techniques Leg Length Discrepancy, How To Prevent, How To Manage - Michael Ast, MD Michael P. Ast Recon - THA Leg Length Discrepancy A 11/2/2020 163 views 4.5 (2) Bobby Menges Memorial HSS Limb Deformity Course 2020 Limb Length Equalization with and After THA - S. Robert Rozbruch, MD S. Robert Rozbruch Recon - THA Leg Length Discrepancy A 10/20/2020 677 views 5.0 (2) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques Evolving Technique Update: Achieving Leg Lengths By Using The Soft Tissue: 5 Tips, 5 Minutes - Darwin Chen, MD (OSET 2018) Darwin Chen Recon - THA Leg Length Discrepancy C 7/26/2019 406 views 3.0 (1) ReconâȘTHA Leg Length Discrepancy Orthobullets Team Recon - THA Leg Length Discrepancy Listen Now 6:39 min 5/13/2020 177 plays 5.0 (2)