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 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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% (2998/3414) 2 Increasing the femoral neck length 1% (36/3414) 3 Incomplete insertion of a cemented femoral stem 1% (42/3414) 4 Making a high femoral neck cut just below the femoral head 5% (171/3414) 5 Bone grafting superior to the acetabulum to seat the cup more inferior 4% (150/3414) 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% (75/2739) 2 Excessive medialization of the acetabular component 2% (42/2739) 3 Patient's perceived leg length discrepancy 87% (2393/2739) 4 Hip adduction contracture 6% (166/2739) 5 Malpositioning of the femoral component 2% (55/2739) 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% (63/2477) 2 Use of an arthroplasty system incorporating variable neck lengths 4% (101/2477) 3 Intraoperative assessment of limb length 5% (126/2477) 4 Use of a modular arthroplasty system that allows variable femoral offset 84% (2090/2477) 5 Clinical and radiographic preoperative assessment for limb length discrepancy 3% (86/2477) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (6) Podcasts (1) Orthopaedic Summit Evolving Techniques 2021 Evolving Technique: Drapes Off, Leg Long, Now What - Darwin D. Chen, MD Darwin Chen Recon - THA Leg Length Discrepancy 1/31/2023 212 views 5.0 (1) Login to View Community Videos Login to View Community Videos 2021 ICJR 10th Annual Direct Anterior Approach Hip Course Digital Fluoroscopic Navigation for Limb Length Restoration During Anterior Total Hip Anthroplasty - Robert O'Leary, MD Recon - THA Leg Length Discrepancy 7/26/2022 26 views 0.0 (0) Login to View Community Videos Login to View Community Videos 2021 ICJR 10th Annual Direct Anterior Approach Hip Course Obtaining Correct Leg Length and Offset - Joel M. Matta, MD Recon - THA Leg Length Discrepancy 7/22/2022 194 views 4.7 (6) ReconâȘTHA Leg Length Discrepancy Orthobullets Team Recon - THA Leg Length Discrepancy Listen Now 6:39 min 5/13/2020 257 plays 5.0 (2) See More See Less