Updated: 9/11/2018

THA Leg Length Discrepancy

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
2 2
0
0
0%
0%
Videos
1 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 3.7 of 11 Ratings

Questions (2)

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

QID: 3248
1

Increasing the femoral neck offset

88%

(2389/2728)

2

Increasing the femoral neck length

1%

(30/2728)

3

Incomplete insertion of a cemented femoral stem

1%

(34/2728)

4

Making a high femoral neck cut just below the femoral head

5%

(146/2728)

5

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

4%

(115/2728)

L 1 C

Select Answer to see Preferred Response

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

QID: 995
1

Preoperative templating

3%

(58/2186)

2

Use of an arthroplasty system incorporating variable neck lengths

4%

(85/2186)

3

Intraoperative assessment of limb length

5%

(112/2186)

4

Use of a modular arthroplasty system that allows variable femoral offset

84%

(1846/2186)

5

Clinical and radiographic preoperative assessment for limb length discrepancy

3%

(76/2186)

L 1 D

Select Answer to see Preferred Response

VIDEOS (1)
Topic COMMENTS (1)
Private Note