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Hip-Sparing Equalization Procedures for Leg-Length Discrepancy After Total Hip Arthroplasty: A Retrospective Case Series

  • Original Article
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HSS Journal ®

Abstract

Background

Leg-length discrepancy (LLD) after primary THA is not uncommon. Little is known, however, about the role of hip-sparing procedures for equalization of LLD after THA.

Questions/Purposes

The aim of this study is to report our experiences with these techniques in patients presenting at one institution over a 10-year period.

Methods

We retrospectively reviewed records at one institution to find patients who had sought surgical treatment for LLD after THA between January 2007 and August 2017. Patients who had LLD related to conditions other than the THA, such as bone loss or traumatic defects, were excluded. We recorded the time after THA, laterality, and LLD. Assessment of LLD was performed using clinical and radiographic examinations. Patient demographics and true LLD were recorded, as were prior conservative treatment, equalization procedure performed, final leg length after equalization surgery, time to healing, and complications.

Results

After exclusion of patients with LLD related to other causes, eight patients in whom conservative treatment had failed and who had undergone hip-sparing leg-length equalization surgery were included in the study. The average age was 44.6 years (range, 18 to 66 years). Seven of the patients were female. The pre-operative mean LLD was 3.1 cm (range 1.5 to 7 cm). In those who were long after THA, ipsilateral (THA-side) shortening of femur with a retrograde intramedullary nail (IMN; n = 1) or with a plate (n = 1) was performed. In those who were short after THA, ipsilateral femur lengthening with retrograde Precice nails (n = 2), ipsilateral tibial lengthening with Precice nails (n = 2), or contralateral femur shortening with a retrograde IMN (n = 2) was performed. The average time to full consolidation or union was 6.6 months (range, 2 to 19 months). Two patients had delayed union. All patients but one were satisfied with final results.

Conclusion

We believe that hip-sparing equalization procedures can be part of the treatment algorithm of LLD after THA. These advancements in the field are promising and might expand the indications of lengthening and equalization procedures to include LLD after THA.

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Author information

Authors and Affiliations

  1. Foothills Medical Group, Upper Allegheny Health System, 195 Pleasant St., Bradford, PA, USA

    Asim M. Makhdom MD, MSc, FRCSC

  2. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Austin T. Fragomen MD & S. Robert Rozbruch MD

  3. Weill Cornell Medicine, Cornell University, New York, NY, 10065, USA

    Austin T. Fragomen MD & S. Robert Rozbruch MD

Authors
  1. Asim M. Makhdom MD, MSc, FRCSC
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  2. Austin T. Fragomen MD
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  3. S. Robert Rozbruch MD
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Corresponding author

Correspondence to Asim M. Makhdom MD, MSc, FRCSC.

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Conflict of Interest

Asim M. Makhdom, MD, MSc, FRCSC, declares that he has no conflicts of interest. Austin T. Fragomen, MD, reports receiving consulting fees from Synthesis, NuVasive Specialized Orthopedics, and Smith and Nephew. S. Robert Rozbruch, MD, reports receiving royalties from NuVasive Specialized Orthopedics and Stryker and consulting fees from Smith and Nephew.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study.

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Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Level IV: Retrospective Case Series

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Makhdom, A.M., Fragomen, A.T. & Rozbruch, S.R. Hip-Sparing Equalization Procedures for Leg-Length Discrepancy After Total Hip Arthroplasty: A Retrospective Case Series. HSS Jrnl 16 (Suppl 2), 400–407 (2020). https://doi.org/10.1007/s11420-020-09770-8

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  • DOI: https://doi.org/10.1007/s11420-020-09770-8

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