Clinical Orthopaedics and Related Research®

, Volume 469, Issue 6, pp 1677–1682 | Cite as

Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty

  • Geert MeermansEmail author
  • Ahmad Malik
  • Johan Witt
  • Fares Haddad
Clinical Research



Pelvic radiographs are helpful in assessing limb-length discrepancy (LLD) before and after THA but are subject to variation. Different methods are used to determine LLDs. As a pelvic reference, both ischial tuberosities and the teardrops are used, and as a femoral reference, the lesser trochanter and center of the femoral head are used.


We validated the different methods for preoperative radiographic measurement of LLDs and evaluated their reliability.

Patients and Methods

LLDs were measured on full-leg radiographs for 52 patients (29 men, 23 women) with osteoarthritis (OA) of the hip and compared with different methods for measuring LLDs on AP radiographs of the pelvis.


The true LLD varied from −8.0 to 9.1 mm. When the biischial line was used as a pelvic reference, the LLD measured on AP pelvis radiographs was different from the true LLD. No difference was found when the interteardrop line was used as a pelvic reference. There was substantial interobserver agreement when the lesser trochanter was used as a femoral reference (kappa = 0.66–0.70) and excellent interobserver and intraobserver agreement for all other measurements (kappa = 0.84–0.93).


Our data show use of the biischial line as a pelvic reference should be discouraged and the interteardrop line is a better alternative. The center of the femoral head is a more reliable femoral landmark compared with the lesser trochanter.

Level of Evidence

Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.


Femoral Head Limb Length Ischial Tuberosity Pelvic Radiograph Femoral Reference 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Geert Meermans
    • 1
    • 2
    Email author
  • Ahmad Malik
    • 1
  • Johan Witt
    • 1
  • Fares Haddad
    • 1
  1. 1.Department of OrthopaedicsUniversity College London HospitalLondonUK
  2. 2.BerchemBelgium

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