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Optimizing leg length correction in total hip arthroplasty

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Abstract

Purpose

Residual feeling of leg length discrepancy (LLD) is a common cause of patient dissatisfaction following total hip arthroplasty (THA). The purpose of this study is to propose a method for determining an optimal leg length correction goal in THA.

Methods

We conducted a retrospective study of 132 patients to examine the radiographic LLD (R-LLD), perceived LLD (P-LLD), and whether or not the patient has an uncomfortable feeling about the leg length after THA.

Results

The residual discomfort rate in all patients was 9.1% (12/132 patients), and ten of these 12 patients felt uncomfortable due to a longer leg length. When R-LLD was within 7 mm, the rate was 6.8% (8/118 patients), which is nearly equal to the rate of 7.8% (5/64 patients) in cases in which R-LLD was within 2 mm. On the other hand, when R-LLD was 8 mm or more, the rate was 57.1% (4/7 patients).

Conclusions

The results of our study show that 7 mm may be a reasonable threshold for reducing the residual discomfort. However, even with little or no R-LLD, some patients will continue to experience discomfort. We think that this is because of pre-operative differences between R-LLD and P-LLD in such cases. If the patient has a pelvic declination on the affected hip side and a lumbar scoliosis angle that is convex toward the affected hip side before surgery, the ideal length may be a little shorter than the radiographic isometry, since such patients are likely to feel a longer leg length than that shown radiographically.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan

    Kenji Fujita, Tamon Kabata, Yoshitomo Kajino & Hiroyuki Tsuchiya

  2. Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan

    Kenji Fujita

Authors
  1. Kenji Fujita
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  2. Tamon Kabata
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  3. Yoshitomo Kajino
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  4. Hiroyuki Tsuchiya
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Corresponding author

Correspondence to Tamon Kabata.

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The authors declare that they have no conflict of interest.

Ethical review committee statement

This investigational protocol was conducted with the approval of the Kanazawa University Graduate School of Medicine Ethics Committee. In accordance with the requirements of this review, all subjects provided informed consent.

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Fujita, K., Kabata, T., Kajino, Y. et al. Optimizing leg length correction in total hip arthroplasty. International Orthopaedics (SICOT) 44, 437–443 (2020). https://doi.org/10.1007/s00264-019-04411-0

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  • DOI: https://doi.org/10.1007/s00264-019-04411-0

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