Abstract
Purpose
Although spinal pathology or fusion can change patients’ posture and pelvic orientation, their correlation with perception of limb length discrepancy (LLD) after total hip arthroplasty (THA) is not well understood. We hypothesised that LLD perception after THA would not correlate with a history of spinal pathology, fusion or sagittal lumbar spine stiffness among patients who underwent THA.
Methods
Four hundred consecutive patients who underwent THA and had a complete set of anteroposterior and lateral EOS® imaging in standing and sitting positions were included in this retrospective case–control study. All patients underwent THA between 2011 and 2020. Sagittal lumbar spine stiffness was measured by changes in lumbar lordosis and sacral slope from the standing to the sitting position (lumbar spine stiffness: standing sacral slope-sitting sacral slope < 10°). Anatomical and functional lower extremity length, change in the centre of hip rotation, coronal and sagittal knee alignment, and hindfoot height were measured. Multiple logistic regression was used to investigate the correlation between patient perceptions of LLD, and the variables found to be significant in the univariate analysis.
Results
There was a substantial difference between the patients with and without LLD perceptions regarding axial pelvic rotation (p = 0.001), knee flexum-recurvatum (p = 0.007) and hindfoot height (p = 0.004). There was no significant difference between patients with and without LLD perceptions regarding differences in femoral length (p = 0.06), history of spine pathology or fusion (p = 0.128) and lumbar spine stiffness (p = 0.955).
Conclusions
Our study found no significant correlation between perceptions of LLD after THA and spinal fusion or lumbar spine stiffness. Changes in the position of the centre of hip rotation can affect the functional leg length. Surgeons should consult patients regarding other factors, such as knee alignment or hind-/midfoot pathologies, as well as compensatory mechanisms, such as axial pelvic rotation, that could affect perceptions of LLD.
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References
Sculco PK, Sculco TP (2017) Complications after primary total hip arthroplasty, a comprehensive clinical guide. 89–96. https://doi.org/10.1007/978-3-319-54913-2_9
Thakral R, Johnson AJ, Specht SC et al (2014) Limb-length discrepancy after total hip arthroplasty: novel treatment and proposed algorithm for care. Orthop 37:101–106. https://doi.org/10.3928/01477447-20140124-06
Frueh WW, Hozack WJ (2005) Management of limb length discrepancy after total hip arthroplasty. Semin Arthroplast 16:127–131. https://doi.org/10.1053/j.sart.2005.06.005
Parvizi J, Sharkey PF, Bissett GA et al (2003) Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Jt Surg-Am 85:2310–2317. https://doi.org/10.2106/00004623-200312000-00007
Edeen J, Sharkey PF, Alexander AH (1995) Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop Belle Mead N J 24:347–351
Lazennec JY, Brusson A, Rousseau MA et al (2016) Do patients’ perceptions of leg length correlate with standing 2- and 3-dimensional radiographic imaging? J Arthroplast 31:2308–2313. https://doi.org/10.1016/j.arth.2016.03.065
Lazennec JY, Folinais D, Florequin C, Pour AE (2018) Does patients’ perception of leg length after total hip arthroplasty correlate with anatomical leg length? J Arthroplast 33:1562–1566. https://doi.org/10.1016/j.arth.2017.12.004
Halai M, Gupta S, Gilmour A et al (2015) The Exeter technique can lead to a lower incidence of leg-length discrepancy after total hip arthroplasty. Bone Jt J. 97-B(2):154–159. https://doi.org/10.1302/0301-620x.97b2.34530
Nakanowatari T, Suzukamo Y, Suga T et al (2013) True or apparent leg length discrepancy. J Geriatr Phys Ther 36:169–174. https://doi.org/10.1519/jpt.0b013e318282d2f1
Wylde V, Whitehouse SL, Taylor AH et al (2009) Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop 33:905–909. https://doi.org/10.1007/s00264-008-0563-6
White TO, Dougall TW (2002) Arthroplasty of the hip. Bone Joint J. 84-B(3):335–338. https://doi.org/10.1302/0301-620x.84b3.12460
Huec JCL, Thompson W, Mohsinaly Y et al (2019) Sagittal balance of the spine. Eur Spine J 28:1889–1905. https://doi.org/10.1007/s00586-019-06083-1
Bao H, Yan P, Qiu Y et al (2015) Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy. Bone Jt J 98-B(9):1227–33. https://doi.org/10.1302/0301-620x.98b9.37273
Zhang Z, Liu T, Wang Y et al (2022) Factors related to preoperative coronal malalignment in degenerative lumbar scoliosis: an analysis on coronal parameters. Orthop Surg 14:1846–1852. https://doi.org/10.1111/os.13379
Schwab F, Lafage V, Patel A, Farcy J-P (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833. https://doi.org/10.1097/brs.0b013e3181a13c08
Vigdorchik JM, Sharma AK, Buckland AJ et al (2021) 2021 Otto Aufranc Award: A simple Hip-Spine Classification for total hip arthroplasty: validation and a large multicentre series. Bone Jt J 103-B(7 Suppl B):17–24. https://doi.org/10.1302/0301-620x.103b7.bjj-2020-2448.r2
Schwab F, Patel A, Ungar B et al (2010) Adult spinal deformity—postoperative standing imbalance. Spine 35:2224–2231. https://doi.org/10.1097/brs.0b013e3181ee6bd4
Ailon T, Smith JS, Shaffrey CI et al (2015) Degenerative spinal deformity. Neurosurg 77:S75–S91. https://doi.org/10.1227/neu.0000000000000938
Pheasant MS, Coulter JL, Wallace C et al (2021) Lumbar spine fusion and symptoms of leg length discrepancy after hip arthroplasty. J Arthroplast 36:3241-3247.e1. https://doi.org/10.1016/j.arth.2021.05.006
Huec JCL, Tsoupras A, Leglise A et al (2019) The sacro-iliac joint: a potentially painful enigma. Update on the diagnosis and treatment of pain from micro-trauma. Orthop Traumatol Surg Res 105:S31–S42. https://doi.org/10.1016/j.otsr.2018.05.019
Huec JCL, Hasegawa K (2016) Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J 25:3630–3637. https://doi.org/10.1007/s00586-016-4485-5
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JYL was involved in conceptual design, data collection and image analysis, data analysis and manuscript preparation. AEP was involved in conceptual design, data analysis and manuscript preparation.
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Level of evidence: IV, diagnostic case-control study.
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Lazennec, J.Y., Pour, A.E. Patient perception of leg length after total hip arthroplasty does not correlate with sagittal lumbar spine stiffness, history of spinal pathology or fusion. International Orthopaedics (SICOT) 47, 2041–2053 (2023). https://doi.org/10.1007/s00264-023-05810-0
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DOI: https://doi.org/10.1007/s00264-023-05810-0