Skip to main content
Log in

The effect of leg length discrepancy on clinical outcome after TKA and identification of possible risk factors

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study was investigated on the leg length discrepancy (LLD) after computer-assisted total knee arthroplasty (TKA), and its effects on the post-operative function and patient satisfaction. It is hypothesized that LLD after computer-assisted TKA would affect the clinical outcomes for knee scores.

Methods

A total of 148 cases were analysed retrospectively with a minimum of 2 years of follow-up. Eighty-one knees involved a <15-mm LLD, and 67 knees involved more than a 15-mm LLD. The radiographic outcomes, clinical outcomes, patients’ satisfaction, and perception of LLD were also evaluated.

Results

There was a significant difference in the Knee Society function score and the score for the difficulty with ascending the stairs in the Western Ontario and McMaster Universities score between the groups. There was a statistically significant difference between the two groups in the results of their perception questionnaires, but no difference in the results of their satisfaction questionnaires. The odds ratio for the risk of post-operative LLD increased with the increased pre-operative LLD and the unilateral TKA.

Conclusions

In conclusion, the functional outcomes of more than 15-mm post-operative LLD after computer-assisted TKA were lower than those of the <15-mm LLD. Thus, the reduced post-operative LLD should be considered to improve the functional outcomes of primary TKA. A careful treatment plan for degenerative arthritis should be considered and discussed with patients, especially in unilateral TKAs.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Baker PN, Khaw FM, Kirk LM, Esler CN, Gregg PJ (2007) A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis. J Bone Joint Surg Br 89:1608–1614

    Article  CAS  PubMed  Google Scholar 

  2. Bhave A, Mont M, Tennis S, Nickey M, Starr R, Etienne G (2005) Functional problems and treatment solutions after total hip and knee joint arthroplasty. J Bone Joint Surg Am 87(Suppl 2):9–21

    Article  PubMed  Google Scholar 

  3. Dou Y, Zhou Y, Tang Q, Yang D, Liu J (2013) Leg-length discrepancy after revision hip arthroplasty: are modular stems superior? J Arthroplast 28:676–679

    Article  Google Scholar 

  4. Edeen J, Sharkey PF, Alexander AH (1995) Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop (Belle Mead NJ) 24:347–351

    CAS  Google Scholar 

  5. Fujimaki H, Inaba Y, Kobayashi N, Tezuka T, Hirata Y, Saito T (2013) Leg length discrepancy and lower limb alignment after total hip arthroplasty in unilateral hip osteoarthritis patients. J Orthop Sci 18:969–976

    Article  PubMed  Google Scholar 

  6. Gurney B (2002) Leg length discrepancy. Gait Posture 15:195–206

    Article  PubMed  Google Scholar 

  7. Ha JK, Kim JG, Lee MC, Wang JH, Research Committee for Development of a Novel Knee Evaluation System of Korean Knee S (2012) What symptoms are more important for korean patients in knee osteoarthritis? Development and validation of the Korean knee score. Knee Surg Relat Res 24:151–157

    Article  PubMed  PubMed Central  Google Scholar 

  8. Harvey WF, Yang M, Cooke TD, Segal NA, Lane N, Lewis CE, Felson DT (2010) Association of leg-length inequality with knee osteoarthritis: a cohort study. Ann Intern Med 152:287–295

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hernandez-Vaquero D, Suarez-Vazquez A, Sandoval-Garcia MA, Noriega-Fernandez A (2010) Computer assistance increases precision of component placement in total knee arthroplasty with articular deformity. Clin Orthop Relat Res 468:1237–1241

    Article  PubMed  Google Scholar 

  10. Huang TW, Hsu WH, Peng KT, Hsu RW, Weng YJ, Shen WJ (2011) Total knee arthroplasty with use of computer-assisted navigation compared with conventional guiding systems in the same patient: radiographic results in Asian patients. J Bone Joint Surg Am 93:1197–1202

    Article  PubMed  Google Scholar 

  11. Hungerford DS, Hungerford MW (2005) Alignment of the normal knee; relationship to total knee replacement. In: Bellemans J, Ries M, Victor JK (eds) Total knee arthroplasty. Springer, Berlin Heidelberg, pp 25–31

    Chapter  Google Scholar 

  12. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case–control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplast 20:832–839

    Article  Google Scholar 

  13. Kim SH, Lee HJ, Jung HJ, Lee JS, Kim KS (2013) Less femoral lift-off and better femoral alignment in TKA using computer-assisted surgery. Knee Surg Sports Traumatol Arthrosc 21:2255–2262

    Article  PubMed  Google Scholar 

  14. Kim YH, Yoon SH, Kim JS (2007) The long-term results of simultaneous fixed-bearing and mobile-bearing total knee replacements performed in the same patient. J Bone Joint Surg Br 89:1317–1323

    Article  PubMed  Google Scholar 

  15. Konyves A, Bannister GC (2005) The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br 87:155–157

    Article  CAS  PubMed  Google Scholar 

  16. Lang JE, Scott RD, Lonner JH, Bono JV, Hunter DJ, Li L (2012) Magnitude of limb lengthening after primary total knee arthroplasty. J Arthroplast 27:341–346

    Article  Google Scholar 

  17. Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 19:2027–2032

    Article  PubMed  Google Scholar 

  18. Maloney WJ, Keeney JA (2004) Leg length discrepancy after total hip arthroplasty. J Arthroplast 19:108–110

    Article  Google Scholar 

  19. McWilliams AB, Grainger AJ, O’Connor PJ, Redmond AC, Stewart TD, Stone MH (2013) A review of symptomatic leg length inequality following total hip arthroplasty. Hip Int 23:6–14

    Article  PubMed  Google Scholar 

  20. Moskal JT, Capps SG, Mann JW, Scanelli JA (2014) Navigated versus conventional total knee arthroplasty. J Knee Surg 27:235–248

    Article  PubMed  Google Scholar 

  21. Mufty S, Vandenneucker H, Bellemans J (2014) The influence of leg length difference on clinical outcome after revision TKA. Knee 21:424–427

    Article  CAS  PubMed  Google Scholar 

  22. Mullaji A, Kanna R, Marawar S, Kohli A, Sharma A (2007) Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplast 22:953–959

    Article  Google Scholar 

  23. Reid DC, Smith B (1984) Leg length inequality: a review of etiology and management. Physiother Can 36:177–182

    Google Scholar 

  24. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85:830–835

    CAS  PubMed  Google Scholar 

  25. Swaminathan V, Cartwright-Terry M, Moorehead JD, Bowey A, Scott SJ (2014) The effect of leg length discrepancy upon load distribution in the static phase (standing). Gait Posture 40:561–563

    Article  CAS  PubMed  Google Scholar 

  26. Ulrich SD, Bhave A, Marker DR, Seyler TM, Mont MA (2007) Focused rehabilitation treatment of poorly functioning total knee arthroplasties. Clin Orthop Relat Res 464:138–145

    PubMed  Google Scholar 

  27. Vaidya SV, Patel MR, Panghate AN, Rathod PA (2010) Total knee arthroplasty: limb length discrepancy and functional outcome. Indian J Orthop 44:300–307

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Han-Jun Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, S.H., Rhee, SM., Lim, JW. et al. The effect of leg length discrepancy on clinical outcome after TKA and identification of possible risk factors. Knee Surg Sports Traumatol Arthrosc 24, 2678–2685 (2016). https://doi.org/10.1007/s00167-015-3866-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3866-3

Keywords

Navigation