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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Questions/purposes

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.

Results

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).

Conclusions

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.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, University College London Hospital, London, UK

    Geert Meermans MD, Ahmad Malik MRCS, Johan Witt FRCS & Fares Haddad FRCS

  2. Marie-Josélaan 19, 2600, Berchem, Belgium

    Geert Meermans MD

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  1. Geert Meermans MD
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  2. Ahmad Malik MRCS
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Correspondence to Geert Meermans MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Meermans, G., Malik, A., Witt, J. et al. Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty. Clin Orthop Relat Res 469, 1677–1682 (2011). https://doi.org/10.1007/s11999-010-1588-x

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