Management of limb-length discrepancy after THA



There are several strategies to address the common complication of limb-length discrepancy (LLD) after total hip arthroplasty (THA). From allowing ample time for soft tissues to elongate, to shoe lifts and surgical revision, there are tools available to help surgeons alleviate a patient's symptoms. Perhaps most importantly is clear communication with patients about potential complications and ensuring understanding that there are some cases of LLD that are not correctable. 

 


As discussed in Part I of this article series, leg-length discrepancy (LLD) is a common complication in total hip arthroplasty (THA), with incident reports ranging greatly (between 1 and 50 percent) [1, 2]. Despite patient education about the possibility of LLD after THA, it has been shown that the THA patient is more likely to remember the potential benefits of the procedure over the potential complications [3]. This incongruity may help explain why it is the number one reason for litigation against the US orthopedic community [4, 5]. It is generally accepted that a LLD of less than 10 mm is well tolerated by patients and therefore is a reasonable target for facilitating good functional outcomes [6].

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  • Structural versus functional
  • Presentation
  • Nonoperative treatment suggestions
  • Operative treatment indications and suggestions
  • Conclusion
  • References
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Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Biju Benjamin MD

University College
London Hospital
London, United Kingdom

Babar Kayani MD

University College
London Hospital
London, United Kingdom

Jurek Pietrzak MD

University College
London Hospital
London, United Kingdom

This issue was created by Word+Vision Media Productions, Switzerland

 

References

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  2. Jasty M, Webster W, Harris W. Management of limb length inequality during total hip replacement. Clin Orthop Relat Res. 1996 Dec;(333):165–171.
  3. Hutson MM, Blaha JD. Patients' recall of preoperative instruction for informed consent for an operation. J Bone Joint Surg Am. 1991 Feb;73(2):160–162.
  4. Desai AS, Dramis A, Board TN. Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med. 2013 Dec; 6(4): 336–341.
  5. Hofmann AA, Skrzynski MC. Leg-length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! Orthopedics. 2000; Sep;23(9):943–944.
  6. O'Brien S, Kernohan G, Fitzpatrick C, et al. Perception of imposed leg length inequality in normal subjects. Hip Int. 2010 Oct-Dec;20(4):505–511.
  7. Edeen J, Sharkey PF, Alexander AH. Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop (Belle Mead NJ). 1995 Apr;24(4):347–351.
  8. Wylde V, Whitehouse SL, Taylor AH, et al. Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop. 2009 Aug;33(4):905–909.
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  10. Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry. Chiropr Osteopat. 2005; 13(12). Published online 2005 Jul 20. doi:  10.1186/1746-1340-13-12.
  11. OrthoBullets. THA Leg Length Discrepancy. Available at: http://www.orthobullets.com/recon/12115/tha-leg-length-discrepancy?expandLeftMenu=true. Accessed June 18, 2018.
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  21. Bhave A, Marker DR, Seyler TM, et al. Functional problems and treatment solutions after total hip arthroplasty. J Arthroplasty. 2007 Sep;22(6 Suppl 2):116–124.
  22. Clark CR, Huddleston HD, Schoch EP, et al. Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg. 2006 Jan;14(1):38–45.
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  24. Huddleston JI, Wang Y, Uquillas C, et al. Age and obesity are risk factors for adverse events after total hip arthroplasty. Clin Orthop Relat Res. 2012 Feb;470(2):490–496.
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