A Simple Method to Minimize Limb Length Discrepancy and Restore Offset in Total Hip Arthroplasty
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Published:
Oct 17, 2023
Keywords:
Lower limb length discrepancy, total hip arthroplasty, hip gauge
Main Article Content
Abstract
Introduction: There are more than 20 different techniques to correct lower limb length discrepancy. The method evaluated in this study is based on a fixed pin in the iliac wing connected to a mobile gauge and another pin in the greater trochanter with which the reference is marked. The objective is to evaluate the reliability of this measurement device used during THA to restore lower limb length and femoral offset.
Materials and Methods: Two groups were formed: Group A (patients who did not use the device)and Group B (patients who did use the device). Measurements were taken in the pre-surgery panoramic pelvic radiograph with the patient standing and three months later.
Results: A sample of 80 patients was obtained, with 40 in each group. The difference in limb length could be corrected in each group, however the average correction achieved by both groups did not result in a statistically significant difference (p=0.07). However, when the variance in the correction of the difference in length of each group was examined, a statistically significant difference (p<0.001) was obtained.
Conclusions: We can conclude that while this device, which serves as a more objective quantifiable measurement technique, does not guarantee a correction of the exact length discrepancy to 0 mm, it does allow us to work within a more dependable and safe range.
Materials and Methods: Two groups were formed: Group A (patients who did not use the device)and Group B (patients who did use the device). Measurements were taken in the pre-surgery panoramic pelvic radiograph with the patient standing and three months later.
Results: A sample of 80 patients was obtained, with 40 in each group. The difference in limb length could be corrected in each group, however the average correction achieved by both groups did not result in a statistically significant difference (p=0.07). However, when the variance in the correction of the difference in length of each group was examined, a statistically significant difference (p<0.001) was obtained.
Conclusions: We can conclude that while this device, which serves as a more objective quantifiable measurement technique, does not guarantee a correction of the exact length discrepancy to 0 mm, it does allow us to work within a more dependable and safe range.
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How to Cite
López, P. D., Almada, A. G., Iglesias, S. L., Pioli, I. J., Gómez, J. M., & Allende, B. L. (2023). A Simple Method to Minimize Limb Length Discrepancy and Restore Offset in Total Hip Arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 548-556. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1793
Section
Clinical Research
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References
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knee replacement in the National Health Service. Bone Joint J 2013;95-B(1):122-6. https://doi.org/10.1302/0301-620X.95B1.30908
2. Konyves A, Bannister GC. The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br 2005;87(2):155-7. https://doi.org/10.1302/0301-620x.87b2.14878
3. Bjørdal F, Bjørgul, K. The role of femoral offset and abductor lever arm in total hip arthroplasty. J Orthop
Traumatol 2015;16(4):325-30. https://doi.org/10.1007/s10195-015-0358-7
4. Nossa JM, Muñoz JM, Riveros EA, Rueda G, Márquez D, Pérez J. Leg length discrepancy after total hip
arthroplasty: comparison of 3 intraoperative measurement methods. Hip Int 2018;28(3):254-8.
https://doi.org/10.5301/hipint.5000577
5. McWilliams AB, Grainger AJ, O’Connor PJ, Redmond AC, Stewart TD, Stone MH. Assessing reproducibility for
radiographic measurement of leg length inequality after total hip replacement. Hip Int 2012;22(5):539-44.
https://doi.org/10.5301/HIP.2012.9751
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2018;3(1):18-22. Disponible en: https://methodo.ucc.edu.ar/index.php/methodo/article/view/64
7. Ranawat CS, Rodriguez JA. Functional leg-length inequality following total hip arthroplasty. J Arthroplasty1997;12(4):359-64. https://doi.org/10.1016/s0883-5403(97)90190-x
8. Abouelela A, Mubark I, Nagy M, Hind J, Jayakumar N, Ashwood N, et al. Limb length inequality in patients after
primary total hip arthroplasty: Analysis of radiological assessment and influencing risk factors based on a District
General Hospital experience of 338 cases. Cureus 2021;13(11):e19986. https://doi.org/10.7759/cureus.19986
9. Matsuda K, Nakamura S, Matsushita T. A simple method to minimize limb-length discrepancy after hip
arthroplasty. Acta Orthop 2006;77(3):375-9. https://doi.org/10.1080/17453670610046280
10. González Della Valle A, Slullitel G, Piccaluga F, Salvati EA. The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplasty 2005;20(1):51-8. https://doi.org/10.1016/j.arth.2004.04.016
11. Bose WJ. Accurate limb-length equalization during total hip arthroplasty. Orthopedics 2000;23(5):433-6.
PMID: 10825109
12. Desai AS, Connors L, Board TN. Functional and radiological evaluation of a simple intra operative technique to
avoid limb length discrepancy in total hip arthroplasty. Hip Int 2011;21(2):192-8. https://doi.org/10.5301/HIP.2011.6514
13. Ranawat CS, Rao RR, Rodriguez JA, Bhende HS. Correction of limb-length inequality during total hip arthroplasty. J Arthroplasty 2001;16(6):715-20. https://doi.org/10.1054/arth.2001.24442
14. Jasty M, Webster W, Harris W. Management of limb length inequality during total hip replacement. Clin Orthop Relat Res 1996;(333):165-71. PMID: 8981892
15. Woolson ST, Hartford JM, Sawyer A. Results of a method of leg-length equalization for patients undergoing
primary total hip replacement. J Arthroplasty 1999;14(2):159-64. https://doi.org/10.1016/s0883-5403(99)90119-5
16. Shiramizu K, Naito M, Shitama T, Nakamura Y, Shitama H. L-shaped caliper for limb length measurement during total hip arthroplasty. J Bone Joint Surg Br 2004;86(7):966-9. https://doi.org/10.1302/0301-620x.86b7.14587
17. Desai AS, Dramis A, Board TN. Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med 2013;6(4):336-41. https://doi.org/10.1007/s12178-013-9180-0
18. Kurtz WB. In situ leg length measurement technique in hip arthroplasty. J Arthroplasty 2012;27(1):66-73.
https://doi.org/10.1016/j.arth.2011.02.003
19. Chen X, Xing S, Zhu Z, Wang H, Yu Z, Bai X, et al. Accuracy of the horizontal calibrator in correcting leg length
and restoring femoral offset in total hip arthroplasty. Front Surg 2022;9:845364. https://doi.org/10.3389/fsurg.2022.845364
knee replacement in the National Health Service. Bone Joint J 2013;95-B(1):122-6. https://doi.org/10.1302/0301-620X.95B1.30908
2. Konyves A, Bannister GC. The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br 2005;87(2):155-7. https://doi.org/10.1302/0301-620x.87b2.14878
3. Bjørdal F, Bjørgul, K. The role of femoral offset and abductor lever arm in total hip arthroplasty. J Orthop
Traumatol 2015;16(4):325-30. https://doi.org/10.1007/s10195-015-0358-7
4. Nossa JM, Muñoz JM, Riveros EA, Rueda G, Márquez D, Pérez J. Leg length discrepancy after total hip
arthroplasty: comparison of 3 intraoperative measurement methods. Hip Int 2018;28(3):254-8.
https://doi.org/10.5301/hipint.5000577
5. McWilliams AB, Grainger AJ, O’Connor PJ, Redmond AC, Stewart TD, Stone MH. Assessing reproducibility for
radiographic measurement of leg length inequality after total hip replacement. Hip Int 2012;22(5):539-44.
https://doi.org/10.5301/HIP.2012.9751
6. Mangeaud A, Elías Panigo DH. R-Medic. Un programa de análisis estadístico sencillo e intuitivo. Methodo
2018;3(1):18-22. Disponible en: https://methodo.ucc.edu.ar/index.php/methodo/article/view/64
7. Ranawat CS, Rodriguez JA. Functional leg-length inequality following total hip arthroplasty. J Arthroplasty1997;12(4):359-64. https://doi.org/10.1016/s0883-5403(97)90190-x
8. Abouelela A, Mubark I, Nagy M, Hind J, Jayakumar N, Ashwood N, et al. Limb length inequality in patients after
primary total hip arthroplasty: Analysis of radiological assessment and influencing risk factors based on a District
General Hospital experience of 338 cases. Cureus 2021;13(11):e19986. https://doi.org/10.7759/cureus.19986
9. Matsuda K, Nakamura S, Matsushita T. A simple method to minimize limb-length discrepancy after hip
arthroplasty. Acta Orthop 2006;77(3):375-9. https://doi.org/10.1080/17453670610046280
10. González Della Valle A, Slullitel G, Piccaluga F, Salvati EA. The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplasty 2005;20(1):51-8. https://doi.org/10.1016/j.arth.2004.04.016
11. Bose WJ. Accurate limb-length equalization during total hip arthroplasty. Orthopedics 2000;23(5):433-6.
PMID: 10825109
12. Desai AS, Connors L, Board TN. Functional and radiological evaluation of a simple intra operative technique to
avoid limb length discrepancy in total hip arthroplasty. Hip Int 2011;21(2):192-8. https://doi.org/10.5301/HIP.2011.6514
13. Ranawat CS, Rao RR, Rodriguez JA, Bhende HS. Correction of limb-length inequality during total hip arthroplasty. J Arthroplasty 2001;16(6):715-20. https://doi.org/10.1054/arth.2001.24442
14. Jasty M, Webster W, Harris W. Management of limb length inequality during total hip replacement. Clin Orthop Relat Res 1996;(333):165-71. PMID: 8981892
15. Woolson ST, Hartford JM, Sawyer A. Results of a method of leg-length equalization for patients undergoing
primary total hip replacement. J Arthroplasty 1999;14(2):159-64. https://doi.org/10.1016/s0883-5403(99)90119-5
16. Shiramizu K, Naito M, Shitama T, Nakamura Y, Shitama H. L-shaped caliper for limb length measurement during total hip arthroplasty. J Bone Joint Surg Br 2004;86(7):966-9. https://doi.org/10.1302/0301-620x.86b7.14587
17. Desai AS, Dramis A, Board TN. Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med 2013;6(4):336-41. https://doi.org/10.1007/s12178-013-9180-0
18. Kurtz WB. In situ leg length measurement technique in hip arthroplasty. J Arthroplasty 2012;27(1):66-73.
https://doi.org/10.1016/j.arth.2011.02.003
19. Chen X, Xing S, Zhu Z, Wang H, Yu Z, Bai X, et al. Accuracy of the horizontal calibrator in correcting leg length
and restoring femoral offset in total hip arthroplasty. Front Surg 2022;9:845364. https://doi.org/10.3389/fsurg.2022.845364