Dynamic Leg Length Discrepancy in Hip Arthroplasty Patients: What is the Amount a Patient Can Accept Without a Limp? How to Avoid Medical-Legal Issues

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Published Oct 22, 2024
DOI: https://doi.org/10.18103/mra.v12i10.5891

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Main Article Content

S. J. Massoeurs, MD J. L. Leahey, MD Islam Elnagar Peter Leighton, MD R. K. Leighton, MD, PhD
Dalhousie University

Abstract

Introduction: Leg length discrepancy (LLD) following total hip arthroplasty (THA) is a common occurrence that can spoil an otherwise excellent clinical outcome1,2 as well as have medical-legal ramifications3. Scientifically, the amount of LLD that is clinically significant in THA patients is not well established4,5. The purpose of this study was to determine the relationship between static leg length discrepancy (SLLD) and dynamic leg length discrepancy (DLLD) in total hip arthroplasty patients. We also investigated the correlation between various methods of static leg length discrepancy measurement.


Methods: Static leg length was measured by three methods: tape measure from anterior superior iliac spine to medial malleolus, inclinometer (spirit level) measured with the sacrum for flexion of lumbar spine with the knees extended, ortho-roentgenogram. Participants were assessed for dynamic leg length discrepancy during walking using an inertial measurement unit (IMU). The IMU consisted of three tri-axially arranged accelerometers applied to the lumbar region of the spine in order to measure the centre of mass excursion in three dimensions. Data are recorded at 200 Hz for a maximum of 20 seconds. Each participant completed nine gait tests: four walks with modified shoe lifts applied in random order to the operative or non-operative sides of the THA group or alternate sides on controls, and a normal walk with no lift applied to either side. Lift heights were 0.2 cm, 1.2 cm, 2.2 cm, and 3.2 cm


Results: Data from the inertial measurement unit was plotted in two dimensions to illustrate dynamic leg length discrepancy. A control with no lift and basically equal leg lengths showing a nice shift and equal heights of the Anterior Superior Iliac Crest (ASIS). A patient with a 1.2 cm lift on the right side, indicates a dynamic leg length discrepancy of 1 cm. A patient with 3.2 cm of lift on the right side, measures a 2.75 cm leg length discrepancy dynamically.


Conclusion: Dynamic leg length discrepancy of less than one centimeter is rarely detected by the patient and is quite easily adapted to with a small lift in the other shoe of 80% of the inequality. Dynamic leg length discrepancy of greater than one centimeter (static leg length discrepancy greater than 1.2 cm) usually provides a patient with enough discrepancy that a limp is perceptible. This study emphasizes the need to do careful leg length measurements when performing total hip arthroplasty

Article Details

How to Cite
MASSOEURS, S. J. et al. Dynamic Leg Length Discrepancy in Hip Arthroplasty Patients: What is the Amount a Patient Can Accept Without a Limp? How to Avoid Medical-Legal Issues. Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5891>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v12i10.5891.
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Issue
Vol 12 No 10 (2024): October Issue, Issue 10, VOl.12
Section
Research Articles

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References

1. Benedetti, M. G., F. Catani, E. Benedetti, L. Berti, A. Di Gioia & S. Giannini (2010) To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty? Int Orthop, 34, 1115-21.
2. Bolink, S. A. A. N., E. Lenguerrand, L. R. Brunton, N. Hinds, V. Wylde, I. C. Heyligers, A. W. Blom, M. R. Whitehouse & B. Grimm (2019) The association of leg length and offset reconstruction after total hip arthroplasty with clinical outcomes. Clin Biomech (Bristol, Avon), 68, 89-95.
3. Desai, A. S., A. Dramis & T. N. Board (2013) Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med, 6, 336-41.
4. Edeen, J., P. F. Sharkey & A. H. Alexander (1995) Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop (Belle Mead NJ), 24, 347-51.
5. Gross, R. H. (1978) Leg length discrepancy: how much is too much? Orthopedics, 1, 307-10.
6. Hofmann, A. A. & M. C. Skrzynski (2000) Leg-length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! Orthopedics, 23, 943-4.
7. Jasty, M., W. Webster & W. Harris (1996) Management of limb length inequality during total hip replacement. Clin Orthop Relat Res, 165-71.
8. Lecoanet, P., M. Vargas, J. Pallaro, T. Thelen, C. Ribes & T. Fabre (2018) Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D. Orthop Traumatol Surg Res, 104, 1143-1148.
9. Li, J., A. B. McWilliams, Z. Jin, J. Fisher, M. H. Stone, A. C. Redmond & T. D. Stewart (2015) Unilateral total hip replacement patients with symptomatic leg length inequality have abnormal hip biomechanics during walking. Clin Biomech (Bristol, Avon), 30, 513-9.
10. Licini, D. J., D. J. Burnikel, R. M. Meneghini & J. L. Ochsner (2013) Comparison of limb-length discrepancy after THA: with and without computer navigation. Orthopedics, 36, e543-7.
11. Loughenbury, F. A., A. B. McWilliams, T. D. Stewart, A. C. Redmond & M. H. Stone (2019) Hip surgeons and leg length inequality after primary hip replacement. Hip Int, 29, 102-108.
12. Mahar, R. K., R. L. Kirby & D. A. MacLeod (1985) Simulated leg-length discrepancy: its effect on mean center-of-pressure position and postural sway. Arch Phys Med Rehabil, 66, 822-4.
13. Manzotti, A., P. Cerveri, E. De Momi, C. Pullen & N. Confalonieri (2011) Does computer-assisted surgery benefit leg length restoration in total hip replacement? Navigation versus conventional freehand. Int Orthop, 35, 19-24.
14. McWilliams, A. B., A. Lampropoulos & M. H. Stone (2018) Revision surgery for leg length inequality after primary hip replacement. Hip Int, 28, 554-558.
15. Parvizi, J., P. F. Sharkey, G. A. Bissett, R. H. Rothman & W. J. Hozack (2003) Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am, 85, 2310-7.
16. Pyrko, P. & J. Zuckerman (2016) Leg Length Discrepancy in Primary Total Hip Arthroplasty. Bull Hosp Jt Dis (2013), 74, 82-7.
17. Rajpaul, J. & M. N. Rasool (2018) Leg length correction in computer assisted primary total hip arthroplasty: A collective review of the literature. J Orthop, 15, 442-446.
18. Ranawat, C. S., R. R. Rao, J. A. Rodriguez & H. S. Bhende (2001) Correction of limb-length inequality during total hip arthroplasty. J Arthroplasty, 16, 715-20.
19. Ranawat, C. S. & J. A. Rodriguez (1997) Functional leg-length inequality following total hip arthroplasty. J Arthroplasty, 12, 359-64.
20. Wylde, V., S. L. Whitehouse, A. H. Taylor, G. T. Pattison, G. C. Bannister & A. W. Blom (2009) Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop, 33, 905-9.