leg length discrepancy after THA Luc Kerboull

? introduction Is it a true concern ? depends on : value Origin preoperative status patient expectation. surgeon priority Arthroplasty of the hip. Leg length is not important. JBJS Br. 2002 Apr;84(3):335-8.  White TO, Dougall TW But an actual problem for the surgeon and his patient ?

introduction frequency anatomical basis diagnosis causes consequences treatment how to prevent LLD

frequency frequent under 10 mm in the literature Revision >primary Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop. 2008 Apr 25 Wylde V, Whitehouse SL : 30% (1114 hips) Revision >primary personal experience 2 LLD > 10 mm in revision cases None case during primary surgery usual accuracy < 5 mm in 90% of cases more often lengthening than shortening

anatomical basis True segmental LLD False segmental LLD acetabular side femoral side False segmental LLD Spinal origin (fixed deformity with pelvic obliquity) other length discrepancy in the bone segments or joints under the hip In all cases, a mistake for the patient

diagnosis clinical examination: radiological examination limb length measurement range of motion stiffness fixed abduction radiological examination Pelvic AP radiograph in a standing position long standing view in a standing position

causes Preoperative causes intraoperative causes lack or bad preoperative planning bad assessment of other parameters (spine, bone segments) intraoperative causes acetabular side high position too horizontal inclination lack of impaction : lateralization femoral side neck resection level choice of the prosthesis neck length

consequences lateral hip pain, trochanteric pain muscle weakness or tightness (lack of motion) Limping back pain knee pain (homo or contra lateral) limb nerve damage : pain, palsy radiculopathy loosening The role of overlength of the leg in aseptic loosening after total hip arthroplasty. Ital J Orthop Traumatol. 1993;19(1):107-11. Visuri T, Lindholm TS, Antti-Poika I, Koskenvuo M

Treatment Shoe lift femoral diaphysis shortening Revision uni or bipolar be careful , shortening expose to postoperative instability, lowering of the greater trochanter helps to prevent it

How to prevent LLD preoperative planning PO standard templating Magnification is the problem

How to prevent LLD preoperative planning PO standard templating : complex cases

How to prevent LLD preoperative planning PO digitalized planning (Bfits Biomet) if preoperative discrepancy, it must be calculated on a standard planning

How to prevent LLD Anatomical references acetabular inferior margin lesser trochanter Great trochanter summit Soft tissue tension contra lateral limb ????

How to prevent LLD Intraoperative measurement superposition of the trial femoral prosthesis with the femoral neck along with the femoral axis and according to the preoperative planning

How to prevent LLD Intraoperative measurement Measurement of the resected neck according to the PO Calliper and Carpenter Level P Chiron

How to prevent LLD Intraoperative measurement Measurement of the trochanteric-iliac distance Calliper and Carpenter Level

How to prevent LLD Intraoperative measurement ultrasonographic measurement intraoperative radioscopy

How to prevent LLD Computer Assisted Surgery LLD 0.6 +/- 3 mm (range -5 to 10 mm) [Computer-assisted positioning of the acetabular cup for total hip arthroplasty based on joint kinematics without prior imaging: preliminary results with computed tomographic assessment] RCO. 2006 Jun;92(4):316-25. Laffargue P, Pinoit Y, Tabutin J, Giraud F, Puget J, Migaud H.

conclusion frequent but often well tolerated after 6 months if less than 1 cm Acute preoperative planning (PP) still is the simplest way to avoid major LLD (digitalized PP is more reliable) Intraoperative references may help to check the data coming from the PP, but can not replace it CAS definitely helps to minimize LLD to a very low level Do not forget to inform the patient (before and ….after surgery) I still need to paid attention to this issue even after several thoousand THA

Thank you for your attention