1. Parental perspectives on leg length discrepancy Parental perspectives on leg length discrepancy KM Lee, MD, CY Chung, MD, KH Sung, MD, JH Cho, MD, TW Kim, MD, and MS Park, MD KM Lee, MD, CY Chung, MD, KH Sung, MD, JH Cho, MD, TW Kim, MD, and MS Park, MD Seoul National University Bundang Hospital

2. Introduction Leg length discrepancy (LLD) - 40 to 70% of population - associated with low back pain, hip pain, stress fracture How much LLD triggers intervention How to treat with a certain level of LLD Patient’s and parent’s opinion and interest in health related quality of life, dissatisfaction and discomport

3. LLD of 2cm - generally accepted guideline for treatment LLD of 2cm in pediatric patients - shorter leg length - amount of LLD change in growing children - difficult to predict subjective psychological impact of LLD

4. Purpose of study To examine the parental perspectives on their child’s LLD along with the affecting factors including the amount of LLD, patients’ demographics, functional states and health related quality of life

5. Methods

6. Consecutive patients with chief complaint of LLD over age of 5 Exclusion 1) neuromuscular disease, joint contracture, deformity of leg 2) patient who had undergone surgery for LLD

7. Two groups - posttraumatic LLD and idiopathic LLD - LLD<2% and LLD ≥ 2% Pediatric outcomes data collection instrument (PODCI) and LLD questionnaire by parents Teleroentgenograms to measure LLD

8. Through panel discussion and agreement 34 items for the questionnaire 6 domains: parents’ satisfaction, effect of LLD, preferred treatment, parents’ mood, concern, and expectation regarding treatment 5-point Likert scale: ‘not at all’, ‘slightly’, ‘somewhat’, ‘very’, and ‘extremely’ Additional question for willingness to seek treatment LLD questionnaire

9. Standing anteroposterior teleroentgenogram Length of both legs: between the summit of the femoral head and the distal articular margin of the tibia Divide the amount of LLD by the long leg length for standardization (%) Radiographic measurement

10. Descriptive analysis Spearman’s correlation coefficients : correlation between the LLD and PODCI t-test or Mann-Whitney U test : comparison between the two groups Logistic regression analysis : identification of the significant contributing factors to the willingness to seek treatment Data analysis

11. Results

12. Table 1. Comparison between idiopathic LLD and posttraumatic LLD Idiopathic LLDPosttraumatic LLDP value No.29 - Mean age11.8 (3.8)12.4 (2.7)0.475 M : F17 : 1218 : 110.788 LLD (%)2.5 (1.3)2.1 (1.3)0.153 PODCI U/E & physical fxn99.4 (2.1)98.9 (3.0)0.418 Transfer/basic mobility99.7 (1.1)98.2 (4.5)0.093 Sports/physical fxn96.9 (7.4)91.4 (14.8)0.082 Pain/comfort93.6 (11.3)82.6 (21.3)0.018* Happiness87.2 (20.0)80.0 (26.5)0.249 Global functioning97.4 (4.5)92.7 (9.0)0.015*

13. Table 2. Comparison between LLD≥2% and LLD<2% groups LLD<2% groupLLD≥2% groupP value No.29 - Mean age11.8 (3.4)12.3 (3.2)0.526 M : F17 : 1218 : 110.788 LLD (cm)1.1 (0.4)2.4 (1.0)<0.001 PODCI U/E & physical fxn99.0 (2.5)99.3 (2.6)0.686 Transfer/basic mobility98.7 (3.5)99.3 (3.2)0.456 Sports/physical fxn92.7 (12.8)95.6 (11.1)0.366 Pain/comfort86.7 (18.7)89.4 (17.1)0.565 Happiness80.0 (27.8)87.2 (18.1)0.250 Global functioning94.2 (8.1)95.9 (6.7)0.391 LLD Questionnaire Effect on walking ability3.0 (1.4)3.8 (1.2)0.039* Effect on need for surgical Tx.2.4 (1.1)3.3 (1.0)0.001* Effect on happiness2.5 (1.3)3.6 (1.2)0.003* Preference for surgical Tx.2.5 (1.1)3.2 (0.6)0.011* Parental guilty feeling3.3 (1.3)4.0 (0.9)0.039* Concerns over possible operation3.2 (1.4)4.1 (0.8)0.010* Data are presented as mean (SD)

14. Between the LLD≥2cm and LLD<2cm group Significant differences in their appearance (p=0.012), preference for surgical treatment (p<0.001), effect on happiness (p=0.004), and concerns over possible operation (p=0.010)

15. Table 3. ‘Willingness to seek treatment’ evaluated by logistic regression analysis Exp (B)95% CIP value Global Fxn (PODCI)1.040.941 - 1.1480.444 Age1.020.802 - 1.2940.882 Gender0.2400.047 - 1.2210.086 LLD (%)0.2310.086 - 0.6200.004* Responder (father/mother)0.1950.015 - 2.5900.216 Idiopathic vs posttraumatic1.0870.266 - 4.4380.907 Constant0.509-0.894 CI, confidence interval

16. Conclusion ‘2cm rule’ can be used to evaluate the parents’ perspectives Difference in the health related quality of life between idiopathic LLD and posttraumatic LLD Understanding the parents’ psychological aspects on children’s LLD might enhance communication between surgeons and parents during the decision making

17. Thank you !