Advertisement

Patient-dependent risk factors for self-perceived leg length discrepancy after total hip arthroplasty

  • Blaž MavčičEmail author
  • Drago Dolinar
  • Borut Pompe
  • Vane Antolič
Original Article • HIP - ARTHROPLASTY
  • 25 Downloads

Abstract

Purpose

Patients with equal objective leg length discrepancy (LLD) may have different subjective perceptions of this condition. Our aim was to analyze the effects of gender, age, operated side, surgical approach, body height, body mass index (BMI) and LLD measurements on self-perceived LLD after total hip arthroplasty (THA).

Materials and methods

Observational cohort study with minimum 5-year follow-up included 159 patients with unilateral primary THA at a single institution, who reported subjective feeling of equal or unequal leg lengths after THA. Gender, age, body height, BMI, surgical approach, preoperative and postoperative absolute/relative/pelvic radiographic LLD measurements were included in direct comparison between groups and multivariate analyses with self-perceived LLD as the outcome variable.

Results

Out of 159 participants, 39% subjectively perceived postoperative LLD, while others reported equal leg lengths. The two groups postoperatively differed in the median relative LLD (10 mm vs. 5 mm; p = 0.01) and WOMAC (230 mm vs. 110 mm; p < 0.01), but not in the pelvic radiographic LLD. After adjustment for gender, age, operated side and surgical approach, postoperative relative LLD (odds ratio 1.38 for each 5 mm increment; 95% CI 1.01–1.74) and combination of BMI < 26 kg/m2 and body height < 1.75 m (odds ratio 2.49; 95% CI 1.14–5.41) were independent risk factors for self-perceived LLD.

Conclusions

Clinical relative LLD measurements are better predictors of self-perceived postoperative LLD than pelvic radiographic measurements. Patients with smaller body dimensions will more likely report subjective leg length inequality at a given objective LLD, regardless of gender or age.

Keywords

Hip Arthroplasty Self-perceived outcome Leg length discrepancy 

Notes

Acknowledgements

We thank Dr. Peter Brumat and Dr. Matej Keršič for their help with data acquisition and radiographic analyses.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest with respect to this study.

Ethical approval

The study protocol was reviewed and approved by the National Medical Ethics Committee of the Republic of Slovenia on August 19, 2014, case No.# 97/08/14.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study who provided prospectively collected data.

References

  1. 1.
    Tipton SC, Sutherland JK, Schwarzkopf R (2016) The assessment of limb length discrepancy before total hip arthroplasty. J Arthroplasty 31:888–892CrossRefGoogle Scholar
  2. 2.
    Ellapparadja P, Mahajan V, Atiya S, Sankar B, Deep K (2016) Leg length discrepancy in computer navigated total hip arthroplasty—how accurate are we? Hip Int 26:438–443CrossRefGoogle Scholar
  3. 3.
    Renkawitz T, Weber T, Dullien S, Woerner M, Dendorfer S, Grifka J, Weber M (2016) Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture 49:196–201CrossRefGoogle Scholar
  4. 4.
    Chen G, Nie Y, Xie J, Cao G, Huang Q, Pei F (2017) Gait analysis of leg length discrepancy-differentiated hip replacement patients with developmental dysplasia: a midterm follow-up. J Arthroplasty 33:1437–1441CrossRefGoogle Scholar
  5. 5.
    Haider T, Schnabel J, Hochpöchler J, Wozasek GE (2018) Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients. Arch Orthop Trauma Surg 138:1511–1517CrossRefGoogle Scholar
  6. 6.
    Herisson O, Felden A, Hamadouche M, Anract P, Biau DJ (2016) Validity and reliability of intraoperative radiographs to assess leg length during total hip arthroplasty: correlation and reproducibility of anatomic distances. J Arthroplasty 31:2784–2788CrossRefGoogle Scholar
  7. 7.
    Wylde V, Maclean A, Blom AW (2012) Post-operative radiographic factors and patient-reported outcome after total hip replacement. Hip Int 22:153–159CrossRefGoogle Scholar
  8. 8.
    Kutzner KP, Pfeil J, Kovacevic MP (2017) Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided. Eur J Orthop Surg Traumatol 27:643–651CrossRefGoogle Scholar
  9. 9.
    Keršič M, Dolinar D, Antolič V, Mavčič B (2014) The impact of leg length discrepancy on clinical outcome of total hip arthroplasty: comparison of four measurement methods. J Arthroplasty 29:137–141CrossRefGoogle Scholar
  10. 10.
    Sykes A, Hill J, Orr J, Humphreys P, Rooney A, Morrow E, Beverland D (2015) Patients’ perception of leg length discrepancy post total hip arthroplasty. Hip Int 25:452–456CrossRefGoogle Scholar
  11. 11.
    Haynes J, Nam D, Barrack RL (2017) Obesity in total hip arthroplasty: does it make a difference? Bone Joint J 99-B(1 Suppl A):31–36CrossRefGoogle Scholar
  12. 12.
    Sabharwal S, Kumar A (2008) Methods for assessing leg-length discrepancy. Clin Orthop Relat Res 466:2910–2922CrossRefGoogle Scholar
  13. 13.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with OA of hip and knee. J Rheumatol 15:1833–1840Google Scholar
  14. 14.
    Mahmood SS, Mukka SS, Crnalic S, Sayed-Noor AS (2015) The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty 30:1638–1642CrossRefGoogle Scholar
  15. 15.
    Jamaluddin S, Sulaiman AR, Imran MK, Juhara H, Ezane MA, Nordin S (2011) Reliability and accuracy of the tape measurement method with a nearest reading of 5 mm in the assessment of leg length discrepancy. Singapore Med J 52:681–684Google Scholar
  16. 16.
    Meermans G, Malik A, Witt J, Haddad F (2011) Preoperative radiographic assessment of limb length discrepancy in total hip arthroplasty. Clin Orthop Relat Res 469:1677–1682CrossRefGoogle Scholar
  17. 17.
    DelSole EM, Vigdorchik JM, Schwarzkopf R, Errico TJ, Buckland AJ (2017) Total hip arthroplasty in the spinal deformity population: does degree of sagittal deformity affect rates of safe zone placement, instability, or revision? J Arthroplasty 32:1910–1917CrossRefGoogle Scholar
  18. 18.
    Ochi H, Homma Y, Baba T, Nojiri H, Matsumoto M, Kaneko K (2017) Sagittal spinopelvic alignment predicts hip function after total hip arthroplasty. Gait Posture 52:293–300CrossRefGoogle Scholar
  19. 19.
    Lee SY, Kim W, Lee SU, Choi KH (2018) Relationship between obesity and lumbar spine degeneration: a cross-sectional study from the Fifth Korean National Health and Nutrition Examination Survey, 2010–2012. Metab Syndr Relat Disord.  https://doi.org/10.1089/met.2018.0051 Google Scholar
  20. 20.
    Brumat P, Pompe B, Antolič V, Mavčič B (2018) The impact of canal flare index on leg length discrepancy after total hip arthroplasty. Arch Orthop Trauma Surg 138:123–129CrossRefGoogle Scholar
  21. 21.
    Keršič M, Dolinar D, Antolič V, Mavčič B (2019) Shear force in the femoral neck affects clinical outcome of total hip arthroplasty. Acta Orthop Belg 85Google Scholar
  22. 22.
    Edwards PK, Mears SC, Stambough JB, Foster SE, Barnes CL (2018) Choices, compromises, and controversies in total knee and total hip arthroplasty modifiable risk factors: what you need to know. J Arthroplasty 30:1e6Google Scholar
  23. 23.
    Lazennec JY, Folinais D, Florequin C, Pour AE (2017) Does patients’ perception of leg length after total hip arthroplasty correlate with anatomical leg length? J Arthroplasty 33:1562–1566CrossRefGoogle Scholar
  24. 24.
    Nakanowatari T, Suzukamo Y, Suga T, Okii A, Fujii G, Izumi S (2013) True or apparent leg length discrepancy: which is a better predictor of short-term functional outcomes after total hip arthroplasty? J Geriatr Phys Ther 36:169–174CrossRefGoogle Scholar
  25. 25.
    Beeck A, Quack V, Rath B, Wild M, Michalik R, Schenker H, Betsch M (2018) Dynamic evaluation of simulated leg length inequalities and their effects on the musculoskeletal apparatus. Gait Posture 67:71–76CrossRefGoogle Scholar
  26. 26.
    Assogba TF, Boulet S, Detrembleur C, Mahaudens P (2018) The effects of real and artificial leg length discrepancy on mechanical work and energy cost during the gait. Gait Posture 59:147–151CrossRefGoogle Scholar
  27. 27.
    Haleem AM, Wiley KF, Kuchinad R, Rozbruch SR (2017) Total hip arthroplasty in patients with multifactorial perceived limb length discrepancy. J Arthroplasty 32:3044–3051CrossRefGoogle Scholar
  28. 28.
    Fokter SK, Levašič V, Kovač S (2017) The innovation trap: modular neck in total hip arthroplasty. Slov Med J 86:115–126Google Scholar
  29. 29.
    Zajc J, Predan J, Gubeljak N, Moličnik A, Fokter SK (2018) Modular femoral neck failure after revision of a total hip arthroplasty: a finite element analysis. Eur J Orthop Surg Traumatol.  https://doi.org/10.1007/s00590-018-2314-8 Google Scholar
  30. 30.
    Bletterman AN, de Geest-Vrolijk ME, Vriezekolk JE, Nijhuis-van der Sanden MW, van Meeteren NL, Hoogeboom TJ (2018) Preoperative psychosocial factors predicting patient’s functional recovery after total knee or total hip arthroplasty: a systematic review. Clin Rehabil 32:512–525CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University Medical Centre Ljubljana and Faculty of MedicineLjubljanaSlovenia

Personalised recommendations