Changes in patient-perceived leg length discrepancy following total hip arthroplasty



Leg length discrepancy (LLD) after total hip arthroplasty (THA) prevents functional recovery and reduces patient satisfaction. We investigated impact of changes in patient-perceived LLD on patient satisfaction and walking ability.


one hundred and forty-nine patients with unilateral hip osteoarthritis undergoing THA from 2014 to 2017, (125 women, 24 men; average age, 68.5 years) with an objective LLD < 1 cm were included. Outcome measures included the patient-perceived LLD, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, 10-m walking speed, and affected leg loading rate, assessed preoperatively and at 3 weeks, 3 months, and 1 year postoperatively.


The absolute patient-perceived LLD (mean ± SD) (the number of patients with perceived LLD > 5 mm) were 6.4 ± 9.6 mm [88 patients (59%)] preoperatively; and 2.2 ± 4.0 mm [48 (32%); p < 0.001], 0.7 ± 2.3 mm [17 (11%); p < 0.001], and 0.4 ± 1.6 mm [10 (7%); p = 0.095] at 3 weeks, 3 months, and 1 year postoperatively, respectively. All outcome measures improved over time. One year postoperatively, a weak positive correlation between the patient-perceived LLD and WOMAC or 10-m walking speed (r = 0.24, 0.23, respectively) was found. The risk of patient-perceived LLD persisting > 1 year postoperatively was 5.5-fold higher in patients who exhibited it at 3 months and those with a WOMAC score > 10 at 3 months postoperatively, using multivariate logistic regression.


Achieving a post-THA objective LLD < 1 cm significantly reduced the patient-perceived LLD up to 3 months postoperatively. The residual patient-perceived LLD at 1 year postoperatively was predicted from the WOMAC score or the presence of patient-perceived LLD at 3 months after THA.

Level of evidence

Therapeutic level IV.

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We did not receive grants or outside funding in support of their research or preparation of this manuscript. We thank Yuichi Takeuchi, Yusuke Kimura, and Naoya Kumata for unifying the postoperative physical therapy, and Yoshito Minami, Takahiro Yamabe and Yuuki Shibata for the assistants of the orthopedic surgery in Shiraniwa Hospital.


We did not receive grants or outside funding in support of our research or preparation of this manuscript.

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Correspondence to Kentaro Iwakiri.

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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. This trial was registered as a trial with the University Hospital Medical Information Network (UMIN) registration number UMIN000034024.

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The study protocol was approved by the institutional review board, and all patients provided written informed consent to participate.

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Iwakiri, K., Ohta, Y., Fujii, T. et al. Changes in patient-perceived leg length discrepancy following total hip arthroplasty. Eur J Orthop Surg Traumatol (2021).

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  • Leg length discrepancy
  • Total hip arthroplasty
  • Perceived leg length discrepancy
  • Objective leg length discrepancy