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leg length discrepancy after THA

leg length discrepancy after THA. L uc 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

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leg length discrepancy after THA

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  1. leglengthdiscrepancy after THA Luc Kerboull

  2. 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 ?

  3. introduction

  4. frequency • frequent under 10 mm in the literature • 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

  5. anatomical basis • True 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

  6. diagnosis • clinical 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

  7. causes • Preoperative 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

  8. 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

  9. 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

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

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

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

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

  14. 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

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

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

  17. How to prevent LLD • Intraoperative measurement • ultrasonographic measurement • intraoperative radioscopy

  18. 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.

  19. 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

  20. Thank you for your attention

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