Abstract
BackgroundLeg length inequality (LLI) was identified as a problem of total hip arthroplasty soon after its introduction. Leg lengthening is the most common form of LLI. Possible consequences are limping, neuronal dysfunction and aseptic component loosening. LLI can result in an increased strain both on the contralateral hip joint and on the abductor muscles. We assessed the influence of leg lengthening and shortening on walking capacity, hip pain, limping and patient satisfaction at 2-year follow-up.Methods478 cases with postoperative lengthening and 275 with shortening were identified, and matched with three controls each. Rigorous adjustment for potential differences in baseline patient characteristics was performed by propensity-score matching of covariates. The arbitrarily defined desired outcomes were a walking capacity >60 minutes, no hip pain, no limping, and excellent patient satisfaction. Differences in not achieving the desired outcomes between the groups were expressed as odds ratios.ResultsIn the lengthened case group, the odds ratio for not being able to walk for an hour was 1.70 (95% CI 1.28-2.26) for cases compared to controls, and the odds ratio for having hip pain at follow-up was 1.13 (95% CI 0.78-1.64). The odds ratio for limping was 2.08 (95% CI 1.55-2.80). The odds ratio for not achieving excellent patient satisfaction was 1.67 (95% CI 1.23-2.28). In the shortening case group, the odds ratio for not being able to walk for an hour was 1.23 (95% CI 0.84-1.81), and the odds ratio for having hip pain at follow-up was 1.60 (95% CI 1.05-2.44). The odds ratio for limping for cases was 2.61 (95% CI 1.78-3.21). The odds ratio for not achieving excellent patient satisfaction was 2.15 (95% CI 1.44-3.21).ConclusionsWalking capacity, limping and patient satisfaction were all significantly associated with leg lengthening, whereas pain alleviation was not. In contrast, hip pain, limping and patient satisfaction were all significantly associated with leg shortening, whereas walking capacity was not.
Highlights
Leg length inequality (LLI) was identified as a problem of total hip arthroplasty soon after its introduction
An excellent clinical result with respect to pain relief and radiographic appearance must be considered a surgical failure if patients are dissatisfied because of leg length inequality leading to functional deficiencies
Leg lengthening Patient characteristics leg lengthening From a total of 10'415 potential follow-up examinations, 478 cases with leg lengthening were identified, comprising 405 patients with a lengthening of 1 cm and 73 patients with a lengthening of more than 1 cm
Summary
Leg length inequality (LLI) was identified as a problem of total hip arthroplasty soon after its introduction. We assessed the influence of leg lengthening and shortening on walking capacity, hip pain, limping and patient satisfaction at 2-year follow-up. Relief of pain and improvement of function are the main objectives of THA, the maintenance or re-establishment of equal leg length is highly desirable. Postoperative leg length inequality is a bothersome complication and one of the main reasons for lawsuits after THA in the United States [3]. An excellent clinical result with respect to pain relief and radiographic appearance must be considered a surgical failure if patients are dissatisfied because of leg length inequality leading to functional deficiencies. Research on the impact of a postoperative leg length discrepancy on patient function and satisfaction is scarce
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