Leg Length Difference Research Articles

Ergebnisse der VKB-Ersatzplastik mit Periost-Patellasehnen-Periost-Transplantat im Wachstumsalter

The results of 16 patients in growth age (mean age at surgery 13.7 years) with an ACL rupture that was treated with an ACL reconstruction using an periost-patella tendon-periost graft were reviewed. The follow-up was done 12 months postoperatively. All patients were satisfied with the result of the surgery. No leg length differences or abnormalities of the axis were found. 14 patients had already regained their original sports level. In the Tegner score, an average level of 8 was reached and a mean of 97 points in the Lysholm score. In the IKDC score we found a level of A (normal) 9 times and of B (nearly normal) 7 times. These follow-up examinations show that the treatment of an ACL rupture in growth age with a periost-patella tendon-periost graft leads to good results. It is a good alternative to the other methods (e.g., semitendinosus). Today, it can be regarded as a standard that an ACL rupture with open growth plates should be treated operatively.

Interexaminer Reliability of the Prone Leg Length Analysis Procedure

Objective The purpose of this study was to perform an interexaminer reliability evaluation of the prone leg length analysis procedure. Methods Two chiropractors each examined a series of 45 patients with a history of low back pain. Patients were in the prone position, with the knees in both extended and flexed positions, and with the head rotated right and left. The clinicians were asked to determine the side of the short leg with knees extended and if a change in leg length occurred with head rotation or when the knees were flexed. They were also asked to visually judge the amount of leg length differential by categorizing the difference as either less than 0.25, 0.25 to 0.5, 0.5 to 0.75, or more than 0.75 in. The head rotation portion of the test was performed only with patients (n = 22) in whom the leg length differential was determined to be less than 0.25 in. Results κ statistics and frequency distributions were calculated for each of the respective observations. Reliability of determining the side of the short leg with knees extended was good at 82% agreement ( κ = 0.65) but fair for determining the amount of leg length difference at 67% agreement ( κ = 0.28). Reliability of the head rotation testing procedure was extremely poor, with only 50% and 45% agreement about the observed change in leg length with the head rotated left and right, respectively ( κ = 0.04, κ = −0.195). There was no significant correlation found between the side of reported pain by the patient and the side of the short leg as noted by either clinician ( χ 2 = 0.55, P = .91, and χ 2 = 1.55, P = .67). All of the patients (100%) were judged to have a leg length difference by both clinicians. When the knees were flexed, there was 93% agreement that the short leg became longer (43/45 cases), with no reported cases of the short leg getting shorter. Calculation of κ statistics was confounded for these last 2 observations because of extremely high prevalence bias. Conclusions The results indicate that 2 clinicians show good reliability in determining the side of the short leg in the prone position with knees extended but show poor reliability when determining the precise amount of that leg length difference. The head rotation test for assessing changes in leg length was unreliable in this sample of patients. There does not appear to be any correlation between the side of pain noted by the patient and the side of the short leg as observed by the clinicians; all 45 patients in this sample were found to have a short leg by both clinicians.

Comparative Validity Assessment of Five Activity Monitors: Does Being a Child Matter?

The purpose of this study was to determine the effects of age and leg length on the energy-expenditure predictions of five activity monitors. Participants (N=86, ages 8-40 years) performed three progressive bouts of treadmill activity ranging from 4 to 12 km/hr. Differences between measured energy expenditure (VO2) and activity-monitor-predicted energy expenditure were assessed across five leg length categories to determine the influence of leg length. Accelerometer counts or pedometer steps along with age, weight, and leg length accounted for 85-94% of measured energy expenditure. The addition of age and leg length as predictor variables explained a larger amount of variance in energy expenditure across all speeds. Differences in leg length and age might affect activity-monitor validity and, therefore, should be controlled for when estimating physical activity energy expenditure.

Effective limb length and the scaling of locomotor cost in terrestrial animals

Relative to body size, smaller animals use more energy to travel a given distance than larger animals, but the anatomical variable driving this negative allometry remains the subject of debate. Here, I report a simple inverse relationship between effective limb length (i.e. hip height) and the energy cost of transport (COT; J kg(-1) m(-1)) for terrestrial animals. Using published data for a diverse set of terrestrial species including birds, mammals, reptiles and arthropods, I show that between-species differences in locomotor cost are driven by differences in limb length. Notably, there is no independent effect of body mass on cost. Remarkably, effective limb length explains 98% of the observed variance in locomotor cost across a wide range of terrestrial species including mammals, birds, reptiles and arthropods. Variation about the limb-length/COT scaling relationship is attributable to taxonomic differences in limb design, with birds and arthropods exhibiting greater residuals than mammals. Differences in COT between semi-aquatic, generalist and cursorial species also corresponds to differences in leg length between these groups. These results are discussed in light of previous investigations of the limb length and locomotor cost.

The Influence Of Leg Segment Length On Pedaling Motion

PURPOSE: Leg length strongly affects the motion of the leg joints in pedaling. However, many investigations have not considered the influence induced by anthropometric factors. Therefore, we investigated the influence of leg length and segment length ratio on joint motion and electromyographic response during pedaling. METHODS: Subjects were 17 male university students (noncyclists). They performed pedaling at 60 rpm (2.4 w/kg body weight) on an electrically braked bicycle ergometer. The saddle height was adjusted to 98–100% of leg length. The relative crank length was chosen as 18% of leg length(to normalize the difference in leg length among the subjects). The foot was fixed on the pedal axis with two straps. The joint motion and surface electromyography on the left side were recorded. Segment length ratio was determined as a given segment length relative to the sum of three different segment lengths (thigh, shank, and foot) in the same leg. RESULTS: The ranges of each segment length ratio were 0.426-0.458 for thigh, 0.404-0.436 for shank, and 0.119-0.147 for foot. The results of correlation analysis on each item showed that as thigh length ratio increased, the hip and knee joint angles through a crank cycle increased (p<0.01), the velocity of dorsi flexion at a crank angle of 160-270° (denned by the top of the crank cycle as 0°) was higher (p<0.05), and the onset of muscle activation in the knee extensor was earlier (p<0.05) at 315-340°. As the velocity of dorsi flexion at 160-270° became lower, the gastrocnemius lateralis at 160-170° (p<0.05) was more highly activated with no relation to the activity of the tibialis anterior. CONCLUSIONS: The thigh length ratio nearly determined the hip and knee joint angles in the whole crank cycle and was correlated with the level of activation in the knee extensors near 0°. The results suggested that the difference of timing in the activity of knee extensors near 0°may be related to the concurrent “ankling” motion of the contralateral leg. Thus, the individual thigh length ratio determined the strategy of ankling, which may act in fixation of the ankle joint by the planter flexors or dorsi flexors. In many reports, ankling has been discussed relating to the skill of the cyclist. We concluded that the motion and muscle activity during pedaling were influenced by anthropometric factors.

Adolescent Back injury Baseball

HISTORY: 14 YOM pitcher presents to U of U Ortho Clinic c/o 5 months of back pain. He plays 3–4x/wk for 8 mo/yr, but no record of pitch counts, starts or times at bat. Pain is initially only exacerbated by swing follow through & cocking phase of pitching. Pain is focal to low back, stabbing with exacerbations & dull/achy after pitching full innings or long batting practice. No radicular symptoms, pain with sitting or pain outside activity. No weakness, functional limitation, or detriment to play. No weight loss or night sweats. Evaluation by PCP after 3 months of insidiously increasing symptoms yields a diagnosis of lumbar strain with spasms. He had 1 month of rest with no symptoms. On presentation to our clinic, he had played club ball for 1 month with recurrence of similar complaints. His pain now occurs with ADLs, at night & affects his abililty to pitch & bat. PHYSICAL EXAMINATION: GENERAL: A&O, NAD, normal posture GAIT: Not antalgic, no foot drop NEURO: Reflexes 2+/equal in the LE. Normal strength/tone. Normal sensation. Negative slump & straight leg tests PELVIS: Equal PSIS/ASIS alignment in neutral, flexion & extension. No leg length difference. No sacral malalignment. SI: nontender & tests negative. Trendelenberg negative BACK: -ROM: Touches toes with normal lumbar curature. Nontender side-bending & rotation. Increased pain at the extreme of extension -Positive stork test -Focally tender L2-3, nontender lower lumbar -No vertebral body rotation DIFFERENTIAL DIAGNOSIS: Spondylolysis, spondylolisthesis, stress reaction, lumbar strain, discogenic pain, neoplasm TEST AND RESULTS: A P/Lat Lumbar X-Ray: Normal bony malalignment, no fractures Lumbar MRI: Initial T1/T2 images read as normal. Subsequent T1 STIR & fat suppression images revealed edema & stress reaction at L3 pars interarticularis bilaterally. No bony defect. Normal discs without bulge or protrusion. No mass lesion FINAL WORKING DIAGNOSIS: Bilateral L3 pars interarticularis stress reaction in a year round young pitcher seen only on T1 stir and fat suppression images. TREATMENT AND OUTCOMES: Rest from all extension activities without bracing. Core strength and stabilization exercises. Pain has subsided at night & with ADLs. Return to limited play is planned. We expect healing of the pars and full recovery. Follow up scheduled November 2006.

Clinical features of patellar tendinopathy and their implications for rehabilitation

This study investigated the clinical features of patellar tendinopathy (PT), with focus on individuals with unilateral and bilateral PT. A cross-sectional study design was employed to compare individuals with unilateral (n = 14) or bilateral (n = 13) PT and those without PT (control, n = 31). Features assessed included thigh strength (normalized peak knee extensor torque) and flexibility (sit-and-reach and active knee extension), calf endurance (heel-rise test), ankle flexibility (dorsiflexion), alignment measures (arch height and leg length difference), and functional measures (hop for distance and 6 m hop test). Groups were matched for age and height; however, unilateral and bilateral PT had greater mass with a higher body mass index (BMI) than control. Also, bilateral PT performed more sport hours per week than both unilateral PT and control. Unilateral PT had less thigh strength than control and bilateral PT, whereas bilateral PT had more thigh flexibility than control and unilateral PT. Both unilateral and bilateral PT had altered alignment measures compared to control. Features that predicted symptoms in PT were lower thigh flexibility and strength, whereas those that predicted function were higher thigh strength and lower ankle flexibility. These findings indicate that unilateral and bilateral PT represent distinct entities, and that thigh strength appears particularly important in PT as it predicted both symptoms and function in PT.

Focused life history data and linear enamel hypoplasia to help explain intergenerational variation in relative leg length within Taiwanese families

This study first examines the hypothesis that significant intergeneration increases in stature within 85 Taiwanese families in two study locations were primarily the result of increases in subischial leg length. It then evaluates a second hypothesis that independent assessments of the extent of intergenerational change in childhood environments within these families helped account for parent-offspring differences in relative leg length. Childhood environments were assessed using two criteria: developmental environment scores derived from life history data and evidence of linear enamel hypoplasia (LEH). Relative leg length was represented in two ways, as either the difference between internally estimated sex-specific z-scores of sitting height and subischial leg length (z(D) = z(SH) - z(LL)) or as relative sitting height (RSH; sitting height/height x 100). Paired Student t tests indicated intergenerational increases in relative leg length were significantly greater than zero in both study locations (P < or = 0.012). The second hypothesis, tested using a hierarchical model with maximum likelihood estimation that allowed for nesting of more than one offspring per family, received support as midparent-offspring differences in composite scores were significantly positively associated with midparent-offspring differences in relative leg length. This was true alone (P = 0.018), and when significant associations with LEH prevalence among mothers and offspring were statistically controlled for (P = 0.010). Evidence also indicated that while the large majority of offspring were taller than their midparental average height (84.3%; 91/108), offspring who were taller were also more likely to have relatively longer legs than by chance alone (Fishers exact, P = 0.027).

Associations between orthopaedic disturbances and unilateral crossbite in children with asymmetry of the upper cervical spine

The objective of the present study was to detect possible associations between unilateral crossbite and orthopaedic disturbances in children with asymmetry of the upper cervical spine. Fifty-five children aged 3-10 years (22 girls and 33 boys) with a unilateral crossbite and 55 gender- and age-matched children with a symmetric occlusion but no crossbite, who served as the control group, were selected from an orthopaedic cohort of 240 patients. In all children, asymmetry of the upper cervical region was confirmed by radiographs and palpation. The following orthopaedic aspects were investigated: oblique shoulder and pelvis, scoliosis, functional leg length difference, and laxity of ligaments of the foot. The differences between the groups were analysed by means of an unpaired t-test. An increased occurrence of orthopaedic parameters in the frontal plane was observed in children with a unilateral malocclusion. A unilateral crossbite was not necessarily combined with a pathological orthopaedic variable, but statistically, children with a unilateral malocclusion showed more often an oblique shoulder (P = 0.004), scoliosis (P = 0.04), an oblique pelvis (P = 0.007), and a functional leg length difference (P = 0.002) than children with symmetry. The results suggest that a unilateral crossbite in children with asymmetry of the upper cervical spine is associated with orthopaedic disturbances. There is no evidence of a causal link.

Two-stage operative strategy without local antibiotic treatment for infected hip arthroplasty: clinical and radiological outcome

Two-stage revision hip surgery with insertion of local antibiotic carriers is the therapy of choice for infected hip arthroplasty. The disadvantages are the incalculable pharmacokinetics of the antibiotic, with the danger of resistance and sensitisation. In a retrospective study, the effectiveness of a two-stage revision strategy done without local antibiotics was to be investigated. Thirty-one patients (32 hips) after two-stage revision hip surgery for infection without local antibiotics were monitored clinically and radiologically, with a follow-up of 41.3 months. Nine re-debridements in combination with a systemic antibiosis had to be conducted for eradication of the infections after explantation. Reconstruction of the majority of the hips was possible without the use of revision implants and without using large structured allografts. The re-infection rate was 6.3%, the patients achieved a Harris hip score of 75.4 (range 36.1-97.0) points at the latest follow-up, and the average difference in leg length was -0.7 (range -4.5 to + 2.5) cm. Two-stage revision of the hip can be conducted without local antibiotic application, to achieve a comparatively efficient cure of the infection and function. This investigation underlines the significance of radical surgical debridement. The optional use of more effective antibiotic carriers may reduce the number of re-debridements in the future.

Estudo da relação entre o comprimento da banda iliotibial e o desalinhamento pélvico

Study on the Relationship Between Iliotibial Band Length and Pelvic Misalignment Background: Pelvic misalignments such as lateral pelvic tilt may lead to dysfunctions and pain complaints. Studies in the literature have indicated several factors associated with lateral pelvic tilt, and one of these is the length of the iliotibial band. Objective: Investigate the presence of an association between iliotibial band length and frontal plane pelvic tilt. Method: Thirty-two asymptomatic individuals of both sexes (22.5 ± 2.6 years), without leg-length differences or pelvic torsion, were included in the study. The modified Ober test, performed with a pelvic level and an inclinometer, was used to assess the iliotibial band length. To determine the pelvic misalignment in the frontal plane, the individual was positioned on standard support equipment and pelvic structure measurements were obtained using an anthropometer. Pearson’s correlation coefficient was utilized to determine the degree of association between pelvic misalignment in the frontal plane (established as the difference in height between higher and lower anterosuperior iliac spines) and the length of the iliotibial band (established as the difference in iliotibial band lengths corresponding to the higher and lower anterosuperior iliac spines). Results: No statistically significant correlations were found between the variables analyzed (r=0.12; p=0.53). Conclusion: The present findings indicate that iliotibial band length alone does not appear to influence frontal plane pelvic alignment. Other factors may be involved and these still need to be identified.

Are differences in leg length predictive of lateral patello‐femoral pain?

Lateral patello-femoral pain can shorten an athletic career and generally decrease an individual's physical activity and functional level, such as preventing stair climbing and reducing the ability to rise from a chair. Leg length inequality is associated with patello-femoral pain. A leg length test that best distinguishes the difference between people who have lateral patello-femoral pain and those who do not would have clinical utility. The purpose of the present study was, first, to determine if unilateral, lateral patello-femoral pain was associated with the longer leg when inequality of leg lengths existed and, second, to determine if leg length direct measurement, indirect measurement or quadriceps angle (Q angle) could correctly classify participants according to the presence or absence of patello-femoral pain. The study used an ex post facto, two-group quasi-experimental design. A volunteer sample of 52 participants (14 males, 38 females), ranged in age from 18 to 52 years. Three methods were used to measure leg lengths: palpation meter (PALM) on anterior superior iliac spines (ASIS) while participants maintained centred weight-bearing position on a high resolution pressure mat; tape measurement from ASIS to medial malleolus (supine); tape measurement from ASIS to lateral malleolus (supine). Additionally, Q angle was measured in supine position. Patellar grind test, medial retinacular and lateral patellar palpation screened for patello-femoral pain. Logistic regression analysis determined correctness of membership in painful and non-painful patello-femoral groups. The PALM method of indirect measurement of leg length differences overall correctly classified approximately 83 % of the participants. Tape measure to medial and lateral malleoli as well as Q angle did not yield significant results. The results suggested that the PALM method of measuring leg length differences may have clinical utility in differentiating between patients who are likely to sustain patello-femoral pain syndrome and those who will not.

Reversible Pelvic Asymmetry: An Overlooked Syndrome Manifesting as Scoliosis, Apparent Leg-Length Difference, and Neurologic Symptoms

Objective The objective of this study was to investigate the occurrence of pelvic asymmetry in neurologic patients with symptoms not explained by their neurologic diagnosis. Methods We analyzed 150 consecutive neurologic patients referred to physiatric consultation based on their clinical examination findings. Results We observed pelvic asymmetry associated with either C-type or S-type scoliosis and apparent leg-length difference in 87% of the patients. Symmetry could be reestablished by all patients, although 15% showed immediate or imminent relapse. Maintenance of symmetry showed a highly significant ( P < .001) correlation with improvement in functional ability and reduction of pain as evaluated during the last visit to the physiatrist. In the follow-up questionnaire, 78% of the patients reported improvement in functional ability and reduced pain. Conclusions Our results support the view that leg-length difference and scoliosis may be more often of reversible nature than previously considered. Acquired postural asymmetry of the sacroiliac joint may be a neglected cause of several neurologic and other pain-related symptoms that can be relieved by a simple and safe treatment.

Energy Expenditure and Ground Reaction Forces of an Active Video Game, Dance Dance Revolution, in Healthy Weight and Overweight Children

Levels of physical activity in children are at an all-time low in the US which has tremendous public health impact and implications for chronic disease including cardiovascular disease, obesity and osteoporosis. A popular 'active' video game, Dance Dance Revolution (DDR), combines the popularity of video games with physical activity. The game has potential benefits for both cardiovascular fitness and for bone health in children. PURPOSE: To assess the oxygen consumption, heart rate, and ground reaction forces of DDR play in healthy weight and overweight children. METHODS: 66 overweight (body mass index, BMI ≥ 85th percentile, n = 23, mean age = 11.9y) and healthy weight (BMI <85th percentile, n = 43, mean age = 12.2y) boys and girls participated. Peak heart rate and peak oxygen consumption were assessed with a graded treadmill test (VO2peak, Medical Graphics Corp.). Peripheral quantitative computed tomography (pQCT, Stratec XCT 3000) was used to measure total bone area (ToA) and total density (ToD) at the 66% site of the tibia. Heart rate (HR), VO2, and ground reaction forces (GRF, Pedar System, Novell Inc.), were measured during the last minute of 3 DDR trial songs. GRFs were also measured for walking, running, and tuck jump. RESULTS: There were no differences in age, Tanner Stage, height or leg length between HW and OW children. The OW group (31.1 ml/kg/min) had significantly (p <0.0001) lower VO2peak compared to the HW group (39.4 ml/kg/min), while there was no difference in HRmax achieved. ToA at the 66% site of the tibia was 20% higher (p = 0.002) in the OW group but there was no difference in ToD, adjusted for Tanner stage, sex, and leg length. VO2 during the last minute of DDR play ranged from 17–66% (mean + SD = 41.2 ± 11.0%) of VO2peak and mean HR measured at the end of the song was 73% (range 52.8–97.9%) of HRpeak. Mean peak GRF for DDR was ∼1x body weight, which was similar to walking and slightly lower than running or tuck jumps (both ∼2x body weight). CONCLUSION: An active video game, DDR, that both overweight and healthy weight children enjoy playing, has potential for improving cardiovascular health. Osteogenic characteristics (peak GRF) of DDR were low compared to tuck jumps, but the diversity of movements could be of benefit to bone health.

Implant position calculation for acetabular cup placement considering pelvic lateral tilt and inclination

Objective: The purpose of this study was to investigate the relationship of cup position versus pelvic lateral tilt and inclination. While computer assisted navigation systems use only the pelvic frontal plane for cup placement, it is important to realize the effect of leg length differences or increased pelvic inclination, i.e., caused by contracted hip flexors.Materials and Methods: Using a sawbone model of the pelvis, cup position measurements were performed with different pelvic inclination and lateral tilt angles. The measured values were compared with outcome variables from a mathematical model. A computer program was developed to perform a reverse calculation to verify the mathematical model.Results: The mathematical model proved correct in the sawbone pelvis experiment. The cup position changed from 15° anteversion in 0° pelvic inclination to 0.5° retroversion in 15° pelvic inclination. Regardless of pelvic inclination, the vertical cup projection stayed in a safe range of 37–47°. Leg length differences greater than 3 cm have significant effects on the positioning of acetabular cups in the frontal plane.Conclusions: Using computer navigation, it is possible to determine pelvic inclination and lateral tilt during an operation by calculating the angular difference between the anatomic frontal plane and the “real world” frontal plane (i.e., the OR table). This method may be helpful in increasing the accuracy of positioning of acetabular cups.

Leg Length Inequality in Total Hip Arthroplasty

Postoperative leg length inequality after total hip arthroplasty frequently leads to medical liability issues because no standard exists regarding the acceptable disparity. Modular stems allow control of offset, independent sizing of the distal femoral anatomy, as well as proximal medullary sizing. The authors compared the restoration of leg length in two cohort protocols. In the 2001 cohort, tapered stems were exclusively used, giving priority to fit and fill of the medullary canal. In the 2004 cohort, porous-tapered stems, or an S-ROM modular stem (DePuy Orthopaedics Inc., Warsaw, Ind) when needed, were used based on preoperative templating to restore the center of femoral head rotation. Prior to and after surgery, length from center measurements were taken (center of rotation of the femoral head to the top of the lesser trochanter) and the vertical vector to compare the difference in actual leg length. In the 2001 cohort, the mean increase of length from center was 9 mm (7 mm leg length). In the 2004 cohort, 25% of the hips were inappropriate for tapered stems. S-ROMs were used because a tapered stem would lengthen the leg. In the standard offset tapered stem, the mean increase of length from center was 6 mm (4 mm leg length). In the high offset tapered stem, the mean increase of length from center was 7 mm (5 mm leg length). In the S-ROM stem with varying offsets, the mean increase of length from center was 6 mm (4 mm leg length). Only the S-ROM consistently avoids overlengthening in the majority of patients.

Patellofemoral pain syndrome

The patellofemoral pain syndrome is of high socioeconomic relevance as it most frequently occurs in young working patients. As its etiology is often unknown there is no standard treatment protocol. Several studies analyzed the different causes of patellofemoral pain and their different therapies. Static problems (pes planovalgus, instabilities, leg length differences) or chronic overuse of the knee extensor mechanism have to be identified and treated. After exclusion of intra-articular pathologies, the treatment of patellofemoral pain syndrome begins with conservative management. Stretching of the flexor and extensor muscles and training of the quadriceps muscle are the main approaches. If conservative treatment fails and patellofemoral pain persists, there are several surgical procedures for realignment of the patella in the trochlear groove and reduction of the patellofemoral pressure. Overweight patients exhibit chronic mechanical overuse of the patellofemoral joint. This leads to a higher rate of cartilage degeneration and problems at the inserting tendons and stabilizing tissues.

Saphenous Vein Harvest With SaphLITE System Versus Conventional Technique: A Prospective, Randomized Study

Minimally invasive saphenous vein harvest (MIVH) techniques have been evaluated and reported with heterogeneous results. The aim of this study was to evaluate the efficacy of MIVH on the outcomes of postoperative leg wound healing and pain using the SaphLITE retractor system. Two hundred twenty-five patients undergoing elective coronary artery bypass grafting surgery were randomized to receive either SaphLITE vein harvest (SVH) or conventional open vein harvest (OVH). There were no significant differences between the two groups in demographics, postoperative mortalities and major complications. For SVH group and OVH group, total leg wound length was 18.33 +/- 7.93 cm vs 46.10 +/- 15.63 cm (p < 0.001), and vein harvest time was 50.70 +/- 16.55 minutes vs 40.35 +/- 16.43 minutes (p < 0.001). In-hospital leg wound healing disturbance (LWHD) rate was 4.7% for SVH group and 1.7% for OVH group (p = 0.190). Delayed LWHD rate was 16.0% for SVH group and 39.5% for OVH group (p < 0.001). Combined, LWHD rate was 20.8% for SVH group and 41.2% for OVH group (p = 0.001). There was no significant difference in the worst postoperative leg wound pain or length of hospital stay between the 2 groups. Double-blinded histologic examinations revealed normal vascular structure in the harvested veins from both groups. Our study demonstrated that harvesting saphenous vein with SaphLITE retractor system is a good technique which is associated with reduced rate of delayed LWHD, preserved venous structural integrity, and acceptable harvest speed.

Prevalence of frontal plane pelvic postural asymmetry--part 1.

Despite 80 years of study, questions of how leg length difference relates to recurrent pain and somatic dysfunction remain controversial. The authors hypothesize that a correlation exists between leg length inequality and back pain. They further hypothesize that if common compensatory patterns described in classic osteopathic medical literature exist, these patterns should interact with the pelvic postural asymmetry patterns of Lloyd and Eimerbrink in a predictable, most probable, and congruent fashion. This article reviews the osteopathic medical, as well as the allopathic medical and chiropractic literature for studies that meet criteria for evidence-based comparison. Using lumbar radiographic studies produced with subjects standing, the authors examined the prevalence of six types of pelvic postural asymmetry in a consecutive case series of 421 patients with low back pain. Establishing the frequency of pelvic postural asymmetry patterns is a necessary first step in creating an evidence-based foundation to further clarify postural compensatory patterns. Various correlations between and within these patterns are identified.

The use of bilobed porous-coated acetabular components without structural bone graft for type III acetabular defects in revision total hip arthroplasty: A prospective study with a minimum 2-year follow-up

A prospective analysis was undertaken of 11 hips (in 11 patients) that underwent revision acetabuloplasties with bilobed, porous-coated, acetabular implants without the use of structural bone graft for type III acetabular defects. The average patient age was 66.3 years, with an average follow-up of 38 months (range, 24–49 months). No acetabular components required or are pending revision surgery. Average pain and hip scores improved from 8 and 36 preoperatively to 42 and 89 postoperatively, respectively. Average leg-length differences decreased from 34 mm preoperatively to 7 mm postoperatively. The use of bilobed acetabular components without structural bone graft is a feasible alternative for reconstructing type III acetabular defects, and can provide good short-term clinical results, while reconstructing the hip center and maximizing host-implant contact.