Incidence Of Leg Length Discrepancy Research Articles

Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck Fractures: Comparison with Conventional Posterolateral Approach.

BackgroundThe aim of this study was to determine if it was feasible and safe to perform total hip arthroplasty (THA) using the direct anterior approach (DAA) when compared with the conventional posterolateral approach (PA) in patients with femoral neck fractures. The time required to start walking was investigated to identify advantages of the muscle-sparing approach. Safety of the approach was judged based on the incidence and nature of all complications.MethodsWe retrospectively reviewed 67 THA cases due to femoral neck fractures from October 2015 to January 2019. The PA was used in 31 cases, and the DAA was used in 36 cases. The average operative time and amount of bleeding were evaluated. Cup inclination, anteversion, and leg length discrepancy (LLD) were also measured on radiographs. The time to start walking and complications (e.g., intraoperative fracture, infection, and dislocation) were recorded.ResultsThe mean operative time was 84.35 ± 13.95 minutes in PA group and 99.22 ± 20.33 minutes in DAA group (p = 0.010). But after experiencing 20 cases using the DAA, there was no statistically significant difference in the operative time between the groups. The mean volume of bleeding was 428.73 ± 207.26 mL in the PA group and 482.47 ± 150.14 mL in the DAA group. There was no difference in the acetabular cup position between two groups. Ambulation was started at 3.94 days after surgery on average in the PA group and 3.14 days in the DAA group, showing a statistically significant difference. Intraoperative fracture and infection were not observed in either group. The incidence of LLD was 1 in each group. The dislocation rate was 3.2% (1 case) in the PA group and 5.5% (2 cases) in the DAA group.ConclusionsAlthough the DAA for THA was similar to the PA in terms of operative time, volume of bleeding, and complications, the DAA showed a great advantage in early rehabilitation as a muscle-sparing procedure in the elderly with femoral neck fractures.

Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review

Background: Growth disturbance is an uncommon but potentially serious complication after anterior cruciate ligament (ACL) reconstruction in skeletally immature patients. Purpose: To describe how the pediatric ACL literature has assessed preoperative skeletal maturity and the amount of growth remaining and to comprehensively review the incidence, reporting, and monitoring of postoperative growth disturbance. Study Design: Systematic review; Level of evidence, 4. Methods: This review included studies reporting original research of clinical outcomes of skeletally immature patients after ACL reconstruction. Patient characteristics, surgical techniques, preoperative assessments of skeletal maturity or growth remaining, and postoperative assessments of growth disturbances were extracted. Results: A total of 100 studies met inclusion criteria. All studies reported chronological age, and 28 studies (28%) assessed skeletal age. A total of 44 studies (44%) used Tanner staging, and 12 studies (12%) obtained standing hip-to-ankle radiographs preoperatively. In total, 42 patients (2.1%) demonstrated a leg length discrepancy (LLD) >10 mm postoperatively, including 9 patients (0.5%) with LLD >20 mm; furthermore, 11 patients (0.6%) with LLD underwent growth modulation. Shortening was the most common deformity overall, but overgrowth was reported more frequently in patients who had undergone all-epiphyseal techniques. Most LLDs involved the femur (83%). A total of 26 patients (1.3%) demonstrated a postoperative angular deformity ≥5°, and 9 of these patients underwent growth modulation. The most common deformities were femoral valgus (41%), tibial recurvatum (33%), and tibial varus (22%). Although standing hip-to-ankle radiographs were the most common radiographic assessment of growth disturbance, most studies inadequately reported the clinical and radiographic methods of assessment for growth disturbance. Additionally, only 35% of studies explicitly followed patients to skeletal maturity. Conclusion: This systematic review described significant variability in the reporting and monitoring of growth-related complications after ACL reconstruction in skeletally immature patients. The incidence of LLD and angular deformity appeared to be low, but the quality of research was not comprehensive enough for accurate assessment. Registration: CRD42019136059 (PROSPERO)

Incidence analysis of axial and lower extremity deviations based on the physical characteristics between domestic and foreign college students.

This research was performed to identify the incidence and to determine the effects of risk factors of axial and lower extremity deformities. One hundred forty-seven domestic college students (102 males and 45 females) and 72 foreign students (33 males and 39 females) were subjects in this study. Data collecting was performed by questionnaire and visual postural evaluation. For backpack shoulder dominance, higher incidences of genu varus (P=0.043) and lower incidence of leg length discrepancy (LLD) (P=0.001) were found in both shoulder carrier, while the incidence of lordosis was higher in left (P=0.001) and both (P=0.012) carrier in domestic students. The incidence of genu varus (P=0.022) and scoliosis (P=0.002) were significantly lower in both shoulder carrier in foreign students. For dominant arm, the incidence of forward head (P=0.001) and of lordosis (P=0.029) were significantly higher in left handedness both in domestic students and in foreign students. As the body mass index increases, the incidence of protruding abdomen (P=0.001) and lordosis (P=0.009) showed significant increase, but, the incidence of kyphosis (P=0.022) and scoliosis (P=0.001) decreased in domestic students, and same tendency for lordosis (P=0.001) and for scoliosis (P=0.001) in foreign students. As a whole, in domestic students, female students revealed significantly high (P=0.004) incidence of genu recurvatum compared to significantly low (P=0.022) incidence of LLD. However, no significant incidence difference found in foreign students. Male students showed significantly low incidence (P=0.001) of LLD and high incidence (P=0.014) of lordosis. In foreign students, female students also showed significantly low incidence (P=0.032) of LLD in foreign students compared to their counterparts.

Femoral neck osteotomy guide for total hip arthroplasty.

BackgroundTotal hip arthroplasty (THA) is a common last-resort treatment for hip disease, but postoperative patients often complain of discrepancies in leg length. This study introduces a device designed to increase the precision of the femoral neck osteotomy and reduce the incidence of leg length discrepancy.MethodsForty-eight patients undergoing THA were divided into two groups, with and without the use of the femoral osteotomy guide. All operations were performed through a posterolateral approach. Differences in leg length were recorded before and after the operation. Measurements were also made to compare the preoperative plan with the actual amount of bone removed.ResultsThe mean average difference in femoral neck resection height was 0.84 mm when using the osteotomy guide and 1.69 mm without the guide. Discrepancies in postoperative leg length were 5.45 mm and 13.37 mm in the groups with and without the guide, respectively.ConclusionThe femoral neck osteotomy guide is an effectively auxiliary tool for increasing the accuracy of bone resection in arthroplasty using the posterolateral approach.Trial registrationChiCTR-OOC-15005904; date: 2015-01-30

Leg-Length Discrepancy After Revision Hip Arthroplasty: Are Modular Stems Superior?

We retrospectively reviewed data for 79 consecutive patients who underwent revision hip arthroplasty using cementless femoral stems at our center between September 2008 and November 2010. Two cohorts were included, one using MP (modular) femoral stems and the other using Wagner (monoblock) femoral stems. We assessed leg-length discrepancy (LLD) before and after revision and compared the occurrence of leg-length inequality between the 2 cohorts. We found that the incidence of LLD was high in revision hip arthroplasty and that leg shortening was more common than lengthening. Both acetabular and femoral sides contributed to postoperative LLD. Appropriate placement of the femoral components was most critical in adjusting LLD. We also found that compared with monoblock stems, modular stems made adjustment of postoperative leg length easier.

Leg Length Discrepancy in Total Hip Arthroplasty with the use of Cemented and Uncemented Femoral Stems. A Prospective Radiological Study

Leg length discrepancy may occur following total hip arthroplasty, with a potentially impaired functional outcome as a result. The aim of this study was to compare the leg length discrepancy between both cemented and uncemented femoral stems when used in total hip arthroplasty. A prospective radiological study of 200 consecutive primary total hip arthroplasties was performed between June 2005 and December 2006. Pre and post-operative radiographs were analysed. 56 (56%) of the total hip arthroplasties where an uncemented femoral stem was used had a leg length discrepancy over 1 cm. However only 23 (23%) of the total hip arthroplasties with a cemented femoral stem had a leg length discrepancy over 1 cm. The use of cemented femoral stems in total hip arthroplasty results in a lower incidence of leg length discrepancy, with a potentially better functional outcome.

Fractures about the Knee: Growth Disturbances and Problems of Stability at Long-Term Follow-Up

The aim of this study was to collect information about the incidence of leg-length discrepancy, axis deviation and instability resulting from fractures about the knee in childhood. We reviewed 43 patients with a clinical and radiological examination after a mean follow-up period of 13 years. The fractures were divided into four subgroups, each one presenting typical problems. Growth disturbance (shortening and axis deviation) making secondary procedures necessary was seen in 5 out of 14 (36%) distal femoral epiphyseal fractures. Complex instability was observed in 3 out of 7 (43%) proximal tibial epiphyseal fractures. In the tibial spine fractures anatomical reduction often did not prevent moderate cruciate ligament insufficiency; and in the metaphyseal fractures 2 of the 7 cases showed leg-lenghtening. In conclusion, the Salter classification seems to be of little prognostic value at the knee as Type-II fractures are frequently followed by asymmetric growth arrest. Open reduction is not reliable in avoiding this complication. Associated ligament injuries are not rare and deserve more attention.