Treatment of Leg Length Discrepancy after Total Hip Arthroplasty

CHAPTER 59 Treatment of Leg Length Discrepancy after Total Hip Arthroplasty




Patient’s perception of leg length inequality in the early postoperative period is relatively common. Fortunately, in the majority of patients this symptom resolves with time and physical therapy. However, a minority of patients, mostly those with marked leg length discrepancy, may have substantial disability as a result of persistent pain and functional impairment.1 This situation is a disturbing problem for both the surgeon and the patient. Although revision arthroplasty usually is considered to be a last resort in these cases, continuing recurrent instability, profound functional impairment (abductor weakness, dysfunctional gait, or low back pain), and failure of conservative treatment may necessitate surgical intervention. Also, it is important to realize that patient dissatisfaction with leg length discrepancy after total hip arthroplasty (THA) is one the most common reasons for litigation against orthopedic surgeons.2,3





CLINICAL PRESENTATION


The majority of patients with minor leg length discrepancy after THA have few symptoms, and most patients with moderate leg length discrepancy have readily manageable symptoms. However, a small group of patients, mostly those with marked leg length discrepancy, may have substantial disability as a result of pain and functional impairment.1 Common symptoms include pain, paresthesias, and instability of gait (Fig. 59-1).



Leg length discrepancy after THA has been associated with complications including sciatic, femoral, and peroneal nerve palsy; low back pain6,8,9; and gait abnormalities.1014 Nerve injury is one of the most serious complications associated with leg length inequality.15 Edwards and colleagues,16 in a review of 23 THAs complicated by peroneal and sciatic nerve palsy, noted an average lengthening of 2.7 cm (range 1.9 to 3.7 cm) for peroneal palsy and 4.4 cm (range 4.0 to 5.1 cm) for sciatic palsy. Pritchett17

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Mar 10, 2016 | Posted by in Reconstructive surgery | Comments Off on Treatment of Leg Length Discrepancy after Total Hip Arthroplasty

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