This Article Full Text Full Text (PDF) CME: Take the exam for this article: CME 4: October, November, December 2003 [Supplementary Material] Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in JBJS Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Parvizi, J. Articles by Hozack, W. J. Search for Related Content PubMed PubMed Citation Articles by Parvizi, J. Articles by Hozack, W. J. Social Bookmarking             What's this?

Surgical Treatment of Limb-Length Discrepancy Following Total Hip Arthroplasty

¹ Rothman Institute of Orthopedics, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for W.J. Hozack: william.hozack{at}mail.tju.edu

Investigation performed at the Department of Orthopedics, Rothman Institute and Thomas Jefferson University, Philadelphia, Pennsylvania

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

A video supplement to this article is available from the Video Jour- nal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Methods: We retrospectively reviewed the clinical and radiographic records of patients who had undergone revision hip surgery at our institution for the treatment of a symptomatic limb-length discrepancy following a previous total hip arthroplasty. We identified twenty-one patients (twenty-one hips) who had an average age of sixty-six years at the time of revision hip arthroplasty. The average duration of follow-up was 2.8 years, and no patient was lost to follow-up. The indications for revision hip arthroplasty were severe hip and/or back pain for eleven patients, instability of the hip for eight, hip pain and ipsilateral limb paresthesia for one, and hip pain and ipsilateral foot drop for one.

Results: Revision arthroplasty was performed at a mean of eight months (range, six days to six years) after primary total hip replacement. The mean limb-length discrepancy at the time of the revision was 4 cm (range, 2 to 7 cm). Following revision arthroplasty, which involved revision of a malpositioned acetabular and/or femoral component, equalization of the limb lengths was achieved in fifteen patients. In the remaining six patients, the mean discrepancy had decreased to 1 cm. The mean Harris hip score improved significantly, from 56.5 points before the revision to 83.2 points at the time of the latest follow-up (p < 0.005). All but two patients were satisfied with the outcome of the revision surgery.

Conclusions: Limb-length discrepancy following hip arthroplasty can be associated with pain, paresthesia, and hip instability. In these patients, careful evaluation of the position and orientation of the components may reveal the cause of the discrepancy. Revision arthroplasty may be indicated when a surgically correctable cause of limb-length discrepancy can be identified.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

Related articles in JBJS:

Surgical Treatment of Limb-Length Discrepancy Following Total Hip Arthroplasty • W.J. Hozack and J. Parvizi reply

Bipin Theruvil, Vikas Kapoor, William J. Hozack, and Javad Parvizi
JBJS 2004 86: 1829. [Extract] [Full Text]  

This article has been cited by other articles:

				P Zhang, G M Malacinski, and H Yokota Joint loading modality: its application to bone formation and fracture healing Br. J. Sports Med., July 1, 2008; 42(7): 556 - 560. [Abstract] [Full Text] [PDF]

				J. Parvizi, E. Picinic, and P. F. Sharkey Revision Total Hip Arthroplasty for Instability: Surgical Techniques and Principles J. Bone Joint Surg. Am., May 1, 2008; 90(5): 1134 - 1142. [Full Text] [PDF]

				B. A. Rothbart Relationship of functional leg-length discrepancy to abnormal pronation. J Am Podiatr Med Assoc, November 1, 2006; 96(6): 499 - 504. [Abstract] [Full Text] [PDF]

				C. R. Clark, H. D. Huddleston, E. P. Schoch III, and B. J. Thomas Leg-Length Discrepancy After Total Hip Arthroplasty J. Am. Acad. Ortho. Surg., January 1, 2006; 14(1): 38 - 45. [Abstract] [Full Text] [PDF]

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2003 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.