1 / 20

leg length discrepancy after THA

leg length discrepancy after THA. L uc Kerboull. introduction. Is it a true concern ? depends on : value Origin preoperative status patient expectation. surgeon priority Arthroplasty of the hip. Leg length is not important. JBJS Br. 2002 Apr;84(3):335-8.  White TO , Dougall TW

saima
Download Presentation

leg length discrepancy after THA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. leglengthdiscrepancy after THA Luc Kerboull

  2. introduction • Is it a true concern ? depends on : • value • Origin • preoperative status • patient expectation. • surgeon priority • Arthroplasty of the hip. Leg length is not important. • JBJS Br. 2002 Apr;84(3):335-8.  • White TO, Dougall TW • But an actual problem for the surgeon and his patient ?

  3. introduction

  4. frequency • frequent under 10 mm in the literature • Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. • Int Orthop. 2008 Apr 25 • Wylde V, Whitehouse SL : 30% (1114 hips) • Revision >primary • personal experience • 2 LLD > 10 mm in revision cases • None case during primary surgery • usual accuracy < 5 mm in 90% of cases • more often lengthening than shortening

  5. anatomical basis • True segmental LLD • acetabular side • femoral side • False segmental LLD • Spinal origin (fixed deformity with pelvic obliquity) • other length discrepancy in the bone segments or joints under the hip • In all cases, a mistake for the patient

  6. diagnosis • clinical examination: • limb length measurement • range of motion • stiffness • fixed abduction • radiological examination • Pelvic AP radiograph in a standing position • long standing view in a standing position

  7. causes • Preoperative causes • lack or bad preoperative planning • bad assessment of other parameters (spine, bone segments) • intraoperative causes • acetabular side • high position • too horizontal inclination • lack of impaction : lateralization • femoral side • neck resection level • choice of the prosthesis neck length

  8. consequences • lateral hip pain, trochanteric pain • muscle weakness or tightness (lack of motion) • Limping • back pain • knee pain (homo or contra lateral) • limb nerve damage : pain, palsy • radiculopathy • loosening • The role of overlength of the leg in aseptic loosening after total hip arthroplasty. • Ital J Orthop Traumatol. 1993;19(1):107-11. • Visuri T, Lindholm TS, Antti-Poika I, Koskenvuo M

  9. Treatment • Shoe lift • femoral diaphysis shortening • Revision • uni or bipolar • be careful , shortening expose to postoperative instability, lowering of the greater trochanter helps to prevent it

  10. How to prevent LLD • preoperative planning PO • standard templating • Magnification is the problem

  11. How to prevent LLD • preoperative planning PO • standard templating : complex cases

  12. How to prevent LLD • preoperative planning PO • digitalized planning (Bfits Biomet) • if preoperative discrepancy, it must be calculated on a standard planning

  13. How to prevent LLD • Anatomical references • acetabular inferior margin • lesser trochanter • Great trochanter summit • Soft tissue tension • contra lateral limb ????

  14. How to prevent LLD • Intraoperative measurement • superposition of the trial femoral prosthesis with the femoral neck along with the femoral axis and according to the preoperative planning

  15. How to prevent LLD • Intraoperative measurement • Measurement of the resected neck according to the PO • Calliper and Carpenter Level P Chiron

  16. How to prevent LLD • Intraoperative measurement • Measurement of the trochanteric-iliac distance • Calliper and Carpenter Level

  17. How to prevent LLD • Intraoperative measurement • ultrasonographic measurement • intraoperative radioscopy

  18. How to prevent LLD • Computer Assisted Surgery • LLD 0.6 +/- 3 mm (range -5 to 10 mm) • [Computer-assisted positioning of the acetabular cup for total hip arthroplasty based on joint kinematics without prior imaging: preliminary results with computed tomographic assessment] • RCO. 2006 Jun;92(4):316-25. • Laffargue P, Pinoit Y, Tabutin J, Giraud F, Puget J, Migaud H.

  19. conclusion • frequent but often well tolerated after 6 months if less than 1 cm • Acute preoperative planning (PP) still is the simplest way to avoid major LLD (digitalized PP is more reliable) • Intraoperative references may help to check the data coming from the PP, but can not replace it • CAS definitely helps to minimize LLD to a very low level • Do not forget to inform the patient (before and ….after surgery) • I still need to paid attention to this issue even after several thoousand THA

  20. Thank you for your attention

More Related