Statistically LLD is one of the most often complications that is underestimated by surgeons and exaggerated by patients. In the USA it is one of the most often reasons for legal problems to the surgeons after THR.
After several years of experience with THR I found some patients (several % of patients) with an elongation of operated leg 2cm. Currently, I perform THR with an additional tool for measuring distance between pelvis and femur during surgery and it improved a lot the results. I wonder what are the others opinions to this problem?
Dear Wieslaw
These articles may be useful for you
1) Chir Narzadow Ruchu Ortop Pol. 2011 May-Jun;76(3):169-74.
[Possibilities of leg length equalization in total hip replacement].
Kaczmarek W1, Pietrzak K, Pucher A.
2) Instr Course Lect. 2011;60:229-46.
Achieving stability and lower limb length in total hip arthroplasty.
Berend KR1, Sporer SM, Sierra RJ, Glassman AH, Morris MJ
3) J Bone Joint Surg Am. 2013 Aug 7;95(15):1426-36.
Limb-length discrepancy after hip arthroplasty.
Ng VY1, Kean JR, Glassman AH
4) Orthopedics. 2005 Sep;28(9):951-3.
Limb length and stability in total hip replacement.
Cuckler JM.
Dr. Kaczmarek, thank you very much for the question.
I believe preoperative planning is essential. In my clinic no patient is allowed to enter OP theater with the plan.
We use metaphyseal stems and I think the postoperative length is more precisely controlled. We also check clinically the length during the operation.
Yours sincerely,
dr. antolic
www.ortopedska-klinika.si
www.antolic.si
Dr. Kaczmarek,
sorry for the mistake in the answer:
no one is allowed to enter Op without the plan .....
Regards
Than you dr Antolic for an answer, but I found the method of preoperative planning and intraoperative control of LLD insufficient in some selected patients. Preoperative planning is more precise for the stem positioning (one can control distance between stem and lesser trochanter) but cup positioning is less intraoperatively controlled. Excessive number of postoperative LLD led me to construction of a special device for intraoperative LLD control.
Dr. Kaczmarek: I agree with you. So far I have not found this problem so significant to led me to a use of an intraoperative device. By-the- way: what kind of device do you use and which approach?
The picture of the device that I constructed you can see here: http://bori2.republika.pl/htmle/illc.html
If you need any further information considering this device feel free to ask a question
Dear W Kaczmarek, congratulation in constructing such interesting device. Actually we use preop planning, radiography, in some cases CT scan, but also intraop evaluation.
Regards,
Cen
Well said, lack of understanding of the biomechnics and lack of preop planing may lead to such problem. One must be attentive and well read
Dear W Kaczmarek, thank YOU to ask. Actually we use preop planning, radiography, in some cases CT scan, but also intraop evaluation. Very important in the approach and most important is the pacient position. I strongly believe that the supine position, give a reproducible data. The external Hardinge approach is also reproductible. Intraoperative measurements will give the possibility to equalize the length, and the stability in adduction,external rotation or flection internal rotation. So the intraoperative mesurement SIAS patella or internal maleola will give the satisfaction.
Being a PT, I would like to add that once LLD has confirmed and if it is less than 2 cm one can go with insole modification and if it is greater than that one can go with out sole lift on opposite side LL.
I m sorry if you are looking for only surgical aspects..
I find the following quite useful especially if used together:
1. Pre-op templating with measurement of LLD: Plan the relative stem/cup position to correct for any LLD; measure distance from top of lesser trochanter to level of planned neck osteotomy medially.
2. Pre-op measurement of the level of the head centre in relation to the tip of the greater trochanter on AP pelvic radiograph.
3. Visualise the LLD at the knee when patient secured in lateral position and draped (Heels together & operated limb lying onto contralateral limb (adducted)). Keep this image in your head and compare at trial reduction.
4. Intra-op confirmation of the approximate level of head centre in relation to tip of GT just before neck osteotomy.
5. Measure accurately where to make the neck osteotomy to match pre-op plan using a sterile paper ruler.
6. At trial reduction, check level of head centre in relation to tip of GT & think about any change that has happened.
If all these checks are done, you will significantly minimise the LLD post-op.
all planning beforehand is just a help, but no solution. Very well worked the intraoperative length-measuring instrument developped by E.Engelbrecht (ENDO-Klinik) I am not sure, whether he wrote an article about it; at least I helped to find the cases for him. The instrument is still used for ex. by Dr.Sellckau, Klinik Fleetinsel Hamburg and produced by W.Link. With this instrument you are sure how much is the true leg-length after the THA and in relation to before.
- Badges
- Science topic
- Similar topics
- Philosophy
- Ethics