Useful Method for Minimizing Leg Length Discrepancies in Hip Arthroplasty: Use of an Intraoperative X-ray

Jong Won Kim; Young Soo Jang; Hyun Soo Park; Jong Deuk Rha; Jin Phil Yang; Jae Hyuk Choi; Sung Ju Bae

doi:10.5371/jkhs.2011.23.4.262

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Kim, Jang, Park, Rha, Yang, Choi, and Bae: Useful Method for Minimizing Leg Length Discrepancies in Hip Arthroplasty: Use of an Intraoperative X-ray

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(4): 262-267.

Published online: 31 December 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.4.262

Useful Method for Minimizing Leg Length Discrepancies in Hip Arthroplasty: Use of an Intraoperative X-ray

Jong Won Kim, MD, Young Soo Jang, MD, Hyun Soo Park, MD, Jong Deuk Rha, MD, Jin Phil Yang, MD, Jae Hyuk Choi, MD, Sung Ju Bae, MD

Department of Orthopedic Surgery, Hanil General Hospital, Seoul, Korea.

Address reprint request to Young Soo Jang, MD. Department of Orthopedic Surgery, Hanil General Hospital, 388-1 Ssangmoon 3-dong, Dobong-gu, Seoul 132-703, Korea. TEL: +82-2-901-3078, FAX: +82-2-901-1745, pooljang105@hanmail.net

Received 17 July 2011 Revised 7 December 2011 Accepted 9 December 2011

Abstract

Purpose

There are numerous opinions about the methods and usefulness of minimizing leg length discrepancies after hip arthroplasty. In this study, we tried to evaluate the usefulness of an intraoperative x-ray in addition to preoperative templating for minimizing leg length discrepancy.

Materials and Methods

We reviewed pre- and post-operative pelvis AP x-rays of 46 patients who underwent hip arthroplasty due to a traumatic femoral neck fracture or intertrochanteric fracture between May 2008 and February 2009. A leg length discrepancy is the difference in vertical distance between a horizontal line drawn along the bottom of the ischial tuberosities and the most inferior points of the lesser trochanter. It was measured in a pelvis AP x-ray. In each case, pre-operative templating was performed and an intraoperative pelvis AP x-ray was taken again to assess the accuracy of preoperative planning. Implant positions were readjusted when necessary.

Results

The mean post-operative leg-length discrepancy was 0.3 mm (SD, 3.1 mm). The range was from -5.8 mm to +5.9 mm.

Conclusion

Combining preoperative templating and intraoperative x-rays is a useful method of minimizing leg length discrepancy during hip arthroplasty.

Keywords: Hip, Femur, Arthroplasty, Leg length discrepancy, Preoperative templating, Intraoperative x-ray

Figures and Tables

Fig. 1

Method for evaluation of limb length. A line connection the bottom of the ischial tuberosities was drawn, and the differences in limb length were measured using the relationship between this line and the most inferior point of the lesser trochanter. Leg length discrepancy was -9.16 mm.

Fig. 2

Preoperative anteroposterior pelvis x-rays of right hip arthroplasty show (A) cup component templated (B) femoral component templated.

Fig. 3

The patient is a 85-year-old male with right femoral neck fracture. (A) Intraoperative anteroposterior pelvis x-rays of left bipolar hip arthroplasty shows shortened right lower extremity. LLD was 11.6 mm. It can be corrected with a longer femoral head. (B) Postoperative anteroposterior pelvis x-rays shows restoration of leg lengths. LLD was 0.3 mm.

Table 1

Diagnosis and Operation

Table 2

Leg-Length Discrepancy

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