Stability and leg length equality in total hip arthroplasty

Limp is one of the most frustrating persistent symptoms after hip arthroplasty for both the patient and surgeon. There are a multitude of causes of limp; however, leg-length inequality is the leading culprit. Leg-length inequality can lead to anger, litigation, morbidity, and ultimately revision surgery. However, geometrically equal leg lengths may not be an attainable goal in all patients. The stability of the total hip arthroplasty is intimately related to leg length, and equality may need to be sacrificed for stability. Therefore, both the patient and the surgeon should have realistic expectations and an awareness of this problem.