The Impact of Leg Length and Offset Change on Dislocation Risk Following Primary Total Hip Arthroplasty

Soft tissue management in total hip arthroplasty includes appropriate restoration and/or alteration of leg length (LL) and offset to re-establish natural hip biomechanics. The purpose of this study was to evaluate the effect of LL and offset-derived variables in a multivariable survival model for dislocation.

Clinical, surgical, and radiographic data was retrospectively acquired for 12,582 patients undergoing primary total hip arthroplasty at a single institution from 1998 to 2018. There were twelve variables derived from preoperative and postoperative radiographs related to LL and offset that were measured using a validated automated algorithm. These measurements, as well as other modifiable and nonmodifiable surgical, clinical, and demographic factors, were used to determine hazard ratios for dislocation risk.

None of the LL or offset variables conferred significant risk or protective benefit for dislocation risk. By contrast, all other variables included in the multivariable model demonstrated a statistically significant effect on dislocation risk with a minimum effect size of 28% (range 0.72 to 1.54) (sex, surgical approach, acetabular liner type, femoral head size, neurologic disease, spine disease, and prior spine surgery).

Contrary to traditional teaching and our hypothesis, operative changes in LL and offset did not demonstrate any clinically or statistically significant effect in this large and well-characterized cohort. This does not imply that these variables are not important in individual cases, but rather suggests the overall impact of LL and offset changes is relatively minor for dislocation risk compared to other variables that were found to be highly clinically and statistically significant in this population. These results may also suggest that surgeons do a good job of restoring native LL and offset for patients, which may mitigate their analyzed impact.