Limb length discrepancy and related problems following total hip joint replacement

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Limb length discrepancy is a recognized complication following total hip replacement (THR).
• Patient-reported issues related to limb length changes after THR can impact functional outcomes and satisfaction.

Purpose of the Study:

• To quantify the operative change in limb length after total hip replacement.
• To evaluate the accuracy of radiologic assessment for limb length changes.
• To identify the incidence and potential contributing factors for subjective complaints and neurological complications post-THR.

Main Methods:

• Radiologic evaluation of limb length was performed on 150 patients who underwent total hip replacement.
• Data were analyzed to determine average limb lengthening and identify factors influencing it, such as greater trochanter removal.
• Patient-reported outcomes, including the need for heel lifts, and neurological complications, specifically sciatic nerve palsies, were documented and analyzed.

Main Results:

• Radiologic evaluation accurately assessed limb length changes.
• A significant majority of limbs (144 out of 150) experienced lengthening, averaging 15.9 mm.
• Limb lengthening was slightly reduced when the greater trochanter was removed during surgery.
• Twenty-seven percent of patients (40/150) required heel lifts for satisfactory gait.
• Partial sciatic nerve palsies occurred in 3.3% of cases, correlating with repeat surgeries but resolving or improving in all instances.

Conclusions:

• Total hip replacement frequently results in limb lengthening, accurately measured by radiography.
• While limb lengthening is common, interventions like heel lifts are often necessary to address gait abnormalities.
• Sciatic nerve palsies are a rare but potential complication, particularly after revision surgeries, with a generally favorable prognosis.