Management of limb length inequality during total hip replacement

Significant limb length inequality is not an uncommon problem after total hip replacement. Preoperative measurement of limb length inequality, preoperative planning with radiographic templates, and intraoperative correction with measurements of limb lengths before and after the insertion of the trial components using special calipers can reduce the incidence and magnitude of this problem. A review of 85 consecutive patients who had primary total hip arthroplasty in which these techniques were used by a single surgeon, showed that 43 had limb inequality preoperatively ranging from 0.5 to 7.25 cm, but only 14 (16%) had limb length inequality after surgery. Eleven limbs (13%) had been lengthened 0.5 to 1 cm compared with the contralateral limb. Of the 42 patients with equal limb lengths preoperatively, 3 had a lengthened limb postoperatively compared with their contralateral limb. Four patients were using lifts on the same side because the limb was too short, and 2 were using lifts on the other side because the limb was too long. None of the other patients complained about limb length inequality. The techniques described above are helpful in minimizing limb length inequality during total hip replacements.