Clinical and radiographic outcomes of surgical management for leg length inequality after primary total hip arthroplasty

Background

Limb length inequality (LLI) is a leading cause of patient dissatisfaction and litigation after total hip arthroplasty (THA). However, the surgical treatment of this complication remains controversial. In this retrospective and observational study, we evaluated the results obtained from 31 patients who underwent revision surgery for symptomatic LLI after conservative treatment had failed. Our primary endpoint was the radiographic correction of LLI. Secondary endpoints included assessing the improvement in quality of life (QoL) after surgical treatment [using the Harris Hip Score (HHS) and the 12-item Short Form Survey (SF-12)] and tracking possible complications (e.g., dislocation, residual instability).

Materials and methods

Type of surgery, implanted materials, preoperative sciatic nerve deficit, and the development of postoperative complications were recorded. Radiographic assessment was performed by measuring LLI, Femoral Offset (FO), Acetabular Offset (AO), Global Offset (GO), and height of the Center of Rotation (CORL), and calculating the difference with the contralateral side and postoperative measurements. Clinical assessment was performed by having patients answer to the HHS and the SF-12, which comprises a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12).

Results

LLI, GO, and CORL showed a statistically significant variation between preoperatory and postoperatory radiographs. The same was found to apply also to clinical results, the HHS, and the SF-12. Linear regression analysis showed a single association between sex and postoperative HHS. No other association was found to be statistically significant.

Conclusions

In selected patients who have symptomatic structural LLI after primary THA, revision surgery can be a valid approach to restore the proper limb length and to improve the clinical outcomes with an acceptable risk of complications and instability.