Analysis of the Functional Outcome of Limb Length Discrepancy after Total Hip Replacement

Background: The Aim of the study was to analyze the functional outcome of limb length discrepancy after total hip replacement. . Methods: It is a Prospective study on 21 patients who underwent total hip replacement with different hip pathology between November 2015 and October 2017. Results: 13 males and 8 females patients with a mean age of 35.31±7.42 (21-50) were followed up for a time of 12months. Limb length discrepancy and hip function of 21 patients who underwent primary total hip arthroplasty were assessed before surgery and 1month, 3 month and 12 month after surgery. Limb length discrepancy was evaluated before and after surgery by clinical and radiological method, Functional outcome assessed by using the Oxford hip score (OHS) and Harris hip score(HHS). Preoperatively all patients had shorter limb length as compared to contra lateral side. Postoperatively in 42.9% (9/21) the limb operated on was longer, in 19 %( 4/21) of cases limb operated on was shorter and in 31 %( 8/21) postoperative limb length were equal. Postoperatively limb length discrepancy was present in 61.9 %( 13/21) & was perceived by 53.8 %( 7/13 of cases) when either shortening or lengthening exceeded 10mm. Oxford hip score (OHS) and Harris hip score (HHS) were significantly increased at subsequent follow up (at 1, 3 and 12 months). Functional scores (OHS and HHS) were excellent in patients with equal limb length as compared to those having shorter or longer limb length. Conclusion: Patient with limb length discrepancy had negative influence in relation to limping and pain. Patients should be counseled preoperatively about possible limb length differences and associated symptoms.

Tratamiento quirúrgico de las dismetrías y deformidades angulares de miembros inferiores mediante epifisiodesis con tornillos transfisarios (técnica de Metaizeau) / Surgical treatment of lower limb length discrepancy and angular deformity by epiphysiodesis with transphyseal screw (Metaizeau technique) / Tratamento cirúrgico das dismetrias e deformidades angulares de membros inferiores mediante epifisiodese com parafusos transfisários (técnica de Metaizeau)

Evaluamos los niños con dismetrías y deformidades angulares operados mediante la Técnica de Metaizeau en el período 2010-2014, mediante un estudio retrospectivo de 11 pacientes, analizados en 2 Grupos. Grupo 1 (Dismetrías), formado por 5 pacientes, de los cuales 3 fueron operados solamente mediante esta técnica, mientras que 2 requirieron adicionalmente procedimientos de alargamiento femoral, valoramos dismetría inicial, dismetría por predicción para el último control y para el final de la madurez, y dismetría final. Grupo 2 (Deformidades Angulares), formado por 6 pacientes, de los cuales 1 presentaba genu varo, 4 genu valgo y 1 valgo de tobillo, valoramos el ángulo femorotibial anatómico, ángulo femoral distal lateral anatómico, ángulo tibial proximal medial, y ángulo tibioastragalino. En ambos Grupos se valoraron las complicaciones. El seguimiento promedio fue de 2 años y 5 meses. En el Grupo 1 obtuvimos dismetría promedio inicial 7,64 cm., dismetría promedio por predicción para el último control 8,54 cm., dismetría promedio final 7,62 cm., corrección promedio lograda 0,91 cm. En el Grupo 2 el promedio de corrección del ángulo femorotibial anatómico 16,85˚, promedio de corrección del ángulo femoral distal lateral anatómico 16,85˚, promedio de corrección del ángulo tibial proximal medial 7,62˚. No detectamos complicaciones en ningún paciente. En 8 (72,72%) pacientes la Técnica fue efectiva, mientras que en 3 (27,27%) los resultados fueron malos por errores técnicos o error en la predicción. La Técnica de Metaizeau, respetando los detalles quirúrgicos y realizando una adecuada predicción, es una buena opción para el tratamiento de dismetrías y deformidades angulares.

We evaluated children with lower limb length discrepancy and angular deformity operated by the Metaizeau technique in the 2010-2014 period through a retrospective study of 11 patients analyzed in 2 groups. Group 1 (Lower limb length discrepancy), consisted of 5 patients, among whom 3 were operated only by Metaizeau technique, whereas the other 2 additionally required procedures for femoral elongation. We evaluated initial discrepancy, predicted discrepancy for ultimate control and at maturity, and final discrepancy. Group 2 (Angular deformity), consisted of 6 patients, among whom 1 had genu varum, 4 genu valgum and, 1 ankle valgus. We evaluated anatomic femorotibial angle, anatomic lateral distal femoral angle, medial proximal tibial angle, and tibio talar angle. In both groups the complications were assessed. The average follow-up was 2 years and 5 months. In Group 1 we obtained the following values: average initial discrepancy, 7.64 cm; average discrepancy predicted for ultimate control, 8.54 cm; average final discrepancy, 7.62 cm and average correction achieved, 0.91 cm. In Group 2 the values were: average correction anatomic femorotibial angle, 16.85˚; average correction anatomic lateral distal femoral angle, 16.85˚ and average correction medial proximal tibial angle, 7.62˚. We found no complications in any patient. In 8 patients (72.72%) the technique was effective, while in 3 (27.27%) the results were poor due to technical errors or prediction errors . Metaizeau Technique, respecting the surgical details and making an accurate prediction is an effective, simple and uncomplicated procedure.

Avaliamos as crianças com dismetrias e deformidades angulares operadas pela técnica de Metaizeau no período de 2010 até 2014, mediante um estudo retrospectivo de 11 pacientes analisados em dois grupos. Grupo 1 (Dismetrias), constituído por cinco pacientes, dos quais 3 foram operados apenas por esta técnica, enquanto que os outros dois precisaram de procedimentos adicionais de alongamento femoral. Avaliamos a dismetria inicial, a dismetria por predição para o último controle e para o final da maturação, e a dismetria final. Grupo 2 (deformidades angulares), constituído por 6 pacientes, entre os quais um apresentava genu varo, 4 genu valgo e um, valgo do tornozelo. Avaliamos o ângulo femorotibial anatômico, o ângulo femoral distal anatômico o ângulo femoral distal lateral anatômico, o ângulo tibial proximal medial, e o ângulo tibioastragalino. Em ambos os grupos foram avaliadas as complicações. O seguimento médio foi de 2 anos e 5 meses. No Grupo 1, obtivemos dismetría inicial média de 7,64 cm, dismetria média por previsão para o último controle de 8,54 cm, dismetría final média de 7,62 cm e correcção média atingida de 0,91 cm. No Grupo 2, a correção de ângulo tibiofemoral anatómica média 16,85˚, correção média do ângulo femoral distal lateral anatómico 16,85˚, e correção média de ângulo tibial proximal medial de 7,62˚. Não detectamos complicações em nenhum paciente. A técnica foi efetiva em 8 (72,72%) pacientes, mas em 3 (27,27%) os resultados foram insatisfatórios por erros técnicos ou na predicção. A técnica de Metaizeau, desde que sejam respeitados os detalhes cirúrgicos e seja feita uma predicção adequada, é uma boa escolha para o tratamento de dismetrías e deformidades angulares.

Hip Screening in Infants Presenting with Asymmetricity of Lower Extremity / 대한정형외과학회잡지

PURPOSE: This study aimed to investigate the clinical features of congenital postural deformities and lower extremity asymmetry with respect to the presence of developmental dysplasia of the hip (DDH) in infants with a discrepancy of the limb length referred for suspected DDH. MATERIALS AND METHODS: We retrospectively reviewed the medical records and radiographs of 150 infants who visited Korea University Anam Hospital Orthopedic Clinic for suspected DDH between March 2013 and March 2015. RESULTS: There were greater numbers of infants with a shorter lower extremity on the left side (n=86, 57.3%) than the right. Plagiocephaly was present in 62 infants and trunk curvature in 124 infants (82.7%). Pelvic tilting—indirectly assessed by a skewed direction of the external genitalia in female infants—was present in 62 infants (63.3%). None of the 139 infants with normal physical examination of the hip were diagnosed with DDH. Of those 11 infants with abnormal findings from the hip physical examination, a total of 6 infants were diagnosed with DDH. CONCLUSION: Regardless of the associated findings of congenital postural deformation, all infants diagnosed with DDH had abnormal findings from the physical examination of the hip joint. Thus, we conclude that the hip examination is important as the primary clinical screening in aiding the diagnosis of DDH.

Alargamiento de extremidades: actualización y revisión del tema / Limb lengthening: review and update

El alargamiento de extremidades trata las discrepancias de longitud de extremidades superiores e inferiores. Lograr un adecuado tratamiento temprano evita secuelas irreversibles como la artrosis. El estudio de las discrepancias se realiza con una telerradiografía estandarizada, la cual entrega la información de cuál es el segmento óseo comprometido y cuál es el largo total a corregir. Menos de 15mm de discrepancia se ha demostrado que no tiene influencia sobre la mecánica de la marcha ni de las articulaciones. Más de 15mm produce una alteración en las cargas articulares, rangos de movimiento articular, compensaciones musculares, compensaciones de columna (escoliosis compensatoria), entre otras, que producen secuelas a largo plazo. Los métodos de tratamiento existentes son conservadores y quirúrgicos. Dentro de estos últimos están los fijadores externos e internos. Los fijadores externos tienen una alta frecuencia de infecciones superficiales a través de las agujas, sin embargo, son versátiles y capaces de corregir prácticamente cualquier deformidad. Los fijadores internos (por ejemplo, clavos intramedulares) no pueden corregir grandes deformidades, así como tampoco realizar grandes alargamientos, sin embargo, su frecuencia de complicaciones es mucho menor y son mucho mejor tolerados por el paciente. Estos métodos de tratamiento logran resultados muy precisos. Tienen un margen de error de 3,5 mm de longitud, lo cual no tiene consecuencias mecánicas para una extremidad. La tasa de satisfacción es de alrededor del 90 por ciento y logran un alivio del dolor significativo...

Limb lengthening can be used to correct upper and lower limb length discrepancies. To obtain an appropriate treatment early in life prevents irreversible consequences, such as arthritis. The limb length discrepancies study is performed with a standardised leg length X-ray. This X-ray shows the compromised bone segment and what the total limb length discrepancy is. A limb length discrepancy of less than 15mm has no influence on factors such as, gait mechanics, joint range of motion, or long term joint degeneration. Over 1.5cm, several consequences appear such as: joint overload, decreased joint range of motion, muscle compensations and compensatory spine malalignment. Existing treatment includes non-surgical and surgical methods. Among the latter are internal and external fixations. External fixations have a high frequency of superficial infections, but are highly versatile, being able to correct virtually any deformity. The internal fixation (e.g. intramedullary nails) cannot correct large deformities, or make big lengthenings, but its complication rate is much lower and is much better tolerated by the patient. These treatment methods achieve very accurate results. They have an error of 3.5mm in length, which has no mechanical consequences to an extremity. The satisfaction rate is high, with around 90 percent achieving a significant pain relief...

Roux-en-Y gastric bypass: limb length and weight loss / Derivação gástrica em Y-de-Roux: comprimento das alças e emagrecimento

BACKGROUND: Roux-en-Y gastric bypass is a surgical technique widely used in the treatment of obesity. It is unclear, however, if the length of the biliopancreatic and alimentary limb interferes with the magnitude of weight loss. AIM: To evaluate if the length of these limbs is related to the percentage of weight loss one year after surgery. METHOD: One hundred and twenty obese people underwent surgery between 2009 and 2011. Patients were inserted into four groups: A) biliopancreatic limb with 50 cm length and alimentary limb with100 cm length; B) biliopancreatic limb with 50 cm length and alimentary limb with 150 cm length; C) biliopancreatic limb with 100 cm length and alimentary limb with100 cm length; D) biliopancreatic limb with 100 cm length and alimentary limb with150 cm length. Age, gender, body mass index and the percentage of total weight loss were analyzed. Data were collected preoperatively and one year after surgery. The groups were compared and weight loss compared between groups. RESULTS: The follow-up occurred in 78.3% of the sample. The composition of the groups was similar, with no statistical significance. The average age was 43 years in groups A, C and D and 42 years in group B. The female gender predominated in all groups (about 60% of the sample). The mean body mass index was 46 kg/m2 for groups A, C and D and 42 kg/m2 in group B. The percentage of weight loss was 33% for group A and 34% for groups B, C and D. There was no significant difference among groups. CONCLUSION: Different lengths of the biliopancreatic and alimentary limbs did not affect the percentage of total weight loss. .

RACIONAL: A derivação gástrica em Y-de-Roux é técnica cirúrgica amplamente empregada no tratamento da obesidade. Não está claro, porém, se o comprimento das alças biliopancreática e alimentar interfere na magnitude da perda de peso. OBJETIVO: Avaliar se o comprimento dessas alças tem relação com a percentagem de perda de peso, um ano após a operação. MÉTODO: Cento e vinte obesos foram submetidos à cirurgia entre 2009 e 2011. Eles foram inseridos, por sorteio, em qautro grupos: A) alça biliopancreática de 50 cm e alimentar de 100 cm; B) alça biliopancreática de 50 cm e alimentar de 150 cm; C) alça biliopancreática de 100 cm e alimentar de 100 cm; e D) alça biliopancreática de 100 cm e alimentar de 150 cm. Analisou-se a idade, o gênero, o índice de massa corpórea e a percentagem de perda do peso total. Os dados foram coletados no pré-operatório e um ano após a operação. Os grupos foram comparados entre si e a perda ponderal comparada entre os grupos. RESULTADOS: O acompanhamento ocorreu em 78,3% da casuística. A composição dos grupos foi semelhante, sem significância estatística. A média de idade foi de 43 anos nos grupos A, C e D e de 42 no grupo B. O gênero feminino predominou em todos os grupos (cerca de 60% da amostra). O índice de massa corpóreo médio foi de 46 kg/m2 para os grupos A, C e D e de 42 kg/m2no grupo B. A percentagem de perda de peso foi de 33% para o grupo A e de 34% para os grupos B, C e D. Sem diferença significante entre os grupos. CONCLUSÃO: Diferentes comprimentos das alças biliopancreática e alimentar não interferiram na percentagem de perda do peso total. .

Difference of Kinematic Pattern According to the Severity of Limb Length Discrepancy: 3-Dimensional Analysis / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to analyze the compensatory motion and extent of the patient with leg length discrepancy. MATERIALS AND METHODS: Thirty seven patients with leg length discrepancy were tested by conventional gait analysis from 2003 to 2012. The patients were divided into mild, moderate, and severe groups. Pelvic obliquity, hip flexion, hip abduction, knee flexion in stance and swing phase, and ankle plantar flexion were measured with regard to affected and unaffected limb. RESULTS: Pelvic obliquity, hip flexion, hip abduction, knee flexion in swing phase, and ankle plantar flexion were significantly difference between affected and unaffected limb. The range of motions in pelvic obliquity and ankle plantar flexion of affected limb were significantly higher according to severity of limb length discrepancy. CONCLUSION: The patients with limb length discrepancy have the different compensatory motion according to affected side and severity. We should adjust the target of treatment in consideration of limb length discrepancy.

Limping gait improvement by femoral lengthening in ankylotic hips and limb length discrepancy in young adults / 中南大学学报(医学版)

To investigate the clinical improvement of limping gait in patients with ankylotic hips and limb length discrepancy.Methods:From 1996 to 2005,12 patients with ankylotic hips and limb length discrepancy were treated by distraction osteogenesis with a mono-lateral external fixator and an intramedullary nail.The limb length discrepancy was 6.20-12.50 (median 8.45) cm.Limping gait was classified according to the recommendations of the American Academy of Orthopedic Surgeons/Hip Society and scored according to Harris:no limping scored 11 points,mild limping scored 8 points,moderate limping scored 5 points,while severe limping scored 0 points.Limping gait was severe in all patients pre-operatively and the total score was 0.Results:All patients were followed up for 30.00-46.00 (median 38.55) months,and all reported improvement in limping gait.The gain in length was 6.00-12.50 (median 8.20) cm,and the mean residual limb length discrepancy was 0-0.50 (median 0.20) cm.The total treatment time was 41.00-82.00 (median 61.50) weeks,the lengthening time was 14.00-38.00 (median 29.55) weeks.At the last follow-up,10patients had mild limping gait and 2 had moderate limping gait; the total score was 90.00.The median score was 7.50 (P25 was 8.00,P75 was 8.00).According to Wilcoxon signed rank test,the post-operative limping gait scores were significantly higher than pre-operative (P=0.001 ).Conclusion:Femoral lengthening can improve the limping gait significantly in ankylotic hips and limb length discrepancy.

The Relationship between Limb-Length Discrepancy on Function, Dislocation, Pain and Acetabular Wear after Bipolar Hemiarthroplasty for Femoral Neck Fracture

PURPOSE: To evaluate the relationship between a limb-length discrepancy and the clinical and radiological outcomes after bipolar hemiarthroplasty for femur neck fractures in elderly patients. MATERIALS AND METHODS: Between August 2004 and January 2007, 60 out of 80 cases over 65 years who underwent cemented bipolar hemiarthroplasty for femur neck fractures with a more than 2 years follow-up were evaluated retrospectively by dividing the patients into two groups, > 5 mm (group 1) and 0.05). CONCLUSION: Limb-lengthening by hemiarthroplasty may be a cause of pain but with little effect on the overall functional outcome.

One stage Versus Two stage Reduction of MalunitedFemoral Fracture with Shortening

Reduction of a malunited femoral diaphyseal fracture can be achieved by osteotomy and immediate internal fixation or gradual skeletal traction followed by delayed internal fixation. We retrospectively reviewed 27 patients with malunited and shortened femur. Nine patients with mean shortening of 4.7 cm (2.5 10.0) underwent acute one stage reduction and gained 2.5 to 5.0 cm length. Eighteen patients with mean shortening of 5.3 cm (3.5 to 9.0) underwent twostage reduction and gained 2.0 to 5.0 cm length. Ther

Total Hip Arthroplasty in Patients who had Previous Infection of the Hip with LegLength Discrepancy / 대한정형외과학회잡지

PURPOSE: To analyze the results of a minimum of three-year follow-up in patients with a severely deformed sequelae pyogenic hip, who had undergone total hip arthroplasty with a simultaneous limb length correction. MATERIALS AND METHODS: The postoperative complication, clinical and the radiographic results were analyzed in 74 out of 102 patients, who were followed for a minimum of three years between December 1987 and May 2003. The average age was 42.8 years. The average follow-up duration was 4 years and 11 months. There were 50 tuberculosis infections, 24 pyogenic infections, and 23 fused hip cases. The average leg length shortening was 4.1 cm (range, 1.0-10.0 cm). RESULTS: Preoperative Harris hip score improved to 90.2 postoperatively from 65.0 (range, 25-92.5) preoperatively. Leg length shortening was corrected by 0.4 cm (0.0-3.0 cm). Radiographically, excluding the 3 revisions, no case met the criteria of definite loosening. The postoperative complications included the recurrence of tuberculosis (2 cases), and variable nerve palsies, including femoral nerve (3 cases), and a sciatic nerve (3 cases). These patients completely recovered from nerve palsy. B-K amputation, after the postoperative exacerbation of circulation to the affected limb, was needed in one case with a preoperatively undetected femoral artery occlusion. CONCLUSION: Although, restoring the normal limb length in the severely deformed pyogenic hip sequelae patients requires highly demanding surgical techniques, with a relatively higher incidence of postoperative complications, it is possible to achieve a higher level of patient satisfaction and definite gait improvement.

Limb Length Estimation Based on Height in Normal People in Busan and Kyungnam Area

OBJECTIVE: To identify the relation between height and limb length using anthropometric data in healthy people. METHOD: One hundred and fifty healthy subjects between the age of 7 months and 67 years were subdivided into five groups: group I (age under 5), group II (5~10), group III (11~20), group IV (21~60), and group V (61 or more). Each group included 15 males and 15 females. Upper arm was measured between acromion and olecranon, and forearm was measured between olecranon and thumb tip. Thigh was measured between ASIS and medial plateau of tibia, and lower leg was measured between medial plateau of tibia and the floor vertically. RESULTS: Ratios of upper arm to height were 0.18+/-0.01 in group I, 0.19+/-0.02 in group II, 0.19+/-0.01 in group III, 0.19+/-0.01 in group IV, and 018+/-0.01 in group V. Ratios of forearm to height were 0.23+/-0.03, 0.23+/-0.03, 0.23+/-0.02, 0.22+/-0.01, and 0.22+/-0.01, respectively. Ratios of thigh to height were 0.27+/-0.03, 0.29+/-0.02, 0.31+/-0.02, 0.31+/-0.01, and 0.31+/-0.01 in each age group. Ratios of lower leg to height were 0.22+/-002, 0.25+/-0.02, 0.25+/-0.01, 0.26+/-0.01, and 0.25+/-0.01, respectively. CONCLUSION: Ratio of each body segment to height was useful in producing prosthesis for the people lost their both upper or lower extremities calculating the ultimate length of extremities through it.

Femoral Lengthening with External Fixator over the Intramedullary Nail / 대한정형외과학회잡지

PURPOSE: The results and complications of femoral lengthening over an intramedullary nail with a external fixator in patients with limb length discrepancy were retrospectively reviewed. MATERIALS AND METHODS: After lengthening 22 femoral segments, all patients were followed-up for a mean of 3.2 years (range, 2 to 5.2 years). They ranged in age from 13 to 35 years (average age, 22.2 years) at the time of the index procedure. The mean lengthening was 5 cm (2.7 to 8.1 cm), and the external fixator was removed after a median 135.9 days (range, 59 to 210 days). The mean external fixation index was 23.8 days/cm of lengthening (range, 11.1 to 34.7 days/cm of lengthening). RESULTS: Nineteen patients achieved the length of their pre-operative goal. However, there were 3 failures with osteomyelitis and the removal of the nail, which had a past history of infection or open trauma. There were 4 knee joint complications when the lengthening was over 20%. These included three cases of a patella subluxation and one case of a posterior knee subluxation. In the other complications, there was one case of a collapse in the lengthened segment with a breakage of the locking screws. CONCLUSION: Although lengthening over a nail can reduce the duration of external fixation, caution is needed in order to prevent complications.