ABSTRACT
ABSTRACT Objective The ceramic-on-metal (CoM) bearing has the theoretical advantages over ceramic-on-ceramic (CoC) and metal-on-metal bearings. This study aimed to analyze factors affecting the metal ion release of CoM bearings and compare clinical performance with CoC bearings. Methods The 147 patients were divided into 96 patients in group 1 (CoM group) and 51 patients in group 2 (CoC group). Additionally, within group1, 48 patients and 30 patients were sub-categorized into group 1-A with leg length discrepancy (LLD) less than 1cm and group 1-B greater than 1 cm. The level of serum metal ions, functional scores and plain radiographs were obtained for the analysis. Results The level of cobalt (Co) 2-years after surgery and chromium (Cr) 1-year after surgery showed significantly higher in the group1 than the group2. LLD indicated statistically significant positive correlation between serum metal ion levels among CoM bearing THAs. In comparison of the average metal ions level changes, group 1-B showed higher level of metal ion than group 1-A. Conclusion In patients underwent THA with CoM bearings, large LLD have a higher risk of complications associated to metal ions. Therefore, it is critical to reduce the LLD to 1 cm or less in using CoM bearing. Level of Evidence III; Case Control Study.
RESUMO Objetivo Uma superfície metalocerâmica (CoM) apresenta vantagens teóricas sobre as superfícies cerâmica-cerâmica (CoC) e metal-metal. Este estudo teve como objetivo analisar os fatores que afetam a liberação de íons metálicos das superfícies CoM e comparar o desempenho clínico com as superfícies CoC. Métodos Os 147 pacientes foram divididos em 96 pacientes no grupo 1 (grupo CoM) e 51 pacientes no grupo 2 (grupo CoC). No grupo 1, 48 pacientes foram subcategorizados em grupo 1-A, com discrepância de comprimento das pernas (LLD) menor que 1 cm; e 30 pacientes no grupo1-B maior que 1 cm. O nível de íons metálicos séricos, escores funcionais e radiografias foram obtidas para a análise. Resultados Os níveis de cobalto (Co) 2 anos após a cirurgia e de cromo (Cr), após o primeiro ano da cirurgia mostraram-se significativamente mais altos no grupo 1 do que no grupo 2. A LLD indicou correlação positiva estatisticamente significativa entre os níveis de íons do soro metálico entre os portadores de THA de CoM. Em comparação com as alterações médias dos níveis de íons metálicos, o grupo 1-B revelou um nível de íons metálicos mais alto do que o grupo 1-A. Conclusão Em pacientes submetidos a THA com superfícies CoM e elevada LLD têm um maior risco de complicações associadas a íons metálicos. Sendo fundamental reduzir LLD para 1 cm ou menos no uso de superfícies CoM. Nível de Evidência III; Estudo de Controle de Caso.
ABSTRACT
SUMMARY: Leg length inequality (LLI) affects gait - primarily pelvic and torso movements. LLI is present in around 40-70 % of the healthy population. Due to LLI's significant impact on the body, as well as the possible occurrence of a variety of associated health problems, the aim of this research is to determine whether there is a significant difference in pelvic movement in all three planes, depending on the degree of LLI. This study was conducted on a sample of 30 healthy subjects. The functional length of lower limbs was measured. When LLI was calculated, kinematic measures were taken of pelvic and lower limb movements during gait using 3D cameras and ©Vicon Motion Systems Ltd. UK. The obtained data on kinematic pelvic movement in all three planes during gait were compared with the reference values. The results show that there is no statistically significant difference in pelvic movement about the axes x, y, and z in cases of LLI of up to 18mm (p>0,05). There is a statistically highly significant positive correlation between the difference in functional leg length (r=0,575; p=0,008) and femur length (r=0,525; p=0,015) on one hand, and the difference in pelvic movement about the axis x on the other, compared to the reference values. In a healthy population with LLI from 0 to 18 mm, gait remains unaffected and an increase in LLI predominantly affects pelvic movement about the horizontal axis (x) - pelvic tilt, which exponentially increases with an increase in femur length discrepancy.
La diferencia en la longitud de las piernas (LLI, por sus siglas en inglés) afecta la marcha, principalmente los movimientos pélvicos y del dorso. La LLI está presente en alrededor del 40-70 % de la población sana. Debido al importante impacto de LLI en el cuerpo, así como a la posible aparición de una variedad de problemas de salud asociados, el objetivo de esta investigación fue determinar si existe una diferencia significativa en el movimiento pélvico en los tres planos, dependiendo del grado de LLI. Este estudio se realizó en una muestra de 30 sujetos sanos. Se midió la longitud funcional de los miembros inferiores. Cuando se calculó el LLI, se tomaron medidas cinemáticas de los movimientos pélvicos y de los miembros inferiores durante la marcha utilizando cámaras 3D y ©Vicon Motion Systems Ltd. UK. Los datos obtenidos sobre el movimiento pélvico cinemático en los tres planos durante la marcha se compararon con los valores de referencia. Los resultados mostraron que no existe diferencia estadísticamente significativa en el movimiento pélvico sobre los ejes x, y, y z en casos de LLI de hasta 18 mm (p>0,05). Existe una correlación positiva estadísticamente muy significativa entre la diferencia en la longitud funcional de la pierna (r=0,575; p=0,008) y la longitud del fémur (r=0,525; p=0,015), y la diferencia en el movimiento pélvico sobre el eje x por otro, en comparación con los valores de referencia. En una población sana con LLI de 0 a 18 mm, la marcha no se ve afectada y un aumento en LLI afecta predominantemente el movimiento pélvico sobre el eje horizontal (x) - inclinación pélvica, que aumenta exponencialmente con un aumento en la discrepancia de longitud del fémur.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Anthropometry , Gait , Leg Length Inequality/pathologyABSTRACT
ABSTRACT Objectives: The leg length (LL) and femoral offset (FO) discrepancy following total hip arthroplasty (THA) are important factors for postoperative outcomes and restoring native hip biomechanics is essential for THA. Hip capsular ligament contributes to joint stability; however, there are few studies about the influence of ligament preservation on LLD and FO following THA. Methods: We conducted a retrospective study involving 60 patients who underwent primary THA using a short stem through the anterolateral approach between June 2016 and August 2018. From August 2017, we preserved the vertical band of iliofemoral ligament and the pubofemoral ligament in THA, and the compared pre- and postoperative radiographic LLD and FO difference between the ligament preservation (n = 30) and ligament excision (n = 30) groups. Results: Postoperative LLD was significantly smaller in the ligament preservation than in the ligament excision group. The ratio of excessive LLD and FO difference was lower in the ligament preservation group than the ligament excision one. Conclusion: The preservation of the hip capsular ligament suppressed the increased LLD and FO difference. Level of Evidence II; Prognostic Study - Investigation of the Effect of a Patient Characteristic on the Outcome of a Disease .
RESUMO Objetivos: A discrepância do comprimento da perna (CP) e do offset femoral (OF) após a artroplastia total do quadril (ATQ) são fatores importantes para os resultados pós-operatórios, e a restauração da biomecânica original do quadril é essencial para a ATQ. O ligamento capsular do quadril contribui para a estabilidade articular; entretanto, existem poucos estudos sobre a influência da preservação ligamentar no LLD e FO após ATQ. Métodos: Realizamos um estudo retrospectivo envolvendo 60 pacientes submetidos à ATQ primária com haste curta por via anterolateral entre junho de 2016 e agosto de 2018. A partir de agosto de 2017, a banda vertical do ligamento iliofemoral e do ligamento pubofemoral na ATQ foram preservadas e compararadas à diferença de LLD e FO radiográficas pré- e pós-operatórias entre os grupos de preservação ligamentar (n = 30) e excisão ligamentar (n = 30). Resultados: O LLD pós-operatório foi significativamente menor no grupo de preservação do ligamento que no grupo de excisão do ligamento. A razão de diferença de LLD e FO excessivas foi menor no grupo de preservação do ligamento do que no grupo de excisão do ligamento. Conclusão: A preservação do ligamento capsular do quadril suprimiu o aumento da diferença de LLD e FO. Nível de evidência II; Estudo Prognóstico - iIvestigação do Efeito da Característica de um Paciente no Desfecho da Doença.
ABSTRACT
ABSTRACT BACKGROUND: Leg length discrepancy (LLD) may play a key role in exercise biomechanics. Although the Podoprint platform has been used in dynamic pressure studies, there are no data regarding the reliability and repeatability of dynamic measurements under simulated LLD conditions. OBJECTIVES: To determine the intra and intersession repeatability and reliability of dynamic parameters of the Podoprint pressure platform under simulated LLD conditions. DESIGN AND SETTING: Observational cross-sectional study at a public university. METHODS: Thirty-seven healthy volunteers participated in this study. LLD was simulated using ethyl vinyl acetate plantar lifts with heights of 5 mm, 10 mm, 15 mm and 20 mm located under the right shoe of each volunteer. The procedure was performed to capture the dynamic parameters of each participant under five different simulated LLD conditions. Stance time, mean pressure and peak pressure measurements were registered in three trials for each foot and each LLD level. Data were collected during two separate testing sessions, in order to establish intrasession and intersession reliability. RESULTS: The intraclass correlation coefficients (ICCs) for intrasession reliability ranged from 0.775 to 0.983 in the first session and from 0.860 to 0.985 in the second session. The ICCs for intersession reliability ranged from 0.909 to 0.990. Bland-Altman plots showed absence of systematic measurement errors. CONCLUSIONS: The results from this study indicate that the Podoprint platform is a reliable system for assessing dynamic parameters under simulated LLD conditions. Future studies should evaluate plantar pressures under LLD conditions, in association with exercise, biomechanics and musculoskeletal disorders.
Subject(s)
Humans , Foot , Leg , Exercise , Cross-Sectional Studies , Reproducibility of ResultsABSTRACT
Objective:To compare the accuracy of two methods in reducing leg length discrepancy(LLD)during hip hemiarthroplasty.Methods:We retrospectively analyzed 89 patients of hip hemiarthroplasty who suffered from femoral neck fracture.There were 47 patients in the new method group(NM), and 42 patients in the traditional method group(traditional method, TM)which comparing the position of the greater trochanter tip and the center of the femoral head.In the NM group, the distance from the center of femoral head to the lesser trochanter(L)and the diameter of femoral head(D)of the healthy side hip were measured on preoperative anteroposterior pelvic X-ray film, and the ratio(R)of D to L was calculated.During operation, the diameter of the femoral head(d)was measured with a caliper, and the distance should be obtained from the center of the femoral head prosthesis to the lesser trochanter according to the ratio R of the healthy side.The difference of postoperative LLD between the two groups and the incidences of |LLD| in each range were compared.Results:In the NM group, the maximum LLD was 11.10 mm and the minimum LLD was -4.0 mm, with an average of(4.4±3.2)mm, 80.9%(38/47)| LLD | < 6 mm, 93.6%(44/47)| LLD | < 10 mm, 6.4%(3/47)| LLD | ≥ 10 mm.In the TM group, the maximum LLD was 13.2 mm and the minimum LLD was -8.3 mm, with an average of (6.2±5.1)mm, 42.9%(18/42)|LLD|<6 mm, 69.0%(29/42)|LLD| <10 mm, 31.0%(13/42)|LLD|≥10mm.The differences of patients of the mean postoperative LLD and the incidences of |LLD| in each range between two the groups were statistically significant( t=-2.036、 χ2=14.629, P=0.046、0.001). Conclusions:The new method is simple, convenient, more accurate and can obtain a more satisfactory LLD compared with the traditional method which refers to the relative position of the great trochanter tip and the center of the femoral head.
ABSTRACT
BACKGROUND: There are many reasons for poor function after knee arthroplasty. Leg length discrepancy is one of them. The extent of influence on the function of knee joint after arthroplasty has not been fully studied. OBJECTIVE: To analyze the change degree, possible influencing factors and functional changes of leg length discrepancy in patients after total knee arthroplasty. METHODS: Totally 107 patients (124 knees), including 23 males and 84 females, were included from October 2016 to September 2018, who entered the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University for total knee arthroplasty. There were 90 cases of unilateral total knee arthroplasty (90 knees) and 17 cases of bilateral total knee arthroplasty (34 knees). Three cases (6 knees) of bilateral total knee arthroplasty received separate treatment with an interval of more than 6 months, and entered the unilateral knee group. Therefore, there were 93 cases (96 knees) in the unilateral knee group, and 14 cases (28 knees) in the bilateral knee group. Patients signed the informed consent. This study was approved by the Hospital Ethics Committee. At preoperative and postoperative 10 days and 6 months, full length anteroposterior radiographs were taken, and the length of the lower limb and hip-knee-ankle angle were measured and recorded. Angle of knee flexion contracture was measured and the hospital for special surgery knee score was recorded. RESULTS AND CONCLUSION: (1) The length of patients' lower limbs was increased by the correction of deformities after total knee arthroplasty. The length of lower limbs 10 days after surgery was longer than that at 6 months after surgery. The lower limbs of 70.2% of the patients were increased 10 days after total knee arthroplasty, and 79.0% of the patients were increased 6 months after total knee arthroplasty. At 10 days and 6 months postoperatively, the postoperative corrected flexion contracture angles were positively correlated with the change of postoperative lower limb length. (3) Limb lengthening on the operative side was positively correlated with increased hospital for special surgery knee score after surgery. (4) The incidence of leg length discrepancy before and after surgery was almost equal: 45.1 % preoperatively, 55.3% 10 days postoperatively, and 46.0% 6 months postoperatively. (5) The leg length discrepancy preoperatively and 6 months postoperatively was influenced by the difference of deformities between the pair of limbs. Preoperative influencing factors were the difference of hip-knee-ankle angle and flexion contracture of both lower limbs. The difference value of flexion contracture of both lower limbs was the factor affecting the leg length discrepancy 6 months after surgery. Leg length discrepancy before surgery and 6 months after surgery was affecting the difference of hospital for special surgery knee score between lower limbs.
ABSTRACT
OBJECTIVE: To evaluate the association between progression of curvature of scoliosis, and correction for functional component in patients with juvenile idiopathic scoliosis (JIS). METHODS: We retrospectively reviewed medical data of patients prescribed custom molded foot orthosis (FO) to correct inequality of RCSPA (resting calcaneal stance position angle), and chose 52 patients (26 females, 26 males) with Cobb angle ≥10° in radiology and uneven pelvic level at iliac crest by different RCSPA (≥3°) as a factor of functional scoliosis. They had different hump angle ≥5° in forward bending test, for idiopathic scoliosis component. Their mean age and mean period of wearing FO were 79.5±10.6 months and 18.6±0.70 months. RESULTS: Cobb angle was reduced from 22.03°±4.39° initially to 18.86°±7.53° after wearing FO. Pelvis height difference and RCSPA difference, were reduced from 1.07±0.25 cm initially to 0.60±0.36, and from 4.25°±0.71° initially to 1.71°±0.75° (p < 0.01). Cobb angle improved most in 9 months. However, there was no significant improvement for those with more than 25° of Cobb angle initially. Mean Cobb angle improved in all age groups, but patients less than 6 years had clinically significant improvement of more than 5°. CONCLUSION: JIS can have functional components, which should be identified and managed. Foot orthosis is useful in correcting functional factors, in the case of pelvic inequality caused by different RCSPA, for patients with juvenile idiopathic scoliosis.
Subject(s)
Female , Humans , Foot Orthoses , Fungi , Leg Length Inequality , Pelvis , Retrospective Studies , Scoliosis , Socioeconomic Factors , SpineABSTRACT
PURPOSE: This study was conducted to compare cemented and cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures via meta-analysis and systematic review of relevant studies. MATERIALS AND METHODS: Systematic review and meta-analysis were performed on 31 available clinical studies; 19 of these studies used cemented stems, 12 used cementless stems, one used both types of stems, and two studies involved a comparative analysis of both stem types. RESULTS: There were statistically significant differences in rates of leg length discrepancy (LLD) greater than 1 cm between the cemented (event rate, 0.089) and cementless groups (event rate, 0.015 and 0.047; P=0.03). CONCLUSION: Cemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates; however, the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group.
Subject(s)
Aged , Humans , Hemiarthroplasty , Hip , Hip Fractures , Leg , Leg Length Inequality , MortalityABSTRACT
BACKGROUND: Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation. METHODS: From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications. RESULTS: The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm. CONCLUSIONS: With proper selection of the bearing surface coupled with adjustment of lengthening, cementless total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy might be a favorable treatment option for high hip dislocation.
Subject(s)
Humans , Arthroplasty , Arthroplasty, Replacement, Hip , Crows , Joint Dislocations , Extremities , Femur , Follow-Up Studies , Hip Dislocation , Hip Dislocation, Congenital , Hip , Leg , Leg Length Inequality , Medical Records , Osteotomy , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: Sacral slanting is a frequent unique phenomenon in patients with adolescent idiopathic scoliosis (AIS) and may be important for selecting the distal fusion level. However, the reason of the phenomenon remains unknown. The purpose of this study was to determine the association between sacral slanting and adjacent structures in patients with AIS. METHODS: A total of 303 AIS patients who underwent both whole spine standing anteroposterior (AP) and whole leg standing AP radiography were included. The degree of sacral slanting, pelvic obliquity, lumbar curve angles (L1-L4), and L4 tilt were assessed on whole spine standing AP radiographs. Whole leg standing AP radiographs were used to assess the degree of leg length discrepancy (LLD). Demographic data and radiological parameters were analyzed descriptively. Pearson correlation analysis and partial correlation analysis of the parameters were performed. A p-value of less than 0.05 was considered statistically significant. RESULTS: The proportion of patients with ≥ 5° of sacral slanting among those with < 3° of pelvic obliquity was 8.9% (27/303). Thirty-two patients (10.6%, 32/303) showed more than 10 mm of LLD. Sacral slanting was positively correlated with pelvic obliquity and lumbar curve (r = 0.445 and r = 0.325, respectively). Pelvic obliquity was also correlated with LLD and L4 tilt (r = 0.123 and r = 0.311, respectively). However, partial correlation analysis showed that LLD was not directly correlated with sacral slanting (r = −0.034). CONCLUSIONS: Sacral slanting can be thought to be a compensatory mechanism for large lumbar curves, which is accompanied by pelvic obliquity. In contrast, a congenitally slanted upper sacrum may contribute to scoliosis in some cases. LLD was not directly correlated with sacral slanting.
Subject(s)
Adolescent , Humans , Leg , Leg Length Inequality , Pelvis , Radiography , Sacrum , Scoliosis , SpineABSTRACT
OBJECTIVE: Femoral fracture is one of the most frequent fractures in children and complications occurs such as malunion and leg length discrepancy after internal fixation using flexible intramedullary nail. The author intended to consider operational treatment using flexible intramedullary nailing through a quantitative data including age, pattern and location of fracture for angulation, and leg length discrepancy. METHODS: A retrospective survey was performed by 30 cases of child patients who underwent internal fixation using flexible intramedullary nail for femoral shaft fracture. Using a simple radiography, duration of union and angulation were measured. Leg length discrepancy was evaluated by scanogram. By measuring each 2 times at an interval of 1 week by 2 observers, error among observers and error in observer were excluded. For statistical validation, t-test and lineal regression analysis were used. RESULTS: Immediate postoperatively, valgus condition of 7 degrees was represented and affected side was represented to show varus of 5.6 degrees on average in 46.6% of child patients. The more age of patient is young, more angulation was represented to be significantly taken place in transverse fracture rather than oblique fracture, but depending on fracture location, significant difference was not observed. Leg length discrepancy showed overgrowth of 6.39 mm on average. And cases of overgrowth over 5 mm being were represented and age of all the child patients was below 9 years old. As a result of statistical analysis, it was observed that the age is younger, leg length discrepancy was prone to be occurred, and its significant relevance with fracture form or fracture location was not represented. CONCLUSION: Transverse fracture is represented at the time of performing internal fixation using flexible intramedullary nail. Occurrence rate of angulation and leg length discrepancy was high but follow-up period is required to be extended even after the time when growth is completed on a long-term basis and in case of imperfect correction, additional treatment such as physeal plate stapling is required. Bone shortening and lengthening may be required and it is considered to be a useful method for femoral shaft fracture of children.
Subject(s)
Child , Humans , Congenital Abnormalities , Femoral Fractures , Follow-Up Studies , Fracture Fixation , Fracture Fixation, Intramedullary , Leg Length Inequality , Leg , Methods , Radiography , Retrospective StudiesABSTRACT
In an effort to overcome the drawbacks of distraction osteogenesis using the Ilizarov external fixator, intramedullary lengthening devices have been developed and applied for long bone distraction osteogenesis. Several successful cases have been reported, leading to the next generation of distraction osteogenesis. However, intramedullary lengthening devices have their own problems, such as device failure, difficulty of control of the lengthening degree. The authors report on a case of device failure during distraction osteogenesis using ISKD(R) (Orthofix Inc.) in the distraction phase, and the strategy that involved switching to a lengthening over nail system, which uses the Ilizarov external fixator, in order to obtain the target length.
Subject(s)
Equipment Failure , Equipment Failure Analysis , External Fixators , Osteogenesis, DistractionABSTRACT
Objective To compare the clinical outcomes and safety of synchronous vs staged bilateral total hip arthroplasty (THA).Methods Fifty-eight cases (116 hip joints) undergone bilateral THA from January 2008 to January 2010 were reviewed retrospectively.Follow-up period was postoperative 2 years,including synchronous bilateral THA in 29 cases (synchronous group) and staged bilateral THA in 29 cases (staged group).The two patient groups were compared in aspects of total operation time,total amount of blood loss,total amount of blood transfusion,duration and cost of hospitalization,postoperative discrepancy in bilateral leg length,preoperative and postoperative function score and perioperative complications.Results During the follow-up,no complications of incision infection,deep vein thrombosis and prothesis dislocation or loosening were noted.And postoperative delirium symptoms occurred only in four cases (three in synchronous group and one in staged group).There were no statistical differences between synchronous group and staged group in aspects of total operating time [(117.9 ± 23.8) minutes vs (124.1 ± 18.8) minutes],total amount of blood loss [338.1 ml (180-720 ml) vs 303.9 ml (200-600 rnl)],total amount of blood transfusion [227.6 ml (0-800 ml) vs 189.7 ml (0-400 ml)],postoperative function score.However,differences of the following data were considered statistical significance between synchronous group and staged group:expense of hospitalization [9.5 ten thousand yuan (7.0-11.3 ten thousand yuan) vs 10.5 ten thousand yuan (8.8-11.0 ten thousand yuan)],length of hospitalization [(12.1 ±3.2) days vs (20.1 ±3.5) days],postoperative discrepancy in bilateral leg length [(0.11 ± 0.22) cm vs (0.42 ± 0.44) cm].Conclusions Synchronous bilateral THA is safe and feasible as far as the patients' physical condition is allowed,perioperative management is rational and physicians have mature surgical techniques.Moreover,it gains advantage over staged bilateral THA considering cost of hospitalization,length of hospitalization and postoperative discrepancy in bilateral leg.
ABSTRACT
Desigualdade de membros inferiores (DMI) está presente em cerca de 70 por cento da população geral, podendo ser do tipo estrutural onde existe diferença no comprimento de estruturas ósseas, ou funcional, como resultado de alterações mecânicas dos membros inferiores. A desigualdade pode ainda ser classificada quanto a sua magnitude, sendo discreta, moderada, ou grave. As desigualdades discretas têm sido associadas especificamente à fratura por estresse, dor lombar e osteoartrite, e quando uma desigualdade está presente em indivíduos cuja sobrecarga mecânica é acentuada pela sua prática profissional, diária ou recreativa, estas alterações ortopédicas podem se manifestar precoce e gravemente. O objetivo deste estudo foi analisar e comparar a força reação do solo (FRS) durante a marcha de corredores com e sem DMI discreta. Os resultados mostraram que os sujeitos com desigualdades de 0,5 a 2,0 cm apresentaram no membro menor maiores valores da força vertical mínima (0,57 ± 0,07 PC) em relação ao membro maior (0,56 ± 0,08 PC). Logo, sujeitos com DMI discreta adotam mecanismos compensatórios capazes de gerar sobrecarga adicional ao sistema musculoesquelético para promover uma marcha simétrica como demonstrado pelos valores do Índice de Simetria Absoluto das variáveis da FRS vertical e horizontal.
Leg length discrepancy (LLD) affects about 70 percent of the general population, and can be either structural - when the difference occurs in bone structures - or functional, because of mechanical changes at the lower limbs. The discrepancy can be also classified by its magnitude into mild, intermediate, or severe. Mild LLD has been particularly associated with stress fracture, low back pain and osteoarthritis, and when the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these orthopaedic changes may appear early and severely. The aim of this study was to analyze and compare ground reaction force (GRF) during gait in runners with and without mild LLD. Results showed that subjects with mild LLD of 0.5 to 2.0 cm presented higher values of minimum vertical GRF (0.57 ± 0.07 BW) at the shorter limb compared to the longer limb (0.56 ± 0.08 BW) Therefore, subjects with mild LLD adopt compensatory mechanisms that cause additional overloads to the musculoskeletal system in order to promote a symmetrical gait pattern as showed by the values of absolute symmetric index of vertical and horizontal GRF variables.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Gait , Leg Length Inequality , Biomechanical Phenomena , KinesisABSTRACT
We presented a case which showed clinical improvements after fabricating new ortho-prosthesis to a patient with severe leg length inequality. He was 51 years old and had developed the leg length inequality on the right due to osteomyelitis that he experienced when he was seven. He had been using the orthosis fabricated by a private orthotic shop for more than twenty years from his twenties. We prescribed a new ortho-prosthesis composed of patellar tendon bearing ankle foot orthosis combined with endoskeletal shank and dynamic SACH foot. With this new ortho-prosthesis, there were significant improvements in initial abnormal gait patterns of excessive knee flexion at mid-stance and decreased maximal knee flexion peak at swing phase in the kinematic parameters on transverse plane. And step width, step length and step time were also improved. He got pain relief and improvement of gait endurance
Subject(s)
Humans , Middle Aged , Ankle , Foot , Foot Orthoses , Gait , Knee , Leg Length Inequality , Leg , Orthotic Devices , Osteomyelitis , Patellar LigamentABSTRACT
This is a follow up study on consecutive series 50 patients of total hip arthroplasty to assess for transient leg-length inequality. The authors report a clinical experience of 50 patients who have been pelvis tilt before total hip replacement. Retrospectively reviewed for the presence of pelvic obliquity preoperative and at the 1, 3 and 6 months follow-up visits. The results were as follows. Fourty-eight patients(96%) with functional leg length inequality related pelvic obliquity were improved within 6months postoperative follow up period after total hip arthroplasty. Two patients(4%) had persistent functional leg length inequality that affected factors-old age, female and soft tissue tightness due to pelvic obliquity. We believe that in most of these patients, the transient functional leg length inequality has a self-limited course, whereas in a small number, the profoud sense of inequality remains.