[Incidence and effect of leg length discrepancy after total hip arthroplasty]. / Incidencia y efecto de la discrepancia en la longitud de la pierna después de la artroplastía total de cadera.

INTRODUCTION: In coxarthrosis pain relief and the restoration of function including leg length are achieved with total hip arthroplasty. Sometimes achieving stability makes it impossible to achieve equal leg length. OBJECTIVE: To determine the incidence of pelvic limb length discrepancy, its effect on function and its emotional effect in a group of patients who underwent total hip arthroplasty. MATERIAL AND METHODS: A total of 252 patients with a diagnosis of grade IV coxarthrosis were assessed. They underwent unilateral primary total hip arthroplasty with a direct lateral approach; 190 were uncemented and 162 hybrid. Limb length was measured from the anterosuperior iliac crest to the medial malleolus of both legs. Patients were divided into four groups depending on leg length discrepancy: A) equal length; B) less than 10 mm; C) more than 10 mm, and D) more than 20 mm. RESULTS: A total of 252 arthroplasties were performed in 252 patients; 194 females (76.98%) and 58 males (23.01%). In 115 patients (45.63%) had a discrepancy < 10 mm; 71 patients (28.17%) > 10 mm; 60 patients (23.80%) did not have length discrepancy, and six patients had > 20 mm of discrepancy with lengthening of the operated limb. CONCLUSIONS: Length discrepancy of the operated limb is reported in the literature. It is a common outcome of primary total hip arthroplasty, and is usually < 10 mm, as reported in world literature.

[Anterior enucleation of a talus with "triple loss of relations". Case report and literature review]. / Enucleación anterior del astrágalo "pérdida triple de su relación". Presentación de un caso.

INTRODUCTION: When the talus loses its triple connection with the ankle mortise, a rare injury occurs in 3-4% of the ankle dislocations; 75% of the injuries are open. A clinical case is presented herein, together with its clinical course and a review of the literature. CLINICAL CASE: The case of a male, 52-year-old patient with a left ankle inversion and extension injury is presented. At the time of admission to the emergency room he had triple closed anterior dislocation of the talus. Closed reduction was performed under anesthesia, an acrylic boot was placed and he was followed-up at the outpatient service. RESULTS: The patient did well and was immobilized initially with an acrylic foot-thigh brace for six weeks; he then wore an acrylic suropodalic brace for 4 weeks and started partial weight bearing with crutches at 10 weeks; total weight bearing with crutches at 12 weeks, and without crutches at 16 weeks. Shortly before this a bone scan was performed and no signs of avascular necrosis were found. CONCLUSIONS: Triple talar dislocation is a rare injury and its major complication is avascular necrosis and secondary arthrosis that could result in the need for panastragalodesis; the prognosis depends on the timeliness of care, it is a true emergency.