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Re: Leg 1&1/4 inch shorter after THR
Fri Sep 17, 2010 2:09pm

A leg length discrepancy of 1.25” is significant and is likely to cause back pain, a limp, diminished activity and a compromised life style. Physiological factors can contribute to post-operative leg length discrepancy. It may result from swelling, spasm, or contracture of the abductor muscles, sometimes from a curvature or lack of flexibility in the spine, or other reasons. We call this a “physiologic” leg length discrepancy rather than a true discrepancy. An extreme leg length discrepancy may be the result of several different problems with the primary hip replacement. There may be some physiologic factors contributing to your leg length discrepancy. However, it is highly unlikely that a leg length discrepancy of 1.25” is completely caused by physiologic factors.

Most patients can accommodate a leg length discrepancy of 1 cm = 3/8 inch and may possibly need a shoe lift. If the patient has a greater leg length discrepancy a larger shoe lift may be used with success. If a patient has severe hip and/or back pain, instability of the hip or an unacceptable life style due to leg length discrepancy, a hip revision may be considered. True discrepancies can be corrected surgically by shortening the femur around the femoral prosthesis. A ring of bone can be removed (like a napkin ring), and the femur shortened around the stem of the prosthesis. However, I would worry that if 1.25 inch were removed, you might then feel that the other leg is too short due to compounding physiological factors. I recommend you consult with a qualified revision surgeon who would take into account any physiological factors prior to shortening the femur should you chose this option. Dr Swanson has been trained in revision surgery and receives many referrals for difficult revision cases.

The success rate for this type of revision is generally good if that initial problem is corrected properly. Of course, risks and benefits must be weighed prior to the patient opting for revision surgery to correct a leg length discrepancy. All revision hip replacement surgery is more complicated and takes longer than a primary hip replacement. For this reason, risks associated with revision surgery are usually twice that of primary surgery and the risk of dislocation is approximately five times greater.
This recent article in the Journal of Bone and Joint Surgery researched the outcome of revision to correct leg length discrepancy.

Surgical Treatment of Limb-Length Discrepancy Following Total Hip Arthroplasty
Javad Parvizi, MD1, Peter F. Sharkey, MD1, Gina A. Bissett, BA1, Richard H. Rothman, MD, PhD1 and William J. Hozack, MD1

http://www.ejbjs.org/cgi/content/abstract/85/12/2310?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Rothman&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1089786288797_20285&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=7/1/2003&journalcode=jobojos

Methods: We retrospectively reviewed the clinical and radiographic records of patients who had undergone revision hip surgery at our institution for the treatment of a symptomatic limb-length discrepancy following a previous total hip arthroplasty. We identified twenty-one patients (twenty-one hips) who had an average age of sixty-six years at the time of revision hip arthroplasty. The average duration of follow-up was 2.8 years, and no patient was lost to follow-up. The indications for revision hip arthroplasty were severe hip and/or back pain for eleven patients, instability of the hip for eight, hip pain and ipsilateral limb paresthesia for one, and hip pain and ipsilateral foot drop for one.

Results: Revision arthroplasty was performed at a mean of eight months (range, six days to six years) after primary total hip replacement. The mean limb-length discrepancy at the time of the revision was 4 cm (range, 2 to 7 cm). Following revision arthroplasty, which involved revision of a malpositioned acetabular and/or femoral component, equalization of the limb lengths was achieved in fifteen patients. In the remaining six patients, the mean discrepancy had decreased to 1 cm. The mean Harris hip score improved significantly, from 56.5 points before the revision to 83.2 points at the time of the latest follow-up (p < 0.005). All but two patients were satisfied with the outcome of the revision surgery.

Conclusions: Limb-length discrepancy following hip arthroplasty can be associated with pain, paresthesia, and hip instability. In these patients, careful evaluation of the position and orientation of the components may reveal the cause of the discrepancy. Revision arthroplasty may be indicated when a surgically correctable cause of limb-length discrepancy can be identified.

Please feel free to contact me for additional information or to schedule an appointment.

Best Wishes,
Pauline

  • Leg 1&1/4 inch shorter after THRSheena Hayes, Tue Sep 14 7:18am
    My operated leg is 1&1/4 inches shorter after THR 5years ago.(Revision surgery after fused hip) Can anything be done. Desperately seeking advice. Sheena
    • Re: Leg 1&1/4 inch shorter after THR — Pauline, Fri Sep 17 2:09pm
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