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Dr Swanson's Reply
Tue Jul 13, 2004 11:02pm

Susan,

Dr Swanson has been teaching in Europe, however, I sent a SOS that we need his expertise here in the good old US of A and he provided this information.

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. 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. An extreme leg length discrepancy may be the result of several different problems with the primary hip replacement. The success rate for this type of revision is generally good if that initial problem is corrected properly. However, it is essential that an orthopedic surgeon who specializes in revision surgery perform the revision. Dr Swanson has been trained in revision surgery and receives many referrals for difficult revision cases. He finds in these cases that with patients with a leg length discrepancy of less than 3/8 inch, only 10-20% choose revision surgery, the rest choose to utilize a shoe lift.

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.

Pauline








  • Dr. Swanson, Thank you for your reply. If the discrepancy is still significant after a three month period, what is the next step to having it repaired? Should my orthopedic surgeon agree to do a... more
    • Dr Swanson's Reply — Pauline, Tue Jul 13 11:02pm
      • leg length discrepancyDr. Swanson, Fri Jul 16 5:14pm
        I'm back in town. Pauline did a good job paraphrasing my response to leg length discrepancies. However, there is 1 error: only approximately 10-20% of my patients with leg length discrepancies... more
    • Answer the question please doctorKarl, Mon Jul 12 9:49pm
      My father has also experienced the discrepancy in leg length (2 cm) after THR in Atlanta, GA. He has been met with resistance from the doctor that performed the surgery and others with the only... more
      • Dr Swanson's RepllyPauline, Tue Jul 13 11:11pm
        Karl, Please see Dr Swanson's reply regarding revision to correct leg length discrepancy above. He also mentioned that in your father's case, age would be a definite factor in weighing the benefits... more
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