Lease this WebApp and get rid of the ads.
Re: 3/4 " discrepancy
Mon Jun 26, 2006 8:31am

Margaret,

I wouldn't rush into revision surgery just 4 months after surgery. Particularly, if your surgeon believes the leg length discrepancy is a muscular situation. Often times a pelvic tilt can augment a leg length discrepancy. Many patients have been able to reduce a leg length discrepancy with the help of a pilates instructor or physical therapist.

Hip revision for leg length discrpancy is considered if the patient has severe hip and/or back pain, instability of the hip or an unacceptable life style due to leg length discrepancy. 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 greater 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.

Best Wishes,
Pauline

  • 3/4 " discrepancyMargaret Smith, Mon Jun 26 8:20am
    I had this procedure done using the 2 insision approch, I am now longer on the operative leg the cut was performed a good bit above the lesser trocater was this done correctly,, this has been... more
    • Re: 3/4 " discrepancy — Pauline, Mon Jun 26 8:31am
      • Re: 3/4 " discrepancyMargaret Smith, Mon Jun 26 1:31pm
        Thank You for your Promp response, I understand the risks involved with revision surgery as I am a n OR nurse and have seen it done many times.. I have gone for a second opinion becasuse my... more
        • Re: 3/4 " discrepancyPauline, Wed Jun 28 7:33am
          Margaret, A leg length discrepancy of 3/4" is significant enough to consider revision surgery. The unfortunate thing about the two incision approach is that it is a new surgical technique and most... more
Click here to receive daily updates