BACKGROUNDTotal hip arthroplasty (THA) is one of the most effective treatments for phase III and IV hip arthrosis. Lower limb length balancing is one of the determining factors of a successful surgery, particularly in patients with developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate the postoperative change in intra-pelvic obliquity (intra-PO) angle in the coronal plane and its effects on leg length discrepancy (LLD) within 2 years.

METHODSA total of 78 patients (70 females, 8 males) were enrolled in this study. All patients were suffering from DDH with varying degrees of LLD. Pelvic plain radiographs were collected before and after the operation. The intra-PO angles were measured 0, 0.5, 1 and 2 years after THA. At the same time, postoperative LLD was measured with blocking test.

RESULTSPO changed significantly in the first year after THA surgery (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01), and the changing value of intra-PO angle (ΔPO) slowed down substantially during the first 2 years after THA (0.5 year vs. 0.5-1 year, P < 0.01; 0.5-1 year vs. 1-2 years, P < 0.01). With the change in intra-PO angle, LLD also got narrow within the 1st year (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01). Elderly patients had a smaller intra-PO angle reduction (Group A vs. Group B, P = 0.01; Group B vs. Group C, P < 0.01).

CONCLUSIONSIntra-PO angle and LLD gap narrowed with time after THA surgery. In particular, elderly patients had smaller change in intra-PO angle.

Age Factors ; Aged ; Arthroplasty, Replacement, Hip ; Female ; Hip Joint ; surgery ; Humans ; Leg Length Inequality ; diagnosis ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND: The hemiepiphyseal stapling has both positive and negative effects on effective leg length. The purpose of this study was to analyze change in effective leg length after angular correction by hemiepiphyseal stapling, and to validate in clinical cases. METHODS: Mathematical analysis of a hemiepiphyseal stapling model was conducted. The induced formula was validated in 6 cases fulfilling the assumptions of the model. Anatomical parameters involved in this formula were measured in additional 21 cases undergoing hemiepiphyseal stapling or hemiepiphysiodesis. RESULTS: Effective leg length increased or decreased according to three parameters in this model: 1) limb length distal to the operated physis (L), 2) width of the operated physis (d), and 3) the amount of angular deformity to be corrected (theta). Actual change in effective leg length of 6 cases similar to this model coincided with the predicted change at least in its direction. L/d ratio was 4.82 +/- 0.51. CONCLUSIONS: Considering the narrow range of the L/d ratio, hemiepiphyseal stapling is likely to decrease effective leg length if the amount of angular correction is less than 10degrees, whereas to increase it if the amount of angular correction is larger than 16degrees. This should be taken into consideration when selecting the surgical method for angular deformity correction in skeletally immature patients.
Adolescent ; Child ; Epiphyses/growth & development/*surgery ; Female ; Genu Valgum/*surgery ; Genu Varum/*surgery ; Humans ; Leg Length Inequality/diagnosis/*etiology ; Male ; *Surgical Stapling/adverse effects

OBJECTIVETo explore the association between the leg length discrepancy and postoperative function after total hip arthroplasty.

METHODSFrom June 2004 to June 2007, the Leg length in 80 consecutive patients (38 males and 42 females, ranging in age from 56 to 86 years, with an average of 72.3 years) who underwent primary unilateral total hip arthroplasty was measured radiologically. Postoperative hip function and patients' satisfaction was assessed using the Oxford Hip Score (OHS) at three months and one year after surgery.

RESULTS(1) Leg length: 52 operated legs were longer than the other side by a mean of (9.2+/-3.2) mm (1 to 22 mm), in which 29 legs were longer for 1 to 10 mm (mean value 4.9 mm) and 23 legs were longer for 11 to 22 mm (mean value 14.6 mm); 13 operated legs were shorter by a mean of (6.4+/-2.1) mm (3 to 19 mm); 15 operated legs were of the same length as the other side. (2) Oxford hip scores: At three months after operation, the mean Oxford hip scores in patients with lengthened legs (two groups) were significantly higher (i.e., worse) than in the patients with shortened legs or in patients with legs of the same length. Significant difference in Oxford Hip Score was not found between the two groups of lengthened legs (1 to 10 mm vs 11 to 22 mm). Significant difference in Oxford Hip Score was also not found between the patients with shortened leg and the patients with legs of the same length. At one year after operation, the Oxford hip scores were significantly higher (i.e. worse) in the patients with lengthened limbs (11 to 22 mm) than in those of shortened limbs, or with limbs of equal length, or patients with lengthened legs (1 to 10 mm). No significantly differences of the Oxford hip scores were found within the patients with shortened limbs, the patients with limbs of equal length and the patients of lengthened limbs (1 to 10 mm). There was no significant difference between the Oxford hip scores at three months' follow-up and that at one year's follow-up in the lengthened group (11 to 22 mm), shortened group or same length group. The Oxford hip score was improved significantly one year after surgery when compared with that of three months after surgery in the lengthened group (1 to 10 mm).

CONCLUSIONLeg length discrepancy, especially for that 11 to 20 mm longer than the healthy side, affects the functional outcome after total hip arthroplasty, and it does not relieve over time. Well planned measures should be taken to minimize leg length discrepancy.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Humans ; Leg Length Inequality ; diagnosis ; etiology ; physiopathology ; Male ; Middle Aged ; Postoperative Complications ; etiology ; psychology

Happle-Tinschert syndrome is a disorder causing unilateral segmentally arranged basaloid follicular hamartomas of the skin associated with ipsilateral osseous, dental and cerebral abnormalities including tumors. Although a case with hemimegalencephaly was previously described, this is the first report of Happle-Tinschert syndrome with discrepant short left leg, ipsilateral skin lesions, hemimegalencephaly and frontal polymicrogyria.
Basal Cell Nevus Syndrome/diagnosis ; Child ; Dental Enamel/abnormalities ; *Frontal Lobe/pathology ; Hamartoma/*diagnosis/pathology ; Humans ; Leg Length Inequality/*diagnosis ; Magnetic Resonance Imaging ; Male ; Malformations of Cortical Development/*diagnosis ; Skin Diseases/*diagnosis/pathology ; Syndrome