OBJECTIVE: To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD) after total hip arthroplasty(THA). METHODS: Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019. All patients' age, sex, side and pelvis anteroposterior digital radiography were retraspectively analyzed. There were 69 males and 62 females, 57 cases of left hip and 74 cases of right hip. The age ranges from 25 to 89 with an average age of 62 years. There were 48 cases of osteoarthritis and 83 cases of osteonecrosis. In this study, femoral cortical index (FCI) was used as the classification of proximal femoral shape, and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography. Grouping according to FCI:> 0.6 was Dorr A group, 0.5 to 0.6 was Dorr B group, <0.5 was the Dorr C group, and the relationship between proximal femur morphology and the leg length discrepancy after total hip arthroplasty was determined. RESULTS: The postoperative average FCI was(0.56±0.08) mm and the median LLD was 5.10 mm (IQR -1.00 to 8.80 mm). Three groups were divided according to the level of FCI, and there were no statistically significant differences in gender, age, side, diagnosis and intraoperative fracture rate distribution among three groups. FCI>0.6, the postoperative LLD was 6.30 mm (IQR 1.00 to 10.95 mm). When FCI was 0.5 to 0.6, the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm). FCI<0.5, the postoperative LLD was 1.95 mm(IQR -2.50 to 6.68 mm). LLD comparison of different proximal femoral shape was statistically significant ( CONCLUSION High FCI increases the risk of lower extremity prolongation after surgery on the affectedside, while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side. The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extremities after total hip replacement.
Arthroplasty, Replacement, Hip/adverse effects* ; Female ; Femur/surgery* ; Humans ; Leg ; Leg Length Inequality/etiology* ; Male ; Middle Aged ; Retrospective Studies

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

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

BACKGROUND: A second staged operation using temporary bridging external fixation (TBEF) has been widely used in patients with periarticular complex fracture, yet few papers have been published on the related complications. The purpose of this study was to report the complication rate and pitfalls directly related to TBEF through a retrospective study and to suggest some solutions. METHODS: Fifty-nine cases that were treated by using TBEF were studied among 195 periarticular complex fractures. We retrospectively collected the clinical and radiological data and then the study data was evaluated for 1) cases with unsatisfactory restoration of length, 2) cases with deep infection caused by half pins invading the zone of definitive fixation, and 3) neurovascular injuries related to half pins. RESULTS: Complications were observed in 7/59 cases (11%). Problems related to the achievement of length were observed in one case of distal tibia fracture and 2 cases of distal femur fracture. Half pin related infection was observed in 2 cases of distal femur fracture. Neurovascular injury (medial calcaneal nerve injury in a distal tibia fracture) was observed in 2 cases. Among 7 complications, four were related to using TBEF in distal femur fracture. This is because the abundant leg muscles have strong deforming force and infection might be increased due to frequent irritation by the half pins. CONCLUSIONS: TBEF is a simple procedure with several advantages. However, complications might be observed if certain principles are not followed. It is thought that many complications due to TBEF can be reduced if the half pins are not inserted in the zone of injury, restoration of length is fully achieved and the neurovascular characteristics are carefully considered. In particular, much more caution is needed in the distal femur, which has abundant muscles surrounding it.
Adult ; Aged ; External Fixators/*adverse effects ; Female ; Femoral Fractures/*surgery ; Fracture Fixation/*adverse effects/methods ; Fractures, Comminuted/*surgery ; Humans ; Leg Length Inequality/etiology ; Male ; Middle Aged ; Peripheral Nerves/injuries ; Retrospective Studies ; Surgical Wound Infection/*etiology ; Tibial Fractures/*surgery ; Young Adult

OBJECTIVETo observe the leg length discrepancy and accompanied knee varus/valgus deformity in matured patients with unilateral dislocation of the hip.

METHODSFrom March 2011 to December 2012, 28 patients who had unilateral dislocation of hip (Hartofilakidis classification II 17 cases and III 11 cases) were involved in this study.There were 6 male patients and 22 female patients, the age of the patients were 13.4-66.2 years, with mean age of 29.8 years. The standing anteroposterior full leg length X-ray films were obtained. Leg length discrepancy, the length of the femur, the length of the tibia and identified the varus/valgus knee deformities were measured. Statistical analysis was performed. A student's t test for paired samples was done for comparison of the parameters in the same patient between dislocated and undislocated leg, and the χ(2) test were used to assess valgus and varus knees, leg length discrepancy in high dislocation and low dislocation groups.

RESULTSSeventeen (60.7%) cases had longer femur length on the dislocated side than that on the undislocated side (t = 1.328, P = 0.197), with the maximum lengthening of 32.7 mm and a mean lengthening of 9.5 mm. Twenty-one (75.0%) cases had longer tibia length on the dislocated side (t = 3.039, P = 0.006), with a maximum lengthening of 10.9 mm and a mean lengthening of 4.5 mm. Twenty (71.4%) cases had longer relative leg length on the dislocated side (t = 2.451, P = 0.022), with a maximum lengthening of 25.0 mm and a mean lengthening of 9.4 mm. On the dislocated side of the leg, the degree of valgus angle was 3° ± 4°,while on the undislocated side, that was -3° ± 4°(t = 5.642, P = 0.000). On the dislocated side, 12 cases (42.9%) were of valgus deformities and 1 case was of varus deformity. On the contralateral side, 15 cases of varus deformities (53.6%) and 1 case of valgus deformity were observed(χ(2) = 18.139,P = 0.000).

CONCLUSIONSMost dislocated legs are longer in length than the contralateral side, both femur and tibia have also lengthened accordingly. Many knees on the dislocated side present valgus deformity, half of the knees on the contralateral side present varus deformity.

Adolescent ; Adult ; Aged ; Female ; Femur ; abnormalities ; diagnostic imaging ; Hip Dislocation, Congenital ; complications ; radiotherapy ; Humans ; Knee Joint ; abnormalities ; diagnostic imaging ; Leg Length Inequality ; diagnostic imaging ; etiology ; Male ; Middle Aged ; Radiography ; Tibia ; abnormalities ; diagnostic imaging ; Young Adult

OBJECTIVE: To explore the efficacy of callus distraction performed by external fixtor in the reconstruction of bone defect and leg shortening of femur after osteomyelitis. METHODS: Nineteen child patients with bone defect and leg shortening after ostemomyelitis were treated by callus distraction with external fixator. The mean length of the bone defect was 1.3 cm. The mean leg-length discrepancy was 4.8 cm. RESULTS: All patients were followed up for 21-82 months. The bone lengthening area grew well, the length of callus distraction was 4.5-8.0 cm, and the mean radiographic consolidation index was 39.7 d/cm. According to the Paley's criteria, the healing effect of 14 cases was excellent, and that of the rest 5 cases was good. The functional recovery of 11 cases was excellent, and that of the rest 8 cases was good. CONCLUSION Callus distraction is a reliable method in the reconstruction of bone defect and leg shortening caused by ostemomyelitis.
Adolescent ; Bony Callus ; Child ; Chronic Disease ; Debridement ; adverse effects ; Female ; Femur ; Humans ; Ilizarov Technique ; Leg Length Inequality ; etiology ; surgery ; Male ; Osteogenesis, Distraction ; instrumentation ; methods ; Osteomyelitis ; complications ; surgery ; Retrospective Studies ; Treatment Outcome