Leg Length Discrepancy in Cementless Total Hip Arthroplasty

Christopher N Peck, Karan Malhotra, Winston Y Kim

.

DOI: 10.4236/ss.2011.24040                

Abstract

The use of cementless total hip arthroplasty (THA) is on the increase. In order to achieve rotational and axial stability larger implants may be required than originally templated for. This could potentially result in a lar-ger leg length inequality. Our objective was to determine whether there is greater inequality in leg length post-operatively in cementless THA as compared to cemented implants. 136 consecutive patients undergoing elective THA between June 2007 and May 2008 were included. Post-operative digital radiographs were ex-amined to determine leg length. Twenty seven patients (20%) underwent a cemented procedure and 109 (80%) a cementless procedure. In the cemented group the mean leg length discrepancy was 7.3 mm (range 19 mm short to 21 mm long). In the cementless group the mean measured leg length discrepancy was 6.3 mm (range 18 mm short to 23 mm long). There was no significant difference between the two groups (P = 0.443). This study shows that with accurate pre-operative templating, both cemented and cementless proce-dures produce comparable and acceptable leg length discrepancies.

Keywords

Hip, Arthroplasty, Cementless, Leg Length

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Barink M, Meuers H, Spruit M, Fankhauser CF, Verdonschot N. How close does an uncemented hip stem match the final rasp position? Acta Orthop Belg 2004; 70: 534-539.
[2]	Carter LW, Stovall DO, Young TR. Determination of accuracy of preoperative templating of noncemented femoral prostheses. J Arthroplasty 1995; 10: 507-13.
[3]	Conn KS, Clarke MT, Hallett JP. A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating. J Bone Joint Surg 2002; 84-B: 269-272.
[4]	Hofmann AA, Skrzynski MC. Leg Length Inequality and Nerve Palsy in Total Hip Arthroplasty: A Lawyer Awaits. Orthopaedics 2000; 23: 943-944.
[5]	Konyves A, Bannister GC. The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg 2005; 87-B: 155-157.
[6]	Leonard M, Magill P, Kiely P, Khayyat G. Radiographic comparison of cemented and uncemented total hip arthroplasty and hip resurfacing. Eur J Orthop Surg Traumatol 2007; 17: 583-586.
[7]	Maloney WJ, Keeney JA. Leg Length Discrepancy After Total Hip Arthroplasty. J Arthroplasty 2004; 19: 108- 110.
[8]	Murphy SB, Ecker TM. Evaluation of a new Leg Length Measurement Algorithm in Hip Arthroplasty. Clin Orthop Rel Res 2007; 463: 85-89.
[9]	National Joint Registry 6th Annual report 2009. http://www.njrcentre.org.uk/NjrCentre/LinkClick.aspx?fileticket=EuUKuR4jPyc%3d&tabid=86&mid=523. (date last accessed 27 October 2009).
[10]	Oddy MJ, Jones MJ, Pendergrass CJ, Pilling JR, Wimhurst JA. Assessment of reproducibility and accuracy in templating hybrid total hip arthroplasty using digital radiographs. J Bone Joint Surg 2006; 88-B: 581-585.
[11]	Ranawat CS, Rao RR, Rodriguez JA, Bhende HS. Correction of Limb-Length Inequality During Total Hip Arthroplasty. J Arthroplasty 2001; 16: 715-721.
[12]	Sugano N, Nishii T, Miki H, Yoshikawa H, Sato Y, Tamura S. Mid-term results of cementless total hip replacement using a ceramic on ceramic bearing with and without computer navigation. J Bone Joint Surg 2007; 89-B: 455-460.
[13]	Suh KT, Cheon SJ, Kim DW. Comparison of preoperative templating with post-operative assessment in cementless total hip arthroplasty. Acta Orthop Scand 2004; 75: 40-44.
[14]	Unnanuntana A, Wagner D, Goodman SB. The Accuracy of Preoperative Templating in Cementless Total Hip Arthroplasty. J Arthroplasty 2009; 24: 180-186.
[15]	White TO, Dougall TW. Arthroplasty of the Hip Leg Length is Not Important. J Bone Joint Surg 2002; 84-B: 335-338.
[16]	Woolson ST, Hartford JM, Sawyer A. Results of a Method of Leg-Length Equalization for Patients Undergoing Primary Total Hip Replacement. J Arthroplasty 1999; 14: 159-164.
[17]	Wylde V, Whitehouse, Taylor AH. Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop 2009; 33: 905-9.