Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of...
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Limb length discrepancy
Andrew Port
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The importance of LLD
• 60% long - mean 1cm– Perceived at 6mm
• 30% short - mean 6mm– Perceived at 1cm
• All due to femoral implant position
• Sign. Worse OHS
• 15% improved between 3/12 – 1 year
Bannister
JBJS 2007
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Reasons for LLD
• Hip causes
• Non hip
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Non hip
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Other limb causes
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Non- hip
• Tib Post
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Reasons for LLD
• Hip causes
• Non hip
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Acutely shortened
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Chronic shortening
CDH
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Perthes
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Symptoms
• Length
• Reduced ROM
• Gait disorder
• Dissatisfaction
• Dislocation
• Back pain
– Thoracic
– Lumbar
• Neurologic
– Paraesthesia
– Palsy
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Evaluation
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Evaluation
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Diagnosis
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Offset
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Offset
• Limitation of uncemented
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Large head hybrids
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Treatment
• Avoidance
• Planning
• Soft tissue balance
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Correction
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Surgical correction
• 21 pts
• 6/7-6yrs
• 2-7cm
• 15 equalised
• 6 <1cm
• Harris Hip score
• All but 2 satisfiedParvizi
JBJS 2003
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Undercorrection?
• Acetabular/femoral balancing
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Cemented
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Shortening / offset
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Large heads
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ROM / offset
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Nerve injury
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Extra-articular
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Summary
• Avoidance techniques
• Length AND Offset
• Non- Hip causes
• Often rewarding