Leg length discrepancy in total hip arthroplasty.

After conducting a thorough literature review, we realized that no consensus exists regarding the definition of a significant postoperative inequality. Whereas some investigators quantitate the disparity, accepting as much as 2.0 cm or in some cases less, others define a significant disparity as one that promotes adverse functional effects postoperatively. This lack of a consistent definition reflects the wide disparity of opinion regarding the problem of postoperative leg length inequalities in total hip surgery. Although the literature may lack consistency, it does reflect the collective experience of many surgeons and provides valuable insight when approaching the issue of limb lengths in reconstructive surgery of the hip. We offer the following suggestions: 1. Begin with a thorough history and physical examination. Question the patient as to whether he or she actually perceives a leg length inequality. 2. Be aware of apparent leg length discrepancies in patients with hip disease. The perceived limb shortening is usually the result of a fixed adduction contracture with little true shortening. 3. Develop a consistent approach of evaluation preoperatively, intraoperatively, and postoperatively. Employ reliable and convenient clinical measures and radiographic techniques. A method of intraoperative assessment is mandatory. 4. Redundancy in the system helps to minimize error. Good preoperative planning does not supplant the need for intraoperative assessment and vice versa. 5. Address the issue of offset in preoperative planning. Anticipate its misleading effects on intraoperative evaluation. 6. Mention potential inaccuracies regarding limb length reconstruction in total hip surgery as part of a routine preoperative evaluation. Patients' expectations should be high but temporized with realism.