Hospital Pierre Paul Riquet, CHU Toulouse, Toulouse, France.
Department of Orthopedic Surgery and Rehabilitation, Howard University Hospital Washington, DC, USA.
Hip Int. 2020 Sep;30(5):536-543. doi: 10.1177/1120700019843121. Epub 2019 Apr 21.
Leg-length discrepancy (LLD) is a frequent and recurring issue after total hip arthroplasty (THA). It can lead to discomfort and litigation due to the patient's perception of this inequality.
The aim of this study was to evaluate the functional impact of postoperative LLD and length correction in patients after primary THA. We hypothesised that clinical outcomes are inversely correlated to length correction and residual discrepancy.
In a prospective cohort, we included 121 patients undergoing unilateral primary THA. Patients were categorised into 3 groups based on their residual LLD using routine EOS imaging; Shorter (<-5 mm); Equal (-5 mm to +5 mm); and Longer (>+5 mm). Delta of Correction (DC) was defined as the difference between pre- and postoperative discrepancy measured on EOS imaging. Functional scores (HHS, Postel Merle d'Aubigné, and WOMAC) were measured preoperatively and at last follow-up. The average follow-up was 24 months. We evaluated the clinical and radiographic outcomes regarding the residual LLD and DC.
All patients had improvement in their functional scores at last follow-up. There was no difference in clinical outcomes, regardless of preoperative or residual LLD. The highest scores were found in the population with the smallest variations (DC -5 to +5 mm, HHS 96). Conversely, poorer results were found in shortened patients (DC <-5 mm), HHS 86, and lengthened patients, corrected by > 15 mm, with HHS of 83, < 0.005. Patient perception of postoperative LLD correlated with the DC ( = 0.004).
The DC measurement is a more effective assessment than arthroplasty.
下肢长度差异（LLD）是全髋关节置换术（THA）后经常出现且反复出现的问题。由于患者对这种不平等的感知，它可能会导致不适和诉讼。
本研究旨在评估初次 THA 后患者术后 LLD 和长度矫正对功能的影响。我们假设临床结果与长度矫正和残余差异呈反比。
在一项前瞻性队列研究中，我们纳入了 121 例接受单侧初次 THA 的患者。根据常规 EOS 成像，患者根据其残余 LLD 分为 3 组；较短（<-5mm）；相等（-5mm 至+5mm）；和较长（>+5mm）。校正差值（DC）定义为 EOS 成像上测量的术前和术后差异。术前和最后随访时测量功能评分（HHS、Postel Merle d'Aubigné 和 WOMAC）。平均随访时间为 24 个月。我们评估了残余 LLD 和 DC 的临床和影像学结果。
所有患者在最后随访时功能评分均有所改善。无论术前或残余 LLD 如何，临床结果均无差异。变化最小的患者（DC -5 至+5mm，HHS 96）得分最高。相反，缩短的患者（DC <-5mm），HHS 86 和矫正超过 15mm 的患者，HHS 为 83，<0.005。患者对术后 LLD 的感知与 DC 相关（=0.004）。
DC 测量比关节置换术更有效。
