Makhdom Asim M, Fragomen Austin T, Rozbruch S Robert
Foothills Medical Group, Upper Allegheny Health System, 195 Pleasant St., Bradford, PA USA.
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
HSS J. 2020 Dec;16(Suppl 2):400-407. doi: 10.1007/s11420-020-09770-8. Epub 2020 Jul 24.
Leg-length discrepancy (LLD) after primary THA is not uncommon. Little is known, however, about the role of hip-sparing procedures for equalization of LLD after THA.
QUESTIONS/PURPOSES: The aim of this study is to report our experiences with these techniques in patients presenting at one institution over a 10-year period.
We retrospectively reviewed records at one institution to find patients who had sought surgical treatment for LLD after THA between January 2007 and August 2017. Patients who had LLD related to conditions other than the THA, such as bone loss or traumatic defects, were excluded. We recorded the time after THA, laterality, and LLD. Assessment of LLD was performed using clinical and radiographic examinations. Patient demographics and true LLD were recorded, as were prior conservative treatment, equalization procedure performed, final leg length after equalization surgery, time to healing, and complications.
After exclusion of patients with LLD related to other causes, eight patients in whom conservative treatment had failed and who had undergone hip-sparing leg-length equalization surgery were included in the study. The average age was 44.6 years (range, 18 to 66 years). Seven of the patients were female. The pre-operative mean LLD was 3.1 cm (range 1.5 to 7 cm). In those who were long after THA, ipsilateral (THA-side) shortening of femur with a retrograde intramedullary nail (IMN; = 1) or with a plate ( = 1) was performed. In those who were short after THA, ipsilateral femur lengthening with retrograde Precice nails ( = 2), ipsilateral tibial lengthening with Precice nails ( = 2), or contralateral femur shortening with a retrograde IMN ( = 2) was performed. The average time to full consolidation or union was 6.6 months (range, 2 to 19 months). Two patients had delayed union. All patients but one were satisfied with final results.
We believe that hip-sparing equalization procedures can be part of the treatment algorithm of LLD after THA. These advancements in the field are promising and might expand the indications of lengthening and equalization procedures to include LLD after THA.
初次全髋关节置换术后肢体长度不等（LLD）并不罕见。然而，对于保留髋关节的手术在全髋关节置换术后肢体长度均衡中的作用知之甚少。
问题/目的：本研究的目的是报告我们在10年期间在一家机构对这些技术治疗患者的经验。
我们回顾性分析了一家机构的记录，以找出2007年1月至2017年8月期间因全髋关节置换术后肢体长度不等而寻求手术治疗的患者。排除因除全髋关节置换术之外的其他情况导致肢体长度不等的患者，如骨质流失或创伤性缺损。我们记录了全髋关节置换术后的时间、患侧、肢体长度不等情况。使用临床和影像学检查评估肢体长度不等情况。记录患者人口统计学资料和实际肢体长度不等情况，以及先前的保守治疗、进行的均衡手术、均衡手术后的最终肢体长度、愈合时间和并发症。
排除因其他原因导致肢体长度不等的患者后，本研究纳入了8例保守治疗失败且接受了保留髋关节的肢体长度均衡手术的患者。平均年龄为44.6岁（范围18至66岁）。其中7例为女性。术前平均肢体长度不等为3.1厘米（范围1.5至7厘米）。对于全髋关节置换术后肢体较长的患者，采用逆行髓内钉（IMN；n = 1）或钢板（n = 1）对患侧（全髋关节置换术侧）股骨进行缩短。对于全髋关节置换术后肢体较短的患者，采用逆行Precice钉对患侧股骨进行延长（n = 2），采用Precice钉对患侧胫骨进行延长（n = 2），或采用逆行IMN对健侧股骨进行缩短（n = 2）。完全骨痂形成或愈合的平均时间为6.6个月（范围2至19个月）。2例患者出现延迟愈合。除1例患者外，所有患者对最终结果均满意。
我们认为保留髋关节的均衡手术可以成为全髋关节置换术后肢体长度不等治疗方案的一部分。该领域的这些进展很有前景，可能会扩大延长和均衡手术的适应证，将全髋关节置换术后肢体长度不等纳入其中。
