Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Ave, MC-184, Albany, NY, 12208, USA.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5417-5423. doi: 10.1007/s00402-022-04759-w. Epub 2023 Jan 11.
Leg-length discrepancy (LLD) presents a significant management challenge to orthopedic surgeons and remains a leading cause of patient dissatisfaction and litigation after total hip arthroplasty (THA). Over or under-lengthening of the operative extremity has been shown to have inferior outcomes, such as dislocation, exacerbation of back pain and sciatica, and general dissatisfaction postoperatively. The management of LLD in the setting of THA is multifactorial, and must be taken into consideration in the pre-operative, intra-operative, and post-operative settings. In our review, we aim to summarize the best available practices and techniques for minimizing LLD through each of these phases of care. Pre-operatively, we provide an overview of the appropriate radiographic studies to be obtained and their interpretation, as well as considerations to be made when templating. Intra-operatively, we discuss several techniques for the assessment of limb length in real time, and post-operatively, we discuss both operative and non-operative management of LLD. By providing a summary of the best available practices and strategies for mitigating the impact of a perceived LLD in the setting of THA, we hope to maximize the potential for an excellent surgical and clinical outcome.
肢体长度差异 (LLD) 给矫形外科医生带来了重大的管理挑战，并且仍然是全髋关节置换术 (THA) 后患者不满和诉讼的主要原因。手术肢体的过度或不足延长已被证明会产生不良后果，例如脱位、加重背痛和坐骨神经痛以及术后总体不满。THA 中 LLD 的管理是多因素的，必须在术前、术中及术后考虑到。在我们的综述中，我们旨在总结通过这些护理阶段中的每一个阶段来最小化 LLD 的最佳可用实践和技术。术前，我们提供了要获得的适当影像学研究及其解释的概述，以及在模板制作时要考虑的因素。术中，我们讨论了几种实时评估肢体长度的技术，术后，我们讨论了 LLD 的手术和非手术管理。通过总结在 THA 环境中减轻感知 LLD 影响的最佳可用实践和策略，我们希望最大限度地提高获得出色手术和临床结果的可能性。
