Loppini Mattia, Bulgarelli Alberto, Chiappetta Katia, Morenghi Emanuela, La Camera Francesco, Grappiolo Guido
Humanitas University, Rozzano, Italy.
IRCCS Humanitas Research Hospital, Rozzano (Mi), Italy.
Arch Orthop Trauma Surg. 2025 Mar 19;145(1):197. doi: 10.1007/s00402-025-05807-x.
Limb length inequality (LLI) is a leading cause of patient dissatisfaction and litigation after total hip arthroplasty (THA). However, the surgical treatment of this complication remains controversial. In this retrospective and observational study, we evaluated the results obtained from 31 patients who underwent revision surgery for symptomatic LLI after conservative treatment had failed. Our primary endpoint was the radiographic correction of LLI. Secondary endpoints included assessing the improvement in quality of life (QoL) after surgical treatment [using the Harris Hip Score (HHS) and the 12-item Short Form Survey (SF-12)] and tracking possible complications (e.g., dislocation, residual instability).
Type of surgery, implanted materials, preoperative sciatic nerve deficit, and the development of postoperative complications were recorded. Radiographic assessment was performed by measuring LLI, Femoral Offset (FO), Acetabular Offset (AO), Global Offset (GO), and height of the Center of Rotation (CORL), and calculating the difference with the contralateral side and postoperative measurements. Clinical assessment was performed by having patients answer to the HHS and the SF-12, which comprises a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12).
LLI, GO, and CORL showed a statistically significant variation between preoperatory and postoperatory radiographs. The same was found to apply also to clinical results, the HHS, and the SF-12. Linear regression analysis showed a single association between sex and postoperative HHS. No other association was found to be statistically significant.
In selected patients who have symptomatic structural LLI after primary THA, revision surgery can be a valid approach to restore the proper limb length and to improve the clinical outcomes with an acceptable risk of complications and instability.
肢体长度不等（LLI）是全髋关节置换术（THA）后患者不满和引发诉讼的主要原因。然而，这种并发症的外科治疗仍存在争议。在这项回顾性观察研究中，我们评估了31例保守治疗失败后因有症状的LLI接受翻修手术患者的治疗结果。我们的主要终点是LLI的影像学矫正。次要终点包括评估手术治疗后生活质量（QoL）的改善情况[使用Harris髋关节评分（HHS）和12项简明健康调查（SF - 12）]以及追踪可能的并发症（如脱位、残余不稳定）。
记录手术类型、植入材料、术前坐骨神经功能缺损以及术后并发症的发生情况。通过测量LLI、股骨偏心距（FO）、髋臼偏心距（AO）、整体偏心距（GO）和旋转中心高度（CORL），并计算与对侧的差值以及术后测量值来进行影像学评估。通过让患者回答HHS和SF - 12进行临床评估，SF - 12包括身体成分总结（PCS - 12）和精神成分总结（MCS - 12）。
LLI、GO和CORL在术前和术后X线片之间显示出统计学上的显著差异。临床结果、HHS和SF - 12也有同样的情况。线性回归分析显示性别与术后HHS之间存在单一关联。未发现其他关联具有统计学意义。
对于初次THA后有症状的结构性LLI的特定患者，翻修手术可以是恢复肢体长度并改善临床结果的有效方法，且并发症和不稳定风险可接受。
