Bianco Prevot Luca, Tronconi Livio Pietro, Bolcato Vittorio, Accetta Riccardo, Di Mauro Lucio, Basile Giuseppe
IRCCS Ospedale Galeazzi-S. Ambrogio, 20157 Milan, Italy.
Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy.
Healthcare (Basel). 2025 Jun 6;13(12):1358. doi: 10.3390/healthcare13121358.
BACKGROUND/OBJECTIVES: Total hip arthroplasty (THA) is a widely performed procedure to alleviate pain and improve function in patients with hip disorders. However, leg length discrepancy (LLD) remains a prevalent complication. LLD can cause gait disturbances, back pain, postural imbalance, and patient dissatisfaction, along with significant medico-legal implications. This review examines the evaluation, management, and medico-legal aspects of LLD.
The review analyzed literature on the prevalence, evaluation methods, and management strategies for LLD in THA. Radiographic and clinical assessment tools were considered, alongside factors such as pelvic obliquity and pre-existing conditions. The importance of preoperative planning, intraoperative techniques (including computer-assisted methods), and comprehensive documentation was evaluated to address both clinical and legal challenges.
The review shows that leg length discrepancy (LLD) following total hip arthroplasty (THA) occurs in 3% to 30% of cases, with mean values ranging from 3 to 17 mm. LLD may result from anatomical or procedural factors, and effective evaluation requires both radiographic imaging and clinical assessment. Preoperative planning plays a critical role in accurately assessing anatomical parameters and selecting appropriate prosthetic components to preserve or restore limb length symmetry. Advanced intraoperative techniques, including computer-assisted surgery, help reduce LLD incidence. While some complications may be unavoidable, proper documentation and patient communication, particularly regarding informed consent, are essential to mitigate medico-legal risks Conclusions: LLD after THA requires a multidimensional approach incorporating clinical, radiological, biomechanical, and legal considerations. Effective preoperative and intraoperative strategies, combined with robust communication and documentation, are essential to minimize LLD and its associated risks. A focus on precision and patient-centered care can improve outcomes and reduce litigation.
背景/目的：全髋关节置换术（THA）是一种广泛开展的手术，用于缓解髋关节疾病患者的疼痛并改善其功能。然而，肢体长度差异（LLD）仍然是一种常见的并发症。LLD可导致步态紊乱、背痛、姿势失衡以及患者不满，同时还具有重大的医疗法律影响。本综述探讨了LLD的评估、管理及医疗法律方面的问题。
该综述分析了关于THA中LLD的患病率、评估方法和管理策略的文献。考虑了影像学和临床评估工具，以及骨盆倾斜和既往疾病等因素。评估了术前规划、术中技术（包括计算机辅助方法）和全面记录的重要性，以应对临床和法律挑战。
该综述表明，全髋关节置换术后肢体长度差异（LLD）在3%至30%的病例中出现，平均值在3至17毫米之间。LLD可能由解剖学或手术因素引起，有效的评估需要影像学检查和临床评估。术前规划在准确评估解剖参数和选择合适的假体组件以保持或恢复肢体长度对称方面起着关键作用。先进的术中技术，包括计算机辅助手术，有助于降低LLD的发生率。虽然一些并发症可能不可避免，但妥善的记录和与患者的沟通，特别是关于知情同意的沟通，对于降低医疗法律风险至关重要。结论：THA后的LLD需要采用一种综合临床、放射学、生物力学和法律考虑的多维度方法。有效的术前和术中策略，结合有力的沟通和记录，对于最小化LLD及其相关风险至关重要。注重精确性和以患者为中心的护理可以改善结果并减少诉讼。
