Temporary Epiphysiodesis Using the Eight-Plate in the Management of Children with Leg Length Discrepancy: A Retrospective Case Series

AimsThe aims of this study were to examine the rate at which the positioning of the acetabular component, leg length discrepancy and femoral offset are outside an acceptable range in total hip arthroplasties (THAs) which either do or do not involve the use of intra-operative digital imaging.Patients and MethodsA retrospective case-control study was undertaken with 50 patients before and 50 patients after the integration of an intra-operative digital imaging system in THA. The demographics of the two groups were comparable for body mass index, age, laterality and the indication for surgery. The digital imaging group had more men than the group without. Surgical data and radiographic parameters, including the inclination and anteversion of the acetabular component, leg length discrepancy, and the difference in femoral offset compared with the contralateral hip were collected and compared, as well as the incidence of altering the position of a component based on the intra-operative image.ResultsDigital imaging took a mean of five minutes (2.3 to 14.6) to perform. Intra-operative changes with the use of digital imaging were made for 43 patients (86%), most commonly to adjust leg length and femoral offset. There was a decrease in the incidence of outliers when using intra-operative imaging compared with not using it in regard to leg length discrepancy (20% versus 52%, p = 0.001) and femoral offset inequality (18% versus 44%, p = 0.004). There was also a difference in the incidence of outliers in acetabular inclination (0% versus 7%, p = 0.023) and version (0% versus 4%, p = 0.114) compared with historical results of a high-volume surgeon at the same centre.ConclusionThe use of intra-operative digital imaging in THA improves the accuracy of the positioning of the components at THA without adding a substantial amount of time to the operation. Cite this article: Bone Joint J 2018;100B(1 Supple A):36–43.

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Revising Substantial Leg Length Discrepancy in Total Hip Arthroplasty Using Computer-assisted Navigated Systems: A Case Series of Three Patients

Cureus ◽

10.7759/cureus.5137 ◽

2019 ◽

Author(s):

John M Dundon ◽

Rachel R Mays

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Case Series ◽

Leg Length Discrepancy ◽

Computer Assisted ◽

Leg Length ◽

Total Hip ◽

Length Discrepancy

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LEG LENGTH DISCREPANCY IN ADOLESCENT IDIOPATHIC SCOLIOSIS

Coluna/Columna ◽

10.1590/s1808-185120191803208752 ◽

2019 ◽

Vol 18 (3) ◽

pp. 192-195

Author(s):

EDUARDO MOREIRA PINTO ◽

JORGE ALVES ◽

ALFREDO MENDES DE CASTRO ◽

SILVA MARCOS ◽

JOSÉ MIRADOURO ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Case Series ◽

Leg Length Discrepancy ◽

X Rays ◽

Leg Length ◽

Coronal Balance ◽

Length Discrepancy ◽

Lenke Classification ◽

Left Limb

ABSTRACT Objective The objective of this study is to evaluate leg length discrepancy in adolescent idiopathic scoliosis. Methods A retrospective study of 80 subjects with adolescent idiopathic scoliosis (AIS) was conducted. The inclusion criteria were patients aged 10 to 18 years old with posteroanterior (PA) and lateral full-length radiographs. The exclusion criteria were patients subjected to surgery or orthotic treatment, those with other spinal disease, and those with poor quality x-rays. The parameters evaluated were: age, sex, Risser stage (RS), triradiate cartilage (TC), scoliotic curvatures, differentiated according to Lenke classification, sagittal (SB) and coronal balance (CB), and leg length discrepancy, which was assessed through the difference between the femoral heads (LLD) and through the assessment of pelvic obliquity (PO). Results The majority of patients with AIS demonstrated a mild LLD (<1 cm). The mean LLD was significantly different (p<0.01) between the scoliotic population with a main thoracolumbar curvature and those with a main lumbar curvature. When there was an LLD, it was the left limb that was shortened in most cases. The side of the longer lower limb had a direct influence on the CB (p=0.052). Conclusions This study demonstrates that in an AIS population with small LLD values, the extent of the shortening has a stronger impact on coronal balance and location than on the dimension of the main scoliotic curvature. These results demonstrate the importance of a more in-depth study on the effects of LLD <1 cm in the development of AIS and coronal imbalance. Level of evidence IV; Case Series.

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Guided Growth in Leg Length Discrepancy in Beckwith-Wiedemann Syndrome: A Consecutive Case Series

Children ◽

10.3390/children8121152 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1152

Author(s):

Maurizio De Pellegrin ◽

Lorenzo Brogioni ◽

Guy Laskow ◽

Graziano Barera ◽

Roberta Pajno ◽

...

Keyword(s):

Genetic Disorder ◽

Case Series ◽

Invasive Procedure ◽

Leg Length Discrepancy ◽

Vascular Lesions ◽

Abdominal Wall Defects ◽

Leg Length ◽

Guided Growth ◽

Length Discrepancy

Beckwith-Wiedemann Syndrome (BWS) is a rare genetic disorder characterized by overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycemia, predisposition to embryonal tumor, lateralized overgrowth, and leg length discrepancy (LLD), which can affect normal posture and gait. Aim of this study was to evaluate the effects of guided growth (temporary epiphysiodesis technique) as LLD management in BWS patients. Between 2007 and 2021, 22 BWS patients (15 F, 7 M) with a mean age of 7.9 years (2.9–14.4) and a mean LLD at first surgery of 3.65 cm (2–10), underwent temporary proximal tibial (PTE) and distal femur epiphysiodesis (DFE). In 18 patients the first surgical procedure was PTE, in one, DFE, and in 3 cases, PTE and DFE at the same time, respectively. Eleven patients reached equality of leg length after a mean follow-up of 7.7 years (3.7–13.0) and mean age of 13.3 years (12.7–27.5); 10 patients underwent 3 surgical procedures, one 7 procedures. Fifteen patients had no complications. No severe complications, infection, articular stiffness, or neuro-vascular lesions occurred in remaining patients; complications included secondary varus or valgus axial deviation in a total of 6 patients, and two screw breakages in two patients. Guided growth as a minimally invasive procedure seems efficient for LLD treatment with low complication rate in BWS patients.

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