Two-stage total hip arthroplasty following skeletal traction after extensive soft tissue release for severe limb-length discrepancy

2019 ◽  
pp. 112070001986574
Author(s):  
Soong Joon Lee ◽  
Kang Sup Yoon
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Limb Lengthening ◽  
Limb Length Discrepancy ◽  
Neurological Complications ◽  
Limb Length ◽  
Soft Tissue Release ◽  
Skeletal Traction ◽  
Length Discrepancy ◽  
Shortening Osteotomy

Introduction: To maximise limb-length discrepancy (LLD) resolution during total hip arthroplasty (THA) for untreated developmental hip dysplasia or septic hip sequelae, THA following limb lengthening was introduced using different methods. We aimed to evaluate 2-stage THA results following limb lengthening via skeletal traction after extensive soft tissue release. Method: In total, 24 hips with severe LLD in 10 men and 14 women (mean age, 49.6 ± 15.2 years) underwent 2-stage THA and were followed thereafter (mean 6.3 ± 3.7 years). The entire abductor muscle origin was subperiosteally released from the ilium, and the soft tissue around the hip joint, including the psoas tendon, short external rotator, joint capsule, and adductor tendon, was extensively released. 2-stage THA was performed after 2-week skeletal traction using proximal tibial pins. During the final THA, 7 hips necessitated subtrochanteric shortening osteotomy (STO) for hip joint reduction. We evaluated the clinical and radiological results and especially focused on LLD and neurological complications. Results: The Harris Hip Score improved from 57.1 ± 9.6 to 88.3 ± 6.3 points. No patients showed worse abductor power. LLD improved from 5.0 ± 2.0 to 1.4 ± 1.0 cm. No permanent neurological complications occurred except for 1 transient peroneal nerve palsy during traction, which resolved fully after cessation of traction. There were 2 hips with STO nonunion treated with osteosynthesis and stem revision. Conclusion: 2-stage THA following skeletal traction after extensive soft tissue release showed favourable results in terms of neurologic complication prevention and LLD resolution. However, a large proportion of patients still necessitated shortening osteotomy with a risk for nonunion at the osteotomy site. Though surgical procedures might be complicated and necessitate longer hospital stays, 2-stage THA with extensive soft tissue release might be an alternative treatment option for patients with severe LLD willing to resolve their limb length discrepancy.

Intraoperative two-stage evaluation of muscle contractures in Crowe type IV hips in total hip arthroplasty (a new surgical technique)

2020 ◽  
pp. 112070002095978
Author(s):  
Ömer F Bilgen ◽  
Osman Yaray ◽  
Müren Mutlu ◽  
Ahmet M Aksakal
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Soft Tissue Balance ◽  
Total Hip ◽  
Length Discrepancy ◽  
Type Iv ◽  
Adductor Muscles

Background: It is important to maintain soft-tissue balance and prevent muscle contractures after hip reduction during total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH). To make such hips functional and durable, the techniques to achieve soft-tissue balance were studied to create an algorithm for intraoperative 2-stage evaluation of muscle contractures, specifying the optimal order for contracture release. Methods: Between February 2011 and March 2015, we evaluated 64 patients (75 hips) with DDH for muscle contractures as they underwent THA. Following acetabular implantation, femoral osteotomy was applied of various lengths according to limb-length discrepancy. First, the distal part of the femur was prepared by broaching, and the hip was then reduced. The tensor fascia lata, rectus femoris, sartorius, hamstrings, and adductor muscles were evaluated, and any contractures were released. A trial conjoining of the distal and proximal parts of the femur was made, and the hip was reduced again. Finally, the iliopsoas and abductor muscles were evaluated, and contractures were released. Results: The mean follow-up duration was 4.6 years. Preoperative and postoperative Harris Hip Scores were 52 and 87, respectively. Limb-length discrepancy was mean 4.2 cm preoperatively, and <1 cm postoperatively. All contractures were released according to our newly developed algorithm. Conclusions: It is challenging to pinpoint the main muscle causing contractures, because other muscles acting on the hip joint have similar secondary functions. The method we describe here may provide better and more specific restoration of muscle function in a hypoplastic hemipelvis in DDH.

scholarly journals Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

2020 ◽  
Vol 9 (12) ◽  
pp. 4104
Author(s):  
Lukas Zak ◽  
Thomas Manfred Tiefenboeck ◽  
Gerald Eliot Wozasek
Keyword(s):  
Hip Dysplasia ◽  
Young Patients ◽  
Limb Lengthening ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Hip Surgery ◽  
Bone Lengthening ◽  
Safe Procedure ◽  
Length Discrepancy ◽  
Healing Index

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

Age Affects the Perception of Limb Length Discrepancy in Patients with and without a Total Hip Arthroplasty

2004 ◽  
Vol 14 (4) ◽  
pp. 249-253 ◽  
Author(s):  
A. Gonzélez Della Valle ◽  
A. Zoppi ◽  
M.G.E. Peterson ◽  
E.A. Salvati
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Total Hip ◽  
Length Discrepancy

scholarly journals Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

2018 ◽  
Vol 4 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Elizabeth Harkin ◽  
S. Robert Rozbruch ◽  
Tomas Liskutin ◽  
William Hopkinson ◽  
Mitchell Bernstein
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Dysplasia ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Total Hip ◽  
Length Discrepancy ◽  
Femoral Nail

scholarly journals Results of limb reconstruction system in failed osteosynthesis of long bones

2017 ◽  
Vol 3 (2) ◽  
pp. 287
Author(s):  
Hiranya Kumar ◽  
Siddalingeshwar Vithoba Honnur ◽  
Manoj Kumar Shukla ◽  
Srikanth Etikala Neruganti
Keyword(s):  
Soft Tissue ◽  
Bone Quality ◽  
Bone Fractures ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Long Bones ◽  
Poor Bone Quality ◽  
Length Discrepancy ◽  
Soft Tissue Problems ◽  
Financial Issues

<p class="abstract"><strong>Background:</strong> The LRS is an excellent option treating the failed osteosynthesis in long bone fractures, because of failure in healing due to loosening of implant, infection, nonunion, poor bone quality and bone loss associated with deformities, limb length discrepancy, soft tissue problems, functional and financial issues.</p><p class="abstract"><strong>Methods:</strong> we prospectively treated 30 cases of failed osteosynthesis of long bones (7 plating, 22 nailing &amp; 1 k-wire with plaster) between April 2009 to October 2015 with LRS. Initially we managed by implant removal, freshening of fracture site or radical debridement followed by LRS application.<strong></strong></p><p class="abstract"><strong>Results:</strong> Union occurred in 93% cases. The eradication of infection was seen in 96.5% cases. Average lengthening done was 4.2 cms. We had 93% excellent and 7 % poor bony result. Functional result was excellent in 45%, good in 48% and failure in 7% cases using ASAMI scoring system.</p><p class="abstract"><strong>Conclusions:</strong> LRS is an excellent option in the management of failed osteosynthesis especially associated with infection, nonunion, deformities, limb length discrepancy, soft  tissue problems, functional and financial issues and also where re-osteosynthesis is challenging with poor bone quality and bone stock. It is simpler technically, patient friendly and short learning curve.</p>

scholarly journals Limb length discrepancy after total hip arthroplasty: a systematic review

2018 ◽  
Vol 4 (5) ◽  
pp. 690 ◽  
Author(s):  
Pradeep Kumar Pathak ◽  
Rakesh Kumar Gupta ◽  
Hari Singh Meena ◽  
Rajendra Fiske
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Total Hip ◽  
Patient Dissatisfaction ◽  
Length Discrepancy ◽  
Hip Stability ◽  
Combined Use ◽  
Limb Length Inequality

<p class="abstract">Correcting limb length inequality without compromising hip stability is one of the major intraoperative challenges in Total hip arthroplasty (THA) as it is a major cause of patient dissatisfaction and litigation against surgeon. Surgeons performing THA should aim to minimize Limb Length Discrepancy (LLD), and therefore should adopt a reliable method of doing so. Thus a reproducible technique which effectively reduces postoperative LLD without increasing operative time and is easy to apply is a need of time. Although various preoperative and intraoperative techniques are described in literature, none is universally applicable and is without limitations. We are presenting a review of 50 articles on limb length discrepancy after total hip arthroplasty, its implications and several techniques to avoid it. We suggest that every effort should be made to minimise postoperative Limb Length Discrepancy by combined use of preoperative and intraoperative techniques.</p>

SURGICAL TREATMENT OF LIMB-LENGTH DISCREPANCY FOLLOWING TOTAL HIP ARTHROPLASTY

2003 ◽  
Vol 85 (12) ◽  
pp. 2310-2317 ◽  
Author(s):  
JAVAD PARVIZI ◽  
PETER F. SHARKEY ◽  
GINA A. BISSETT ◽  
RICHARD H. ROTHMAN ◽  
WILLIAM J. HOZACK
Keyword(s):  
Surgical Treatment ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Total Hip ◽  
Length Discrepancy

Effect of Anesthesia Type on Limb Length Discrepancy After Total Hip Arthroplasty

2008 ◽  
Vol 23 (2) ◽  
pp. 203-209 ◽  
Author(s):  
Sathappan S. Sathappan ◽  
Daniel Ginat ◽  
Vipul Patel ◽  
Michael Walsh ◽  
William L. Jaffe ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Total Hip ◽  
Length Discrepancy
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