Leg length discrepancy in patients with Perthes’ disease

2021 ◽  
Vol 103-B (11) ◽  
pp. 1736-1741
Author(s):  
Jaap J. Tolk ◽  
Deborah M. Eastwood ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Skeletal Maturity ◽  
Perthes Disease ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Unaffected Side ◽  
Tibial Length ◽  
Length Discrepancy ◽  
Length Measurements ◽  
The Mean ◽  
Total Leg

Aims Perthes’ disease (PD) often results in femoral head deformity and leg length discrepancy (LLD). Our objective was to analyze femoral morphology in PD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalization on proximal and subtrochanteric femoral lengths. Methods All patients treated for PD in our institution between January 2013 and June 2020 were reviewed retrospectively. Patients with unilateral PD, LLD of ≥ 5 mm, and long-leg standing radiographs at skeletal maturity were included. Total leg length, femoral and tibial length, articulotrochanteric distance (ATD), and subtrochanteric femoral length were compared between PD side and the unaffected side. Furthermore, we compared leg length measurements between patients who did and who did not have a contralateral epiphysiodesis. Results Overall, 79 patients were included, of whom 21 underwent contralateral epiphysiodesis for leg length correction. In the complete cohort, the mean LLD was 1.8 cm (95% confidence interval (CI) 1.5 to 2.0), mean ATD difference was 1.8 cm (95% CI -2.1 to -1.9), and mean subtrochanteric difference was -0.2 cm (95% CI -0.4 to 0.1). In the epiphysiodesis group, the mean LLD before epiphysiodesis was 2.7 cm (95% CI 1.3 to 3.4) and 1.3 cm (95% CI -0.5 to 3.8) at skeletal maturity. In the nonepiphysiodesis group the mean LLD was 2.0 cm (95% CI 0.5 to 5.1; p = 0.016). The subtrochanteric region on the PD side was significantly longer at skeletal maturity in the epiphysiodesis group compared to the nonepiphysiodesis group (-1.0 cm (95% CI -2.4 to 0.6) vs 0.1 cm (95% CI -1.0 to 2.1); p < 0.001). Conclusion This study demonstrates that LLD after PD originates from the proximal segment only. In patients who had contralateral epiphysiodesis to balance leg length, this is achieved by creating a difference in subtrochanteric length. Arthroplasty surgeons need to be aware that shortening of the proximal femur segment in PD patients may be misleading, as the ipsilateral subtrochanteric length in these patients can be longer. Therefore, we strongly advise long-leg standing films for THA planning in PD patients in order to avoid inadvertently lengthening the limb. Cite this article: Bone Joint J 2021;103-B(11):1736–1741.

Microdose acquisition in adolescent leg length discrepancy using a low-dose biplane imaging system

2017 ◽  
Vol 58 (9) ◽  
pp. 1108-1114 ◽  
Author(s):  
Janni Jensen ◽  
Bo R Mussmann ◽  
John Hjarbæk ◽  
Zaid Al-Aubaidi ◽  
Niels W Pedersen ◽  
...  
Keyword(s):  
Low Dose ◽  
Imaging System ◽  
Statistical Significance ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Planar Imaging ◽  
Length Discrepancy ◽  
Significant Difference ◽  
Length Measurements ◽  
Total Leg

Background Children with leg length discrepancy often undergo repeat imaging. Therefore, every effort to reduce radiation dose is important. Using low dose preview images and noise reduction software rather than diagnostic images for length measurements might contribute to reducing dose. Purpose To compare leg length measurements performed on diagnostic images and low dose preview images both acquired using a low-dose bi-planar imaging system. Material and Methods Preview and diagnostic images from 22 patients were retrospectively collected (14 girls, 8 boys; mean age, 12.8 years; age range, 10–15 years). All images were anonymized and measured independently by two musculoskeletal radiologists. Three sets of measurements were performed on all images; the mechanical axis lines of the femur and the tibia as well as the anatomical line of the entire extremity. Statistical significance was tested with a paired t-test. Results No statistically significant difference was found between measurements performed on the preview and on the diagnostic image. The mean tibial length difference between the observers was −0.06 cm (95% confidence interval [CI], −0.12 to 0.01) and −0.08 cm (95% CI, −0.21 to 0.05), respectively; 0.10 cm (95% CI, 0.02–0.17) and 0.06 cm (95% CI, −0.02 to 0.14) for the femoral measurements and 0.12 cm (95% CI, −0.05 to 0.26) and 0.08 cm (95% CI, −0.02 to 0.19) for total leg length discrepancy. ICCs were >0.99 indicating excellent inter- and intra-rater reliability. Conclusion The data strongly imply that leg length measurements performed on preview images from a low-dose bi-planar imaging system are comparable to measurements performed on diagnostic images.

Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses

2018 ◽  
Vol 100-B (12) ◽  
pp. 1640-1646 ◽  
Author(s):  
M. R. Medellin ◽  
T. Fujiwara ◽  
R. Clark ◽  
L. M. Jeys
Keyword(s):  
Minimally Invasive ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Range Of Movement ◽  
Musculoskeletal Tumor Society ◽  
Non Invasive ◽  
Length Discrepancy ◽  
The Mean

AimsThe aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses.Patients and MethodsA total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System.ResultsThe overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295).ConclusionThe survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.

scholarly journals Tension band plating is less effective in achieving equalization of leg length

2018 ◽  
Vol 12 (6) ◽  
pp. 629-634 ◽  
Author(s):  
W.-C. Lee ◽  
H.-K. Kao ◽  
W.-E. Yang ◽  
C.-H. Chang
Keyword(s):  
Bone Growth ◽  
Skeletal Maturity ◽  
T Test ◽  
Tension Band ◽  
Leg Length Discrepancy ◽  
Length Ratio ◽  
Leg Length ◽  
Level Of Evidence ◽  
Short Side ◽  
Length Discrepancy

Purpose Little data is available on the efficiency of different implants for epiphysiodesis. The purpose of this study is to compare the efficacy between plates and staples in decreasing leg-length discrepancy. Methods A retrospective review of 19 children who underwent temporary epiphysiodesis of the legs was conducted, with a minimum of two years of follow-up. The bone length and length ratio to the short side were measured at six months, one year and two years postoperatively. The change in discrepancy was compared between staples and plates by an independent t-test, and the shortest time to a significant decrease in discrepancy was determined using a paired t-test. Results Ten patients underwent 13 staple procedures in nine femurs and four tibias for a 2.8-cm discrepancy at age 11.8 years, and nine patients underwent 14 plate procedures in seven femurs and seven tibias for a 3.1-cm discrepancy at age 12.4 years. Patients were followed up to skeletal maturity, except two. The use of staples decreased the discrepancy in the bone ratio from +4.8% to +1.2% in two years, and the use of plates decreased this ratio from +5.1% to +3.3% in two years. The change in the length ratio was significantly greater after stapling. Six months were required after stapling before the first significant decrease in discrepancy; it took two years after plating. Conclusions This study showed a significantly lower efficacy for decreasing leg-length discrepancy by tension band plating. Orthopaedic surgeons should be aware of the limitations of using plates for suppressing bone growth. Level of Evidence: III

Leg Length Discrepancy in Legg-Calve-Perthes Disease

2005 ◽  
Vol 25 (2) ◽  
pp. 206-209 ◽  
Author(s):  
Andrzej Grzegorzewski ◽  
Marek Synder ◽  
Piotr Kozłowski ◽  
Wiesław Szymczak ◽  
Richard James Bowen
Keyword(s):  
Perthes Disease ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Length Discrepancy

scholarly journals Two-stage total hip arthroplasty for primary advanced septic arthritis of the hip in adults: comparison of debridement versus femoral head resection with spacer implantation

2020 ◽  
Author(s):  
Zhenzhong Li ◽  
Congcong Wei ◽  
Xiangke Li ◽  
Mengxuan Yao ◽  
Huijie Li
Keyword(s):  
Total Hip Arthroplasty ◽  
Septic Arthritis ◽  
Pain Score ◽  
Hip Arthroplasty ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Two Stage ◽  
Length Discrepancy ◽  
The Mean

Abstract Background To compare the outcomes of debridement and antibiotic-loaded spacer implantation in primary advanced septic arthritis (SA) of the hip in adults treated with two-stage total hip arthroplasty (THA). Methods In the first stage, 9 patients were treated with debridement and 11 patients were treated with antibiotic-loaded spacer implantation. Then, THA was conducted in all patients in the second stage. Patients were evaluated based on the recurrence of infection, Harris hip score, visual analogue scale (VAS) pain score and leg-length discrepancy. Results No cases of infection, deep vein thrombosis, death, and loosening of hip prosthesis were observed during follow-up. The mean follow-up time was 29.09 ± 10.80 months in the debridement with THA group, and 28.22 ± 14.80 months in the spacer implantation with THA group. Before the THA surgery, the mean leg-length discrepancy was 2.80 ± 2.03 cm in the debridement with THA group, and 0.50 ± 0.23 cm in the spacer implantation with THA group (P < 0.05). In the latest follow-up, The Harris hip scores of patients was 90.33 ± 4.85 in the debridement with THA group and 94.36 ± 2.34 in the spacer implantation with THA group (P < 0.05), respectively. There was no statistical significant difference in VAS pain score of the hip between the two groups (P > 0.05).Conclusions Two-stage THA using antibiotic-loaded spacer implantation is an effective method for the treatment of advanced SA of the hip in adults due to it can control infection and significantly improve functional hip.

The use of a non-invasive extendable prosthesis at the time of revision arthroplasty

2018 ◽  
Vol 100-B (3) ◽  
pp. 370-377 ◽  
Author(s):  
M. M. Gilg ◽  
C. L. Gaston ◽  
L. Jeys ◽  
A. Abudu ◽  
R. M. Tillman ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Revision Procedure ◽  
Length Discrepancy ◽  
Prosthesis Revision ◽  
The Mean ◽  
Primary Bone Tumours

Aims The use of a noninvasive growing endoprosthesis in the management of primary bone tumours in children is well established. However, the efficacy of such a prosthesis in those requiring a revision procedure has yet to be established. The aim of this series was to present our results using extendable prostheses for the revision of previous endoprostheses. Patients and Methods All patients who had a noninvasive growing endoprosthesis inserted at the time of a revision procedure were identified from our database. A total of 21 patients (seven female patients, 14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were included. The indications for revision were mechanical failure, trauma or infection with a residual leg-length discrepancy. The mean follow-up was 70 months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). Lengthening was performed in all but one patient with a mean lengthening of 51 mm (5 to 140). Results The mean residual leg length discrepancy at final follow-up of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of whom one required amputation to eradicate the infection; the other required two-stage revision. Implant survival according to Henderson criteria was 86% at two years and 72% at five years. When considering revision for any cause (including revision of the growing prosthesis to a non-growing prosthesis), revision-free implant survival was 75% at two years, but reduced to 55% at five years. Conclusion Our experience indicates that revision surgery using a noninvasive growing endoprosthesis is a successful option for improving leg length discrepancy and should be considered in patients with significant leg-length discrepancy requiring a revision procedure. Cite this article: Bone Joint J 2018;100-B:370–7.

Association Between Leg Length Discrepancy and Posterior Tibial Tendon Dysfunction

2014 ◽  
Vol 7 (2) ◽  
pp. 119-126 ◽  
Author(s):  
Jose Antônio Veiga Sanhudo ◽  
Joao Luiz Ellera Gomes
Keyword(s):  
Case Control ◽  
Leg Length Discrepancy ◽  
Control Group ◽  
Case Group ◽  
Posterior Tibial Tendon ◽  
Leg Length ◽  
Control Series ◽  
Posterior Tibial ◽  
Length Discrepancy ◽  
The Mean

Background. Leg length discrepancy (LLD) is associated with a variety of orthopaedic disorders and biomechanical gait changes that involve possible overload of the posterior tibial tendon (PTT). In view of the biomechanical disturbances induced by LLD, an association may exist between LLD and PTT dysfunction (PTTD). Purpose. To compare the frequency and magnitude of LLD between subjects with and without PTTD and ascertain whether associations exist between clinical features and presence of dysfunction. Study Design. Case–control study. Methods. A total of 118 patients with a diagnosis of PTTD were seen between January 2009 and September 2012 and compared with 118 gender-matched and race-matched volunteers. The frequency of LLD, the mean absolute LLD, and the mean relative LLD were measured by conventional (radiographic) or computed tomography scanography and compared between cases and controls. Results. The prevalence of LLD and mean absolute and relative LLD values were significantly greater in the case group (94.9%, 5.64 mm and 7.36%, respectively) than in the control group (79.7%, 3.28 mm and 4.18%, respectively) (P < .001). Conclusion. The findings of this study demonstrate a relationship between LLD and PTTD. In light of the major biomechanical changes it induces, LLD may be a predisposing factor for development of PTTD. Level of Evidence: Prognostic, Level III: Case–control series, retrospective

scholarly journals Effect of inherent tibial asymmetry on leg length discrepancy measurements after intramedullary nailing of comminuted femoral shaft fractures

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 1 ◽  
Author(s):  
Ian Hudson ◽  
Krystalyn Mauch ◽  
Meg Schuurman ◽  
Muhammad T. Padela ◽  
Petra Gheraibeh ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Femoral Shaft ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Femoral Shaft Fractures ◽  
Length Discrepancy ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Bony Landmarks ◽  
Total Leg

Introduction: Locked intramedullary nailing (IMN) is the standard treatment for femoral shaft fractures in adults with high rates of union and relatively low rates of complications. Leg length discrepancy (LLD) after IMN of femoral shaft fractures is common, and is reported in 20–43% of cases. A known surgical challenge when trying to obtain equal leg lengths is comminuted fracture, which results in a loss of bony landmarks that guide reduction. The purpose of this study was to assess the effect of inherent tibial asymmetry on LLD measurements after IMN. Methods: Postoperative CT scanograms were performed on 79 consecutive patients after locked IMN for comminuted femoral shaft fracture. Leg lengths were determined by measurements taken from the scout view of a CT scanogram. Calculations of discrepancy were made for both femurs, tibias, and total leg length. Assessment was also made on the frequency wherein the tibial discrepancy compounded the femoral discrepancy. In situations where a limb segment was exactly symmetric to the contralateral side, the total leg was not regarded as a having compounded asymmetry. Results: Notable discrepancies were found in tibial length that significantly departed from the null of symmetry (p < 0.0001). Forty-two patients (53.2%) were found to have a tibial asymmetry of 3 mm or more, and 20 patients (25.3%) were found to exhibit a difference of 6.3 mm or more. Median femoral discrepancy was 5.3 mm and median tibial discrepancy was 3.0 mm. Seven patients were found to be asymmetric in total leg length as a consequence of underlying tibial asymmetry. Conversely, 11 patients benefited from their tibial asymmetry, which compensated for femoral asymmetry after IMN. Conclusion: Tibial symmetry cannot be assumed. If not accounted for, inherent tibial asymmetry may influence LLD after IMN of femur fractures.

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