Limb lengthening in Africa: tibial lengthening indicated for limb length discrepancy and postosteomyelitis pseudarthrosis

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.

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

Hip International ◽

10.1177/1120700019865742 ◽

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.

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Reconstruction with tibial lengthening for limb length discrepancy in Crowe Type IV developmental dysplasia of hip in adulthood

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-012-0947-6 ◽

2012 ◽

Vol 23 (2) ◽

pp. 225-231 ◽

Cited By ~ 3

Author(s):

Tang Liu ◽

Xiangsheng Zhang ◽

Zhihong Li ◽

Wen Zeng

Keyword(s):

Limb Length Discrepancy ◽

Developmental Dysplasia ◽

Limb Length ◽

Developmental Dysplasia Of Hip ◽

Tibial Lengthening ◽

Length Discrepancy ◽

Type Iv

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Surgical Treatment of an Infected Nonunion of the Middle Third of the Femur Associated with Femoral Shortening in a Hemophilia Patient

Case Reports in Orthopedics ◽

10.1155/2016/3045262 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Ahmet Salduz ◽

Özcan Kaya ◽

Halil İbrahim Balci ◽

Turgut Akgul ◽

Fatih Dikici ◽

...

Keyword(s):

Weight Bearing ◽

Limb Lengthening ◽

Type A ◽

Limb Length Discrepancy ◽

Limb Length ◽

Full Weight Bearing ◽

Osteotomy Site ◽

Infected Nonunion ◽

Length Discrepancy ◽

Femoral Shortening

The management of nonunion and limb length discrepancy has remained a constant challenge in hemophilic patients. In this study, we aimed to present the treatment of femur infected nonunion and limb length discrepancy in a twenty-seven-year-old patient with hemophilia type A. A 27-year-old male patient with hemophilia type A referred to our institution for the treatment of right femur infected nonunion and 10 cm shortness of the femur. Resection of the nonunion site and bone-to-bone fixation with autologous bone grafting were performed. Compression to the pseudoarthrosis site and distraction from new osteotomy site were applied with the unilateral external fixator. Union was achieved, and 6 cm lengthening was obtained according to the initial length. Patient was followed up for 7 years. After this treatment, the patient is able to walk with full weight bearing on the affected extremity with 4 cm shortening which is compensated by the heel lift. The results of this case indicate that limb lengthening and treatment of nonunion with the external fixation could be reliable and effective method for hemophilic patients.

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