Leg Length Discrepancy After Total Hip Arthroplasty: a Review of Literature

Overview

Journal Curr Rev Musculoskelet Med

Date 2013 Aug 1

PMID 23900834

Citations 77

Authors

Aravind S Desai

Asterios Dramis

Tim N Board

Affiliations

Soon will be listed here.

Abstract

Discrepancy of leg length is often considered to be a problem after total hip replacement and can adversely affect an otherwise excellent outcome. Furthermore, it has been associated with patient dissatisfaction and remains one of the most common reasons for litigation against the orthopedic community. As a consequence of the need to equalize leg length, several authors have sought to validate methods of minimizing limb length discrepancy based on preoperative planning with preoperative radiological templates or intraoperative methods of measurement. In this article, we present a review of the limb length discrepancy in total hip arthroplasty, its implications and several techniques to avoid it. We recommend that a combination of the above mentioned methods will give the best chance for the surgeon to minimise the risk of leg length discrepancy following total hip replacement.

Citing Articles

Efficacy of a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system in restoring limb length and offset.

Buchan G, Hecht 2nd C, Nugent M, Heckmann N, Kanaji A, Kamath A Arch Orthop Trauma Surg. 2025; 145(1):175.

PMID: 40042653 DOI: 10.1007/s00402-024-05648-0.

Intraoperative Fluoroscopy Decreases Magnitude and Incidence of Leg-Length Discrepancy Following Total Hip Arthroplasty.

Blum C, Luzzi A, Frederick J, Cooper H, Shah R, Tatka J Arthroplast Today. 2025; 30:101492.

PMID: 39959375 PMC: 11827086. DOI: 10.1016/j.artd.2024.101492.

"Intra-operative assessment of leg length discrepancy with anterior approach total hip replacement: a comparison between standard table, position table with and without intra-operative radiographs".

Viglietta E, Fenucci S, Iorio R, Parisien A, Grammatopoulos G, Kim P Int Orthop. 2025; .

PMID: 39951054 DOI: 10.1007/s00264-025-06411-9.

Simultaneous bilateral total hip arthroplasty results in smaller Leg length discrepancy than staged bilateral procedures.

Onoi Y, Hayashi S, Kuroda Y, Kamenaga T, Tsubosaka M, Nakano N Arch Orthop Trauma Surg. 2024; 145(1):12.

PMID: 39666096 DOI: 10.1007/s00402-024-05703-w.

Greater Trochanter Tip as an Anatomical Reference to Minimize Leg Length Discrepancy following Hip Arthroplasty.

Butarbutar J, Ivander G, Riantho A, Fidiasrianto K, Edward J, Tasya E Hip Pelvis. 2024; 36(4):302-309.

PMID: 39620571 PMC: 11638752. DOI: 10.5371/hp.2024.36.4.302.

References

Desai A, Connors L, Board T . Functional and radiological evaluation of a simple intra operative technique to avoid limb length discrepancy in total hip arthroplasty. Hip Int. 2011; 21(2):192-8. DOI: 10.5301/HIP.2011.6514. View

Desai A, Barkatali B, Dramis A, Board T . A simple intraoperative technique to avoid limb length discrepancy in total hip arthroplasty. Surgeon. 2010; 8(2):119-21. DOI: 10.1016/j.surge.2009.10.023. View

Turula K, Friberg O, Lindholm T, Tallroth K, Vankka E . Leg length inequality after total hip arthroplasty. Clin Orthop Relat Res. 1986; (202):163-8. View

Edeen J, Sharkey P, Alexander A . Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop (Belle Mead NJ). 1995; 24(4):347-51. View

Cuckler J . Limb length and stability in total hip replacement. Orthopedics. 2005; 28(9):951-3. DOI: 10.3928/0147-7447-20050901-21. View

Hofmann A, Skrzynski M . Leg-length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits!. Orthopedics. 2000; 23(9):943-4. DOI: 10.3928/0147-7447-20000901-20. View

Hossain M, Sinha A . A technique to avoid leg-length discrepancy in total hip arthroplasty. Ann R Coll Surg Engl. 2007; 89(3):314-5. PMC: 1964723. DOI: 10.1308/rcsann.2007.89.3.314. View

Sathappan S, Ginat D, Patel V, Walsh M, Jaffe W, Di Cesare P . Effect of anesthesia type on limb length discrepancy after total hip arthroplasty. J Arthroplasty. 2008; 23(2):203-9. DOI: 10.1016/j.arth.2007.01.022. View

Woolson S, Hartford J, Sawyer A . Results of a method of leg-length equalization for patients undergoing primary total hip replacement. J Arthroplasty. 1999; 14(2):159-64. DOI: 10.1016/s0883-5403(99)90119-5. View

10.

Shiramizu K, Naito M, Shitama T, Nakamura Y, Shitama H . L-shaped caliper for limb length measurement during total hip arthroplasty. J Bone Joint Surg Br. 2004; 86(7):966-9. DOI: 10.1302/0301-620x.86b7.14587. View

11.

Ranawat C . The pants too short, the leg too long!. Orthopedics. 1999; 22(9):845-6. DOI: 10.3928/0147-7447-19990901-16. View

12.

Takigami I, Itokazu M, Itoh Y, Matsumoto K, Yamamoto T, Shimizu K . Limb-length measurement in total hip arthroplasty using a calipers dual pin retractor. Bull NYU Hosp Jt Dis. 2008; 66(2):107-10. View

13.

Sayed-Noor A, Hugo A, Sjoden G, Wretenberg P . Leg length discrepancy in total hip arthroplasty: comparison of two methods of measurement. Int Orthop. 2008; 33(5):1189-93. PMC: 2899101. DOI: 10.1007/s00264-008-0633-9. View

14.

KUNKLE H, CARPENTER E . A simple technique for x-ray measurement of limb-length discrepancies. J Bone Joint Surg Am. 1954; 36-A(1):152-4. View

15.

Woo R, Morrey B . Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982; 64(9):1295-306. View

16.

Clark C, Huddleston H, Schoch 3rd E, Thomas B . Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg. 2006; 14(1):38-45. DOI: 10.5435/00124635-200601000-00007. View

17.

Gonzalez Della Valle A, Slullitel G, Piccaluga F, Salvati E . The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplasty. 2005; 20(1):51-8. DOI: 10.1016/j.arth.2004.04.016. View

18.

Mizuta I, Fujiwara H, Inoue H . A radiographic study of hip-joint alignment after prosthetic hip arthoplasty. Acta Med Okayama. 2002; 56(3):159-66. DOI: 10.18926/AMO/31712. View

19.

Williamson J, RECKLING F . Limb length discrepancy and related problems following total hip joint replacement. Clin Orthop Relat Res. 1978; (134):135-8. View

20.

McGee H, Scott J . A simple method of obtaining equal leg length in total hip arthroplasty. Clin Orthop Relat Res. 1985; (194):269-70. View