Leg length discrepancy after total hip arthroplasty.

Restoration of hip biomechanics, including femoral offset and leg length are desired goals in performing total hip arthroplasty. Minor leg length discrepancies, less than a centimeter, are common after total hip arthroplasty and usually well tolerated. However in some patients, even these small discrepancies are a source of dissatisfaction. In addition, more significant discrepancies can be a risk factor for nerve injury and are a relatively common cause of litigation. Although leg length discrepancy cannot be eliminated after hip arthroplasty, it can be minimized through a series of steps both preoperatively and intraoperatively. These include physical examination to determine true and apparent leg length, and radiographic evaluation to both assess leg length and to preoperatively template the surgical procedure. Finally, the preoperative plan needs to be executed in the operating room using appropriate intraoperative cues.