Yuji Kishimoto1,2, Hiroko Suda3, Takahiro Kishi3, Toshiaki Takahashi3. 1. Department of Rheumatology, Tottori Red Cross Hospital, 117 Shotoku-cho, Tottori-shi, Tottori, 680-8517, Japan. yuji.kish@gmail.com. 2. Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori, 680-8517, Japan. yuji.kish@gmail.com. 3. Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori, 680-8517, Japan.
Abstract
PURPOSE: Leg length discrepancy (LLD) is one of the bothersome complications that reduce patient satisfaction after total hip arthroplasty (THA). This study aimed to investigate the independent risk factors of LLD after primary THA. METHODS: This is a case-control study of 163 THAs for 163 patients at our institution between April 2015 and March 2018. The relevant data about the general characteristics of the patients (age, sex, body mass index, and diagnosis), surgery (surgical approach, type of femoral stem fixation, and surgeon volume), and radiological findings (Dorr classification and pre-operative LLD) were reviewed to identify the risk factors of ≥ 5 mm post-operative LLD according to radiological measurement and to calculate odds ratios (OR) via logistic regression analysis. RESULTS: The median (interquartile) absolute value of post-operative LLD was 3.9 (2.3-7.4) mm, and 57 (35.0%) patients had LLD of ≥ 5 mm. After controlling for possible confounders, a low-volume surgeon was considered the only independent risk factor of post-operative LLD (adjusted OR: 8.26; 95% confidence interval: 3.48, 19.60; P < 0.001). Among the 103 patients performed by high-volume surgeons, 82 (79.6%) had LLD of < 5 mm, whereas among the 60 patients performed by low-volume surgeons, only 24 (40.0%) achieved LLD of < 5 mm (P < 0.001). CONCLUSION: A low-volume surgeon is associated with an increased risk of a post-operative LLD after primary THA, and the importance of measurements should be recognized to prevent post-operative LLD and achieve optimal outcomes. Moreover, surgeons must inform patients about the risk of developing LLD pre-operatively.
PURPOSE: Leg length discrepancy (LLD) is one of the bothersome complications that reduce patient satisfaction after total hip arthroplasty (THA). This study aimed to investigate the independent risk factors of LLD after primary THA. METHODS: This is a case-control study of 163 THAs for 163 patients at our institution between April 2015 and March 2018. The relevant data about the general characteristics of the patients (age, sex, body mass index, and diagnosis), surgery (surgical approach, type of femoral stem fixation, and surgeon volume), and radiological findings (Dorr classification and pre-operative LLD) were reviewed to identify the risk factors of ≥ 5 mm post-operative LLD according to radiological measurement and to calculate odds ratios (OR) via logistic regression analysis. RESULTS: The median (interquartile) absolute value of post-operative LLD was 3.9 (2.3-7.4) mm, and 57 (35.0%) patients had LLD of ≥ 5 mm. After controlling for possible confounders, a low-volume surgeon was considered the only independent risk factor of post-operative LLD (adjusted OR: 8.26; 95% confidence interval: 3.48, 19.60; P < 0.001). Among the 103 patients performed by high-volume surgeons, 82 (79.6%) had LLD of < 5 mm, whereas among the 60 patients performed by low-volume surgeons, only 24 (40.0%) achieved LLD of < 5 mm (P < 0.001). CONCLUSION: A low-volume surgeon is associated with an increased risk of a post-operative LLD after primary THA, and the importance of measurements should be recognized to prevent post-operative LLD and achieve optimal outcomes. Moreover, surgeons must inform patients about the risk of developing LLD pre-operatively.
Entities:
Keywords:
Leg length discrepancy; Primary total hip arthroplasty; Surgeon volume
Authors: E N Glassou; T B Hansen; K Mäkelä; L I Havelin; O Furnes; M Badawy; J Kärrholm; G Garellick; A Eskelinen; A B Pedersen Journal: Osteoarthritis Cartilage Date: 2015-10-21 Impact factor: 6.576
Authors: Dan-Viorel Nistor; Sergiu Caterev; Sorana-Daniela Bolboacă; Dan Cosma; Dan Osvald Gheorghe Lucaciu; Adrian Todor Journal: Int Orthop Date: 2017-04-24 Impact factor: 3.075
Authors: Robert L Barrack; Jeffrey A Krempec; John C Clohisy; Douglas J McDonald; William M Ricci; Erin L Ruh; Ryan M Nunley Journal: J Bone Joint Surg Am Date: 2013-10-02 Impact factor: 5.284
Authors: Lennard Loweg; Karl Philipp Kutzner; Matthias Trost; Marlene Hechtner; Philipp Drees; Joachim Pfeil; Michael Schneider Journal: Eur J Orthop Surg Traumatol Date: 2017-10-13