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Category: Volume 05 Issue 08 August 2017
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Title: Treatment of limb length dyscripancy following surgeries around hip in Tertiary Care Institute in India

Authors: Dr Neetin P Mahajan, Dr E. D. Pawar, Dr Farookh Wadia, Dr Ujjwal Ramteke , Dr Ved Ashish Ravesh, Dr Prasannakumar G S, Dr Ishan Gajbe

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.77

Abstract

Background- Surgeries around the hip joints are commonly found to have been associated with potential risk of immediate or late limb length inequality. Many times most of satisfaction level are associated with this problem. This study was performed in adults to determine the effects of shoe raise in significant limb equalities on patient satisfaction level on long basis.

Materials and Methods: We studied 112 patients attending Orthopaedics department of sir J J Group of Hospitals .with significant limb length inequalities following hip surgery around hip either due to trauma or replacement. Radiological analysis was done to calculate limb lenth difference. The gait analysis was done in 3 month interval till one year follow up. The patient satisfaction level  analysis was done using harris hip score

Results: The gait pattern especially short limb gait was significantly improved following treatment with shoe raises. There was no significant improvement in muscular gaits like trendelen bergs gait or waddling gait. The patient satisfaction level was improved by 10 percent following shoe raises.

Conclusions: The treatment of limb length discrepancy using shoe raise has significant impact on patient satisfaction level especially symptomatic one. The shortening following trauma surgeries should be treated by shoe raises especially in cases of length or varus malunion.

Key Words- Limb Length discrepancy, Hip surgery, trauma and replacement, shoe raise.

References

  1. Gross RH.  Leg length discrepancy: how much is too much? Orthopedics 1978;1:307-10.
  2. Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance.Chiropr Osteopat 2005;13:11.
  3. Kaufman KR, Miller LS, Sutherland DH. Gait asymmetry in patients with limb-length inequality.J Pediatr Orthop 1996;16:144-50.
  4. Goel A, Loudon J, Nazare A, et al.Joint moments in minor limb length discrepancy: a pilot study.Am J Orthop 1997;26:852-56.
  5. Soukka A, Alaranta H, Tallroth K, et al. Leg-length inequality in people of working age. The association between mild inequality and low-back pain is questionable. Spine 1991;16:429-31.
  6. Moseley CF. Leg length discrepancy. Pediatric Orthopaedics. Lovell WW, Winter RB (eds). Philadelphia, Lippincott Williams & Wilkins, Fifth Edn, 2001:1107-08.
  7. Stanitski DF. Limb length inequality: assessment and treatment options.J Am Acad Orthop Surg 1997;7:143-53. Ranawat CS, Rao RR, Rodriguez JA, Bhende HS. Correction of limb length inequality during total hip arthroplasty. J Arthroplasty. 2001;6:715–720. doi: 10.1054/arth.2001.24442.
  8. Sayed-Noor AS, Hugo A, Sjoden GO, Wetenberg P. Leg length discrepancy in total hip arthroplasty: comparison of 2 methods of measurement. Int Orthop. 2009;33:189–193.
  9. Clark CR, Huddleston HD, Schoch EP, Thomas BJ. Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg. 2006;14:38–45.
  10. Parvizi J, Sharkey PF, Bissett BA, Rothman RH, Hozack WJ. Surgical treatment of limb length discrepancy following total hip arthroplasty. J Bone Joint Surg Am. 2003;85:2310–2317.
  11. Hofmann AA, Skrzynski MC. Leg length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! 2000;23:943–944.
  12. Ranawat CS, Rodriguez JA. Functional leg-length inequality following total hip arthroplasty. J Arthroplast. 1997;12:359–364. doi: 10.1016/S0883-5403(97)90190-X.
  13. Sathappan SS, Ginat D, Patel V, Walsh M, Jaffe WL, Di Cesare PE. Effect of anaesthesia type on limb length discrepancy after total hip arthroplasty. J Arthroplast. 2008;23:203–209. doi: 10.1016/j.arth.2007.01.022.
  14. Turula KB, Frieberg O, Lindholm S, Tallroth K, Vankka E. Leg length inequality after total hip arthroplasty. Clin Orthop Relat Res. 1986;202:163–168.
  15. Rand JA, Ilstrup DM. Comparison of Charnley and T-28 total hip arthroplasty. Clin Orthop Relat Res. 1983;180:201.
  16. Frieberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. 1983;8:643–651. doi: 10.1097/00007632-198309000-00010.
  17. Mihalko WM, Philips MJ, Krackow KA. Acute sciatic and femoral neuritis following total hip arthroplasty. J Bone Joint Surg Am. 2001;83:589–592.
  18. Rosler J, Perka C. The effect of anatomical relationships on kinetic parameters after total hip replacement. Int Orthop. 2000;24:23–27. doi: 10.1007/s002640050006.
  19. Ranawat CS. The pants too short, the leg too long! 1999;22:845–846.
  20. Woo RYG, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–1306.
  21. Amstuz SM, Jinnah RH, Mail L. Revision of aseptic loose total hip arthroplasties. Clin Orthop Relat Res. 1982;170:21–33.
  22. Austin MS, Hozack WJ, Sharkey PF, Rothman RH. Stability and leg length equality in total hip arthroplasty. J Arthroplast. 2003;18:88–90. doi: 10.1054/arth.2003.50073.
  23. Love BRT, Wright K. Leg length discrepancy after total hip replacement. Proceedings of Australian Orthopaedic association. J Bone Joint Surg Br. 1983;65:103.
  24. Williamson JA, Reckling FW. Limb length discrepancy and related problems following total hip replacement. Clin Orthop Relat Res. 1978;202:135–138.
  25. Djerf K, Walshtrom O. Total hip replacement comparison between the Mckee-Farrar and Charnley prosthesis in a 5-year follow-up study. Arch Orthop Trauma Surg. 1986;105:158–162. doi: 10.1007/BF00433934.
  26. Rubash HE, Parvataneni HK. The pants too short, the leg too long: leg length inequality after total hip arthroplasty. 2007;30:764–765.

Corresponding Author

Dr Neetin Pralhad Mahajan

Associate Professor, (Orthopaedics)

Flat No. 12, Panchsheel Building, Sir J J Hospital Compound, Byculla, Mumbai 400008

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