Correction of leg-length discrepancy after hip transposition.
Four patients were treated with limb lengthening to correct a leg-length discrepancy that developed after a hip transposition after pelvic resection for sacroma of the pelvis. Three patients had Ewing's sacroma and one patient had osteosarcoma. All patients received chemotherapy; radiotherapy also was administered to the three patients with Ewing's sacroma. Femur lengthening was started at an average of 5.7 years (range, 4.4-6.8 years) after tumor surgery. At the start of elongation, the average age of the patients was 17.3 years (range, 10.3-20.8 years). The average leg-length discrepancy was 10.3 cm (range, 6-12 cm). The average of achieved lengthening was 6.4 cm (range 6-7.5 cm). The average healing index was 32 days (range, 27-40 days) per 1-cm elongation. According to the classification of Paley, two problems and two minor complications were treated by additional interventions. At the final followup, the average functional score was 22 (73%) according to the system of the Musculoskeletal Tumor Society. Leg-length discrepancy after hip transposition can be corrected with distraction osteogenesis. All patients who wore a stiff ankle-foot orthosis before lengthening wore an ordinary shoe lift after lengthening. The problems of the lengthening procedure are similar to the general complication rate of bone lengthening. Because the 5-year survival after resection of a pelvic sarcoma is only 20% to 30%, leg lengthening after hip transposition should be offered only to long-term survivors with at least 5 years event-free survival.
Rödl
Robert
R
Department of Orthopaedics, University Hospital of Muenster, Germany. roedl@uni-muenster.de
Gosheger
Georg
G
Leidinger
Benedikt
B
Lindner
Norbert
N
Winkelmann
Winfried
W
Ozaki
Toshifumi
T
D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology* / Q000601:surgery*; D008297:Male; D012516:Osteosarcoma / Q000601:surgery*; D010388:Pelvis; D012512:Sarcoma, Ewing / Q000601:surgery*; D016896:Treatment Outcome