title: A review of symptomatic leg length inequality following total hip arthroplasty.
abstract: Leg length inequality (LLI) following total hip replacement is a complication which features increasingly in the recent literature. The definition of LLI is complicated by lack of consensus regarding radiological measurement, clinical measurement and the incomplete relationship between LLI and associated symptoms. This paper reviews 79 reports relating to LLI post hip replacement, detailing definitions and classification and highlighting patient populations prone to symptomatic LLI. While there is no universal definition of LLI, there is a broad consensus that less than 10 mm of difference on AP view plain radiographs is clinically acceptable. There are few techniques described that consistently produce a postoperative LLI of less than this magnitude. Where postoperative LLI exists, lengthening appears to cause more problems than shortening. In cases of mild LLI, non-surgical management produces adequate outcomes in the majority of cases, with functional LLI cases doing better than those with true LLI. Operative correction is effective in half of cases, even where nerve palsy is present, and remains an important option of last resort. Poor outcomes in patients with LLI may be minimised if individuals at risk are identified and counselled appropriately.
authors: NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital and University of Leeds, Leeds, UK. abmcwill@hotmail.com
authors: Anthony B
authors: AB
authors: McWilliams
authors: Andrew J
authors: AJ
authors: Grainger
authors: Philip J
authors: PJ
authors: O'Connor
authors: Anthony C
authors: AC
authors: Redmond
authors: Todd D
authors: TD
authors: Stewart
authors: Martin H
authors: MH
authors: Stone
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D010808:Physical Examination; D011300:Preoperative Care; D011859:Radiography