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Limb length discrepancy Andrew Port

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Limb length discrepancy

Andrew Port

The importance of LLD

• 60% long - mean 1cm– Perceived at 6mm

• 30% short - mean 6mm– Perceived at 1cm

• All due to femoral implant position

• Sign. Worse OHS

• 15% improved between 3/12 – 1 year

Bannister

JBJS 2007

Page 3: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Reasons for LLD

• Hip causes

• Non hip

Page 4: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Non hip

Page 5: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Other limb causes

Page 6: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Non- hip

• Tib Post

Page 7: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Reasons for LLD

• Hip causes

• Non hip

Page 8: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Acutely shortened

Page 9: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Chronic shortening

CDH

Page 10: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Perthes

Symptoms

• Length

• Reduced ROM

• Gait disorder

• Dissatisfaction

• Dislocation

• Back pain

– Thoracic

– Lumbar

• Neurologic

– Paraesthesia

– Palsy

Page 12: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Evaluation

Page 13: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Evaluation

Page 14: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Diagnosis

Page 15: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Offset

Page 16: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Offset

• Limitation of uncemented

Page 17: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Large head hybrids

Page 18: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Treatment

• Avoidance

• Planning

• Soft tissue balance

Page 19: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Correction

Page 20: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Surgical correction

• 21 pts

• 6/7-6yrs

• 2-7cm

• 15 equalised

• 6 <1cm

• Harris Hip score

• All but 2 satisfiedParvizi

JBJS 2003

Page 21: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Undercorrection?

• Acetabular/femoral balancing

Page 22: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Cemented

Page 23: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Page 24: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Shortening / offset

Page 25: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Large heads

Page 26: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

ROM / offset

Page 27: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Nerve injury

Page 28: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Extra-articular

Page 29: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Page 30: Limb length discrepancy - lists.ncl.ac.uk · Limb length discrepancy Andrew Port. The importance of LLD • 60% long -mean 1cm –Perceived at 6mm • 30% short -mean 6mm –Perceived

Summary

• Avoidance techniques

• Length AND Offset

• Non- Hip causes

• Often rewarding

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