• Humans
• Arthroplasty, Replacement, Hip/methods
• Retrospective Studies
• Male
• Female
• Middle Aged
• Aged
• Patient Reported Outcome Measures
• Radiography
• Hip Prosthesis
• Acetabulum/diagnostic imaging
• Acetabulum/surgery
• Hip Joint/diagnostic imaging
• Hip Joint/surgery
• Adult
• Aged, 80 and over

• Complications
• LLD
• Leg length discrepancy
• Survey
• Total hip arthroplasty

• Humans
• Leg Length Inequality/surgery
• Leg Length Inequality/therapy
• Leg Length Inequality/etiology
• Arthroplasty, Replacement, Hip
• Postoperative Care/methods
• Surveys and Questionnaires
• Italy
• Practice Patterns, Physicians'/statistics & numerical data
• Male

• Università degli Studi di Firenze

• Cementless stem
• Complication
• Dorr classification
• Leg length discrepancy
• Proximal femoral morphology
• Total hip arthroplasty

• Humans
• Leg Length Inequality/etiology
• Arthroplasty, Replacement, Hip/methods
• Hip Prosthesis
• Female
• Male
• Middle Aged
• Aged
• Prosthesis Design
• Femur/surgery
• Retrospective Studies
• Postoperative Complications/epidemiology
• Incidence
• Risk Factors
• Adult

• Complications
• LLD
• Leg length discrepancy
• Survey
• Total hip arthroplasty

• Humans
• Leg Length Inequality/etiology
• Arthroplasty, Replacement, Hip/methods
• Italy
• Preoperative Care
• Intraoperative Care
• Practice Patterns, Physicians'/statistics & numerical data
• Orthopedic Surgeons
• Female
• Surveys and Questionnaires
• Male

• Università degli Studi di Firenze

• complication
• functional and radiological outcome
• haris-hip score
• osteonecrosis of femoral head
• total hip athroplasty

• Cementless stem
• Femoral neck length
• Hip arthroplasty
• Limb length

• Computed tomography
• Degenerative arthropathy
• Magnetic resonance imaging
• Peri-prosthetic infection
• Rotator cuff integrity
• Shoulder arthroplasty

• Osteonecrosis of the femoral head
• Pre-operative leg length discrepancy
• Proximal femoral shape
• Unilateral total hip arthroplasty

• Female
• Humans
• Middle Aged
• Arthroplasty, Replacement, Hip/adverse effects
• Retrospective Studies
• Femur Head/surgery
• Leg
• Risk Factors
• Leg Length Inequality/diagnostic imaging
• Leg Length Inequality/epidemiology
• Leg Length Inequality/etiology
• Osteonecrosis/complications

• 06-2003-0630 Seoul National University Hospital Research Fund

• artificial intelligence
• deep learning
• leg-length discrepancy
• osteoarthritis
• pelvis

• Humans
• Leg/surgery
• Deep Learning
• Reproducibility of Results
• Radiography
• Leg Length Inequality/diagnostic imaging
• Leg Length Inequality/surgery
• Arthroplasty, Replacement, Hip/methods
• Pelvis/diagnostic imaging
• Pelvis/surgery

• Femoral offset
• Hip biomechanics
• Leg length discrepancy
• Osteoarthritis
• Radiographic variation
• Total hip arthroplasty

• Arthroplasty, replacement, hip
• Follow-Up Studies
• Ions
• Leg length inequality
• Surgical procedures, operative

• acetabular components
• acetabular teardrop
• hip rotation center
• iliac crest
• ischial tuberosity
• limb length discrepancy (LLD)
• obturator foramen
• pelvic axis
• pelvis anteroposterior radiographs
• postoperative evaluation
• total hip arthroplasty

• 109-2314-B-038 -029 Taiwan National Science and Technology Council
• TMU108-AE1-B43 Taipei Medical University

• DAIR
• THA
• dislocation
• instability
• periprosthetic joint infection

• anatomical mark
• femoral neck fracture
• hip arthroplasty
• leg length discrepancy
• manual positioning
• “shoulder-to-shoulder”

Potential sources of inaccuracy in leg length discrepancy (LLD) measurements commonly arise due to postural malalignment during radiograph acquisition. Preoperative planning techniques for total hip arthroplasty (THA) are particularly susceptible to this inaccuracy, as they often rely solely on radiographic assessments. Owing to the extensive variety of pathologies that are associated with LLD, an understanding of the influence of malpositioning on LLD measurement is crucial. In the present study, we sought to characterize the effects of varying degrees of lateral pelvic obliquity (PO) and mediolateral limb movement in the coronal plane on LLD measurement error (ME).

A 3-D sawbones model of the pelvis with bilateral femurs of equal-length was assembled. Anteroposterior pelvic radiographs were captured at various levels of PO: 0°, 5°, 10°, and 15°. At each level of PO, femurs were individually rotated medio-laterally to produce 0°, 5°, 10°, and 15° of abduction/adduction. LLD was measured radiographically at each position combination. For all cases of PO, the right-side of the pelvis was designated as the higher-side, and the left as the lower-side.

At 0° PO, 71% of tested variations in femoral abduction/adduction resulted in LLD ME < 0.5-cm, while 29% were ≥ 0.5-cm, but < 1-cm. ME increased progressively as one limb was further abducted while the contralateral limb was simultaneously further adducted. The highest ME occurred with one femur abducted 15° and the other adducted 15°. Similar magnitudes of ME were seen in 98% of tested femoral positions at 5° of PO. The greatest ME (~ 1 cm) occurred at the extremes of right-femur abduction and left-femur adduction. At 10° of PO, a higher prevalence of cases exhibited LLD ME > 0.5-cm (39%) and ≥ 1-cm (8%). The greatest errors occurred at femoral positions similar to those seen at 5° of PO. At 15° of PO, half of tested variations in femoral position resulted in LLD ME > 1-cm, while 22% of cases produced errors > 1.5-cm. These clinically significant errors occurred at all tested variations of right-femur abduction, with the left-femur in either neutral position, abduction, or adduction.

This study aids surgeons in understanding the magnitude of radiographic LLD ME produced by varying degrees of PO and femoral abduction/adduction. At a PO of ≤5°, variations in femoral abduction/adduction of up to 15° produce errors of marginal clinical significance. At PO of 10° or 15°, even small changes in mediolateral limb position led to clinically significant ME (> 1-cm). This study also highlights the importance of proper patient positioning during radiograph acquisition, demonstrating the need for surgeons to assess the quality of their radiographs before performing preoperative templating for THA, and accounting for PO (> 5°) when considering the validity of LLD measurements.

• Femoral abduction adduction
• Lateral pelvic obliquity
• Leg length discrepancy
• Postural positional malalignment
• Radiographic measurement error
• Total hip arthroplasty THA

• Meta-analysis
• Robot assist system
• cohort study
• systematic review
• total hip arthroplasty

Limb length discrepancy (LLD) is one of the most common postoperative complications and can cause serious consequences. Poor recovery of femoral offset (OD) will result in weakness of the patient's external rotator muscles and affect the patient's postoperative function. The study is aimed to present a simple approach that compensates for the shortcomings of previous measuring devices and combines the advantages of different measuring devices to provide more accurate limb length and femoral offset restoration in total hip arthroplasty (THA).

This study was a prospective controlled trial involving 89 patients with THA. Group I (n = 44) was used for intraoperative measurement of THA with our self-designed horizontal calibrator. Group II (n = 45) was measured by a traditional freehand technique. The main outcome indicators were measured on the Neusoft PACS, including LLD, femoral offset deviation, and operative time. IBM SPSS 23.0 was used for data analysis.

The independent sample t-test was performed for all the data. The operative time, preoperative radiographic LLD, and OD of Group I and Group II had no statistical significance. Postoperative LLD of Group I and Group II were 2.5 ± 2.1 mm (range −5.7 to 8.3 mm) and 6.2 ± 4.3 mm (range −18.0 to 15.2 mm), and the independent sample t-test data of both (P < 0.001; 95% CI = −5.1, −2.2) showed statistical significance. In Group I, there were 38 THAs with LLD <5 mm, accounting for 86% and there were 44 THAs with LLD <10 mm, accounting for 100%. In Group II, there were 20 THAs with LLD <5 mm, accounting for 44%. There were 36 THAs with LLD <10 mm, covering for 80%. There was no significant difference in postoperative femoral offset and OD.

The horizontal calibrator can provide more accurate limb length and femoral offset recovery in THA. It is a simple surgical technique that does not add additionally surgical costs and does not significantly increase operative time, providing a new solution for surgeons to resolve postoperative LLD and restore femoral offset.

• National Natural Science Foundation of China

Direct anterior approach (DAA) total hip arthroplasty (THA) in a supine position provides a unique opportunity to assess leg length discrepancy (LLD) intra-operatively with fluoroscopy. Reported fluoroscopic techniques are useful but are generally complicated or costly. Despite the use of multiple techniques for leg length assessment, LLD continues to be a major post-operative source of patient dissatisfaction further emphasizing the importance of near-anatomic restoration. The utility of an alternative direct measurement of LLD on an intra-operative fluoroscopic pelvic image during DAA THA has not been reported.

To determine the reliability of a novel simple intra-operative measurement of LLD using a parallel line technique on a single fluoroscopic digital image of the pelvis.

One hundred and seventy-one patients who underwent DAA THA were included for analysis. Intra-operative fluoroscopic and post-operative anterior-posterior radiographs were imported to TraumaCad and calibrated for LLD measurement. LLD was measured on each image using the right-left hip differences in lesser trochanter to pelvic reference line distances. Pelvic reference points included the teardrops and ischia. Fluoroscopic LLD was compared to the gold-standard measurement of LLD measured on a post-operative radiograph.

Mean absolute difference in teardrop referenced LLD between fluoroscopic and post-operative radiographs was 2.17 mm and based on the ischia mean absolute difference was 2.63 mm. Linear regression of fluoroscopic and post-operative radiograph LLD based on teardrop and ischia LLD found r² values of 0.57 and 0.84, respectively. Mean absolute difference between fluoroscopic and post-operative x-ray LLD was within 5 mm in 95% of cases regardless of pelvic reference.

This study demonstrates that a single fluoroscopic view obtained during DAA THA for leg length assessment is clinically useful.

• Leg-length discrepancy
• Total hip arthroplasty
• Intra-operative fluoroscopy
• Direct anterior approach
• Limb asymmetry

• Mako robot
• Robot assisted total hip arthroplasty
• accuracy
• posterolateral approach
• safety

• arthroplasty
• dysplasia
• hip
• robotic assisted technology

• limb length discrepancy
• pelvic radiograph
• preoperative planning
• scanogram
• total hip arthroplasty

• Aged
• Arthroplasty, Replacement, Hip/adverse effects
• Female
• Femur/diagnostic imaging
• Femur/surgery
• Humans
• Leg
• Leg Length Inequality/diagnostic imaging
• Leg Length Inequality/epidemiology
• Middle Aged
• Radiography

• component positioning
• direct anterior total hip arthroplasty
• distortion
• image-intensified fluoroscopy
• limb-length measurements

This study was done to observe the incidence of Osteo-line on the femur neck and to explore the clinical application of Osteo-line in osteotomy.

Eighty-nine adult femur specimens were selected to observe the incidence of Osteo-line on the femur neck. From August 2015 to January 2019, a total of 278 patients who completed unilateral hip arthroplasty at the Third Hospital of Hebei Medical University were retrospectively included. Patients who accepted osteotomy via Osteo-line on the femur neck were defined as the experimental group (n = 139), and patients who accepted osteotomy via traditional method (The femoral distance 1.5 cm above the trochanter was retained for osteotomy by visual inspection.) were defined as the control group (n = 139). According to the postoperative pelvic X-ray, Photoshop was used to evaluate the leg length discrepancy (LLD) by the CFR-T-LT method.

Among the 89 specimens, the incidence of anterior Osteo-line was 75.28%, and the incidence of posterior Osteo-line was 100%. According to the clinical application results, the incidence of anterior Osteo-line on the femur neck was 80%, and the incidence of posterior Osteo-line was 100%. The Osteo-line was clearer than those on the femoral specimens. Twenty-six cases had LLD greater than 1 cm (9.29%), including 2 cases in the experimental group and 24 cases in the control group. The average postoperative LLD in the experimental group (0.19 ± 0.38 mm) was significantly shorter than in the control group (0.54 ± 0.51 mm)(P = 0.005).

The incidence of Osteo-line on the femur neck was high, and patients who accepted osteotomy via Osteo-line on the femur neck can achieve shorter postoperative LLD than the control group.

• Leg length discrepancy
• Osteo-line on femur neck
• Osteotomy
• Total hip arthroplasty

• Anterior approach
• Leg length discrepancies
• Standard table
• Total hip arthroplasty
• Traction table

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

• hip surgery
• intramedullary lengthening
• limb length discrepancy
• limb lengthening

• combined offset
• express femoral workflow
• leg length discrepancy
• robot-assisted technology
• total hip arthroplasty

• MAKO robot
• Total hip arthroplasty
• function recovery
• posterolateral approach

• Perceived leg length discrepancy
• Radiographic leg length discrepancy
• Total hip arthroplasty

• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/methods
• Female
• Hip Joint/surgery
• Humans
• Joint Diseases/complications
• Joint Diseases/surgery
• Leg Length Inequality/diagnosis
• Leg Length Inequality/etiology
• Leg Length Inequality/psychology
• Leg Length Inequality/surgery
• Male
• Middle Aged
• Patient Satisfaction
• Perception
• Retrospective Studies

Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter‐nerve and inter‐muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered “the gold standard” treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One‐state and two‐state non‐osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri‐operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.

• Acetabular reconstruction
• Hip dislocation
• Osteotomy
• Postoperative complications
• Total hip replacement

• Anterior approach
• EOS
• Hip arthroplasty
• Leg length discrepancy

• Anatomy
• Image reconstruction
• Pelvis
• Total hip arthroplasty

• Cephalomedullary nail
• Computed tomography
• Hip fracture
• Sliding hip screw

• clinical outcomes
• complications
• forgotten joint score
• robotic-arm assisted
• total hip arthroplasty

• Aged
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Computer Simulation
• Female
• Humans
• Imaging, Three-Dimensional
• Intraoperative Complications/etiology
• Male
• Middle Aged
• Models, Anatomic
• Osteoarthritis, Hip/diagnostic imaging
• Osteoarthritis, Hip/surgery
• Postoperative Complications/etiology
• Prospective Studies
• Retrospective Studies
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Tomography, X-Ray Computed
• Treatment Outcome

• Complication
• Elderly
• Fracture
• Surgical site infection
• Tibial plateau

The application of distraction osteogenesis through the use of magnet-operated, remote-controlled intramedullary lengthening continues to provide new opportunities for accurate limb equalization. While limb-length discrepancy and deformity can be addressed by total hip arthroplasty alone, the magnitude of correction is limited by the soft-tissue envelope and complications such as sciatic nerve palsy. This 3-patient case series presents the combination of staged ipsilateral total hip arthroplasty and retrograde intramedullary femoral nail lengthening for the correction of both deformity and limb-length discrepancy. Our results report leg-length equalization, independent ambulation without assistive devices, and excellent bone and functional outcomes without complications, demonstrating that this combined technique can be used to achieve targeted lengthening and deformity correction.

• Deformity
• Limb lengthening
• Limb-length discrepancy
• PRECICE
• Total hip arthroplasty

• Hip arthroplasty
• Leg length discrepancy
• Navigation

• Anatomical reference
• Femoral neck fracture
• Leg length discrepancy
• Preoperative templating

• Leg Length Inequality
• Osteoarthritis, Hip
• Osteoarthritis, Spine

• Arthroplasty
• Limb length discrepancy
• hip
• hip prosthesis
• leg length inequality
• replacement
• suture technique
• sutures
• total hip arthroplasty

• Arthroplasty
• Hip
• Offset
• Outcome
• Oxford hip score

• accuracy
• component placement
• hip arthroplasty
• multi surgeon
• robotic-guided