Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2025; 16(8): 109885
Published online Aug 18, 2025. doi: 10.5312/wjo.v16.i8.109885
Prior leg length discrepancy in total hip arthroplasty patients causes greater implant complications and faster time to revision
Hugo C Rodriguez, Kevin L Mekkawy, Brandon D Rust, Thomas O Yergler, Arturo Corces, Martin W Roche, Ashim Gupta
Hugo C Rodriguez, Department of Orthopedics, Holy Cross Orthopedic Institute: Fort Lauderdale Practice, Oakland Park, FL 33334, United States
Kevin L Mekkawy, Thomas O Yergler, Arturo Corces, Department of Orthopaedic Surgery, Larkin Community Hospital, South Miami, FL 33143, United States
Brandon D Rust, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, United States
Martin W Roche, Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL 33308, United States
Ashim Gupta, Department of Orthopaedics and Regenerative Medicine, Future Biologics, Lawrenceville, GA 30043, United States
Author contributions: Rodriguez HC, Mekkawy KL, Rust BD, Yergler TO, Corces A, Roche MW and Gupta A drafted, critically reviewed and edited the manuscript; Rodriguez HC and Roche MW conceptualized the study; Roche MW and Gupta A supervised the study; all authors approved the final version of the article for publication.
Institutional review board statement: PearlDiver (PearlDiver Technologies, Colorado Springs, CO, United States), a leading commercial database, serves as a comprehensive repository for extensive de-identified medical records sourced from private insurance claims analysis, conforming to Health Insurance Portability and Affordability Act regulations. Given the de-identification of patients, this study is deemed exempt from the institutional review board.
Informed consent statement: Not applicable.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ashim Gupta, MS, PhD, MBA, DABRM, FABRM, President, Professor, Department of Orthopaedics and Regenerative Medicine, Future Biologics, 2505 Newpoint Pkwy, Lawrenceville, GA 30043, United States. ashim6786@gmail.com
Received: May 26, 2025
Revised: June 11, 2025
Accepted: July 18, 2025
Published online: August 18, 2025
Processing time: 76 Days and 5.7 Hours
Abstract
BACKGROUND

Leg length discrepancy (LLD) following total hip arthroplasty (THA) is a common complaint, leading to decreased patient satisfaction. However, the effect of LLD before THA on outcomes and complications is not well defined.

AIM

To assess the effect of prior LLD on rates of falls, implant-related complications, stay length, readmissions, and implant survival following THA.

METHODS

A retrospective review of a nationwide insurance database was conducted from 2010 to 2021. All cases of THA and those with a prior diagnosis of LLD were identified. THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles. Two-year fall rates and implant complications, lengths of stay, 90-day readmissions, and time to revision were compared between cohorts.

RESULTS

A total of 2038 patients with LLD were matched to 10165 control patients. The LLD group showed significantly greater rates of falls [odds ratio (OR) = 1.58; 95% confidence interval (95%CI): 1.24-2.01], dislocation (OR = 2.61; 95%CI: 2.10-3.24), mechanical loosening (OR = 4.58; 95%CI: 3.28-6.29), and periprosthetic fracture (OR = 2.70; 95%CI: 1.96-3.72) compared to the control group (all P < 0.001). Mean length of stay (LOS) was also significantly higher in the LLD group (3.1 days vs 2.8 days, P = 0.034). No significant difference in 90-day readmission rates (7.75% vs 7.02%, P = 0.244) was observed between the groups (P = 0.244). Time to revision was significantly less in the LLD group (225 days vs 544 days, P < 0.001).

CONCLUSION

LLD in patients having THA is related with significantly higher fall risk, rates of implant-related complications, LOS, and quicker time to revision. Identifying patients with LLD before their THA may help in identifying risks, better patient counselling, and more effective preoperative planning. However, the study have important limitations: Its design lacks information on the degree and cause of LLD, the time between diagnosis and surgery, and which leg with the discrepancy underwent the operation. Future well-designed studies should confirm the findings of this study.

Keywords: Leg length discrepancy; Total hip arthroplasty; Implant complications; Time to revision; Fall risk; Length of stay; Readmission; Outcomes

Core Tip: Leg length discrepancy (LLD) after total hip arthroplasty (THA) is a routine complaint, resulting in decreased patient satisfaction. Yet, the consequence of LLD before THA on outcomes and complications is not well defined. Here, we assessed the effect of prior LLD on rates of falls, implant complications, length of stay, readmissions, and implant survival following THA. Patients undergoing THA with LLD exhibited markedly elevated rates of falls, increased odds of prosthetic complications, prolonged hospitalization, and earlier revision timelines. Considering these implications, assessing limb length before surgery becomes crucial to enhance surgical planning and perioperative management, thereby mitigating associated risks.