Abstract
Purpose
Crowe IV complete dislocated hips were thought to be difficult for primary THA. Correction for leg length discrepancy associated with nerve palsy or tough to reduction during surgery. Purpose of this study was to evaluate 3.5cm total leg length correction for any type of Crowe IV patients setting in anatomical positioning of acetabular cup with femoral shortening osteotomy.
Materials & Methods
24 hips were evaluated averaged 28 months after primary THA. Correction length of center of rotation, amount of femoral shortening, Harris hip score, and abductor muscle power recovery with MicroFet 2 caluculator. Bilateral cases were preformed with 6 months interval. Length of femur and tibia compared to contralateral normal side were evaluated from plain radiograms.
Results
Average LLD before surgery was 7.3 (5 to 8.5) cm, but recovered within 3.5 cm (0.8 to 2.9) after surgery. One cm longer of femur in 9 patients, one cm longer of tibia in 12 patients, and 1cm longer both of femur and tibia in 5 patients compared to contralateral side before surgery. Average OR time was 92 minutes. All patients were women averaged age was 60 (34 to 75). Harris hip score improved from 45 to 92 before and latest follow-up. All patients did not need t-cane 2 years after surgery. Center of rotation was averaged 6.8 (5.2 to 8.1) cm reducted to anatomical position. Femoral shortening averaged 3.3 (1.7 to 4.5) cm, so total correction was 3.5cm (3.1–4.2). No nerve palsy and had good muscle recovery without T-cane. Patients with normal contra lateral side had averaged 2 cm (1.5∼3) heel up orthosis after surgery, but had no complaint about heel up situation in activity of daily living.
Discussion & Conclusion
Amount of correction with leg length discrepancy during THA had controvertial issues especially in cases of completed dislocated hip joint. Several authors demonstrated that muscle-evoked potentials elicited by brain electric stimulation monitoring, but problems was occurred during epidural or spinal anesthesia. Averaged 3.5cm Total correction of leg length was very safe and satisfactory results for all Crowe IV patients.
