Abstract
Introduction
Limb Length discrepancy after total hip replacement has been reported to happen in 1–27% of cases with differences up to 70mm. Occasionally revision THR has been used to achieve limb length equalisation, especially when patients are symptomatic with hip/back pain, neurologic symptoms or instability. However, in presence of a well-functioning, pain free hip without hip symptoms, revision THR for shortening can lead to problems with decrease in offset or stability. An option in these cases would be a distal shortening osteotomy of femur.
Materials and Methods
From 2005 to 2014 five shortening osteotomies were done for LLD with limb lengthening of ipsilateral side following THR. All patients had well-functioning THRs with and no complications as dislocations or nerve symptoms.
A distal metaphyseal shortening osteotomy, fixed using a 95 degree blade plate, was chosen for better healing at this level and ease of surgery.
Results
Cause of LLD – Patient 1 had ‘neck preserving’ Hip replacement and post-operative lengthening. Patient 2 had Bilateral DDH with B/L THR, but with sub-trochanteric shortening on one side and not the other. Patient 3 had Bilateral DDH treated with THR with high hip centre on one side and at site of native cup on the other. Further two patients had total hip replacements for DDH.
The average lengthening was 28mm (25 – 32mm)
No patients had neuro-vascular compromise. All achieved radiological and clinical union by 3 months. At one year all patients were weight bearing without pain or discomfort and had full range of movement at knee. One patient required removal of plate due to discomfort that resolved following plate removal.
Conclusion
Our series of patients demonstrate that in cases with symptomatic limb lengthening in presence of an otherwise well-functioning THR, shortening osteotomy of distal metaphysis of femur is a viable option.
