Introduction: Leg length inequality (LLI) following arthroplasty, though often asymptomatic, can be cause for considerable morbidity and has increasing medicolegal consequences.

There are various methods of quantifying leg length inequality on plain AP radiograph. The aim of this study is to review the established practice in the measurement of leg length inequality and compare it to two methods used locally.

Methods: This is a retrospective study assessing the radiographs of 35 patients with a mix of native, unilateral and bilateral total hip arthroplasty. Two methods of measuring leg length inequality were prominent in the literature, the Woolson method and the Williamson method. A further two methods are used locally. Measurements for all four techniques were made by two senior consultant radiologist to on the trust PACS to assess inter and intra observer variability. Data analysis was performed using SPS 16 to produce intraclass correlation co-efficient (ICC) and Bland Altman plots.

Results: ICC for all methods in the measurement of LLI is excellent (≥0.90). The repeatability ICC for the four methods is; Woolson 0.65, Williamson 0.87, Direct 0.96 and the Leeds method 0.95.

Discussion: This study demonstrates that all four methods have excellent correlation; however the repeatability is better for the Direct and the Leeds methods than the two that are more widely used in the literature. While the Direct measurement is able to give an overall measurement for the leg length inequality, the Leeds method is able to distinguish between any inequality due to cup malpostion and stem malposition. It is therefore of particular value in the assessment of bilateral or revision arthroplasty and the audit of practice.

Percutaneous fixation of syndesmosis is an accepted treatment of isolated Weber C fractures of the ankle. However, the status of syndesmosis after removal of the screws has never been studied to our knowledge. We studied eight patients for any residual diastasis and its clinical significance. CT scan was used to study the residual diastasis of syndesmosis after the removal of screws by comparing with the normal side. Patients were clinically assessed using Maryland and International Foot Scoring systems. The talocrural angles were measured and were compared with the normal side.

Ten patients of isolated Weber C fractures were treated with percutaneous application of syndesmotic position scres from November ’97 to July ’99. Eight were available for follow up and two were lost to follow up. The average follow up was 427.9 days (14.26 months) with a range 167–744 days. There were 7 males and 3 females. The average age was 32.2 years (range 17–66). Left side was involved in 6 cases and right side in 4. The scres were removed after an average period of 78.3 days (11.8 weeks) with a range of 45–189 days.

All patients were found to be having diastasis ranging from 1 mm to 3 mm with an average of 2.06 mm. The Maryland score ranged from 76 to 100 with an average of 90. The international score ranged from 78 to 100 with an average of 87.62. The diastasis roughly paralleled with the Foot scores.

All patients who had percutaneous fixation of syndesmosis had residual diastasis following removal of the screws and this may be clinically significant.