The results of total hip arthroplasty (THA) revisions to correct leg length discrepancy (LLD) are not clear, with only two former limited series (< 25 patients). Therefore, we conducted a retrospective study of THA revisions for LLD to determine: 1) the change in LLD, 2) the function outcomes and whether obtaining equal leg lengths influenced function, 3) the complication and survival rates.

This multicenter study included 57 patients: 42 THA revisions for limb shortening and 15 revisions for limb lengthening. LLD was measured on conventional radiographs and EOS. The Oxford-12 and FJS outcome scores were collected and the number of patients achieving the Oxford-12 MCID.

The revisions were carried out a mean of 2.8 years after the index THA. The median LLD decreased from 7.5 mm (IQR: [5;12]) to 1 mm (IQR: [0.5;2.5]) at follow-up (p=0.0002). Overall, 55 of 57 patients (96%) had < 5 mm LLD at follow-up and 12 patients (21%) had equal leg lengths. The complication rate was 25%: 12 mechanical complications (8 periprosthetic femoral fractures, 2 stem loosening and 1 cup loosening, 1 dislocation) and 1 periprosthetic infection. The patient satisfaction was high with a median FJS of 79.2/100 and 77% of patients reached the Oxford-12 MCID. Lengthening procedures had significantly worst function than shortening (38% vs 91% of patients achieving the Oxford-12 MCID (p=0.0004)). Survivorship was 85% (95% CI: 77.9 – 92.5) at 2 years and 77% (95% CI: 66.3 – 87.1) at 4.6 years when using re-revision for any reason as the endpoint.

When LLD after THA does not respond to conservative management, revision THA should be considered. Although revision THA for LLD improved medium-term functional outcomes with a high patient satisfaction rate, especially for shortening procedures, the complication rate was high, particularly related to periprosthetic femoral fracture.