Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient?
AimsLeg length discrepancy (LLD) is a common pre- and postoperative issue in total hip arthroplasty (THA) patients. The conventional technique for measuring LLD has historically been on a non-weightbearing anteroposterior pelvic radiograph; however, this does not capture many potential sources of LL...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-12-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.312.BJO-2022-0146.R1 |
| _version_ | 1828089378939863040 |
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| author | Max Hardwick-Morris Estelle Wigmore Joshua Twiggs Brad Miles Christopher W. Jones Piers J. Yates |
| author_facet | Max Hardwick-Morris Estelle Wigmore Joshua Twiggs Brad Miles Christopher W. Jones Piers J. Yates |
| author_sort | Max Hardwick-Morris |
| collection | DOAJ |
| description | AimsLeg length discrepancy (LLD) is a common pre- and postoperative issue in total hip arthroplasty (THA) patients. The conventional technique for measuring LLD has historically been on a non-weightbearing anteroposterior pelvic radiograph; however, this does not capture many potential sources of LLD. The aim of this study was to determine if long-limb EOS radiology can provide a more reproducible and holistic measurement of LLD.MethodsIn all, 93 patients who underwent a THA received a standardized preoperative EOS scan, anteroposterior (AP) radiograph, and clinical LLD assessment. Overall, 13 measurements were taken along both anatomical and functional axes and measured twice by an orthopaedic fellow and surgical planning engineer to calculate intraoperator reproducibility and correlations between measurements.ResultsStrong correlations were observed for all EOS measurements (rs > 0.9). The strongest correlation with AP radiograph (inter-teardrop line) was observed for functional-ASIS-to-floor (functional) (rs = 0.57), much weaker than the correlations between EOS measurements. ASIS-to-ankle measurements exhibited a high correlation to other linear measurements and the highest ICC (rs = 0.97). Using anterior superior iliac spine (ASIS)-to-ankle, 33% of patients had an absolute LLD of greater than 10 mm, which was statistically different from the inter-teardrop LLD measurement (p < 0.005).DiscussionWe found that the conventional measurement of LLD on AP pelvic radiograph does not correlate well with long leg measurements and may not provide a true appreciation of LLD. ASIS-to-ankle demonstrated improved detection of potential LLD than other EOS and radiograph measurements. Full length, functional imaging methods may become the new gold standard to measure LLD.Cite this article: Bone Jt Open 2022;3(12):960–968. |
| first_indexed | 2024-04-11T05:38:44Z |
| format | Article |
| id | doaj.art-0e3d2435661c429395d4c347dce10e1e |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-04-11T05:38:44Z |
| publishDate | 2022-12-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-0e3d2435661c429395d4c347dce10e1e2022-12-22T09:52:02ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-12-0131296096810.1302/2633-1462.312.BJO-2022-0146.R1Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient?Max Hardwick-Morris0Estelle Wigmore1Joshua Twiggs2Brad Miles3Christopher W. Jones4Piers J. Yates5360 Med Care, Sydney, NSW, Australia360 Med Care, Sydney, NSW, Australia360 Med Care, Sydney, NSW, Australia360 Med Care, Sydney, NSW, AustraliaCurtin University Faculty of Health Sciences, School of Medicine, Perth, WA, AustraliaOrthopaedics WA, Murdoch, WA, AustraliaAimsLeg length discrepancy (LLD) is a common pre- and postoperative issue in total hip arthroplasty (THA) patients. The conventional technique for measuring LLD has historically been on a non-weightbearing anteroposterior pelvic radiograph; however, this does not capture many potential sources of LLD. The aim of this study was to determine if long-limb EOS radiology can provide a more reproducible and holistic measurement of LLD.MethodsIn all, 93 patients who underwent a THA received a standardized preoperative EOS scan, anteroposterior (AP) radiograph, and clinical LLD assessment. Overall, 13 measurements were taken along both anatomical and functional axes and measured twice by an orthopaedic fellow and surgical planning engineer to calculate intraoperator reproducibility and correlations between measurements.ResultsStrong correlations were observed for all EOS measurements (rs > 0.9). The strongest correlation with AP radiograph (inter-teardrop line) was observed for functional-ASIS-to-floor (functional) (rs = 0.57), much weaker than the correlations between EOS measurements. ASIS-to-ankle measurements exhibited a high correlation to other linear measurements and the highest ICC (rs = 0.97). Using anterior superior iliac spine (ASIS)-to-ankle, 33% of patients had an absolute LLD of greater than 10 mm, which was statistically different from the inter-teardrop LLD measurement (p < 0.005).DiscussionWe found that the conventional measurement of LLD on AP pelvic radiograph does not correlate well with long leg measurements and may not provide a true appreciation of LLD. ASIS-to-ankle demonstrated improved detection of potential LLD than other EOS and radiograph measurements. Full length, functional imaging methods may become the new gold standard to measure LLD.Cite this article: Bone Jt Open 2022;3(12):960–968.https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.312.BJO-2022-0146.R1total hip arthroplastyleg length discrepancyLLDEOSpelvic radiographpreoperative planning |
| spellingShingle | Max Hardwick-Morris Estelle Wigmore Joshua Twiggs Brad Miles Christopher W. Jones Piers J. Yates Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient? Bone & Joint Open total hip arthroplasty leg length discrepancy LLD EOS pelvic radiograph preoperative planning |
| title | Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient? |
| title_full | Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient? |
| title_fullStr | Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient? |
| title_full_unstemmed | Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient? |
| title_short | Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient? |
| title_sort | leg length discrepancy assessment in total hip arthroplasty is a pelvic radiograph sufficient |
| topic | total hip arthroplasty leg length discrepancy LLD EOS pelvic radiograph preoperative planning |
| url | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.312.BJO-2022-0146.R1 |
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