A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty
Abstract Background Leg length discrepancy (LLD) after total hip arthroplasty (THA) is a known source of complications and a leading cause of litigation (J Bone Joint Surg Br 87:155–157, 2005). There are limited studies investigating surgical approach combined with the use of fluoroscopy intraoperat...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | Arthroplasty |
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| Online Access: | http://link.springer.com/article/10.1186/s42836-020-00051-7 |
| _version_ | 1818341185050116096 |
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| author | Henry Dunn Geoff Rohlfing Robert Kollmorgen |
| author_facet | Henry Dunn Geoff Rohlfing Robert Kollmorgen |
| author_sort | Henry Dunn |
| collection | DOAJ |
| description | Abstract Background Leg length discrepancy (LLD) after total hip arthroplasty (THA) is a known source of complications and a leading cause of litigation (J Bone Joint Surg Br 87:155–157, 2005). There are limited studies investigating surgical approach combined with the use of fluoroscopy intraoperatively and their potential effects on LLD after THA. The purpose of this study was to compare the direct anterior (DA) approach utilizing a fluoroscopic overlay technique and anterolateral (AL) approach and their potential effect on LLD. Methods We retrospectively reviewed 121 patients who had undergone primary THA from September 1, 2016 to November 1, 2018 by either DA or AL approach by two separate surgeons. Leg length discrepancies were measured on pre-operative post-anesthesia care unit (PACU) and on post-operative low anterior/posterior (AP) pelvis plain radiographs by two investigators blinded to each other’s measurements. To confirm inter-observer and intra-observer reliability between LLD measurements amongst investigators, a Pearson correlation test was performed. The primary outcome measurement was leg length discrepancy (LLD). Results We observed LLD > 1.0 cm and LLD > 1.5 cm in the DA and AL groups. The DA approach group showed a mean LLD of 4.5 mm against 7.76 mm in the AL group (p < 0.00001). There was a significantly higher rate of LLD in the AL group as compared to the DA group (LLD> 1 cm (28% vs. 8%, p = 0.0037) and LLD > 1.5 cm (7% vs. 0%, p = 0.0096). The LLD measurements showed strong correlation in terms of inter-observer (r = 0.95) and intra-observer reliability (r = 0.99) between the two investigators (p < 0.001). Conclusion In our patient cohort, the DA approach with fluoroscopic overlay technique had less LLD in comparison with the AL approach, suggesting that intraoperative fluoroscopic use does have an impact on LLD. |
| first_indexed | 2024-12-13T15:54:46Z |
| format | Article |
| id | doaj.art-bab0e92a47b8426aaecdbb79ddbff060 |
| institution | Directory Open Access Journal |
| issn | 2524-7948 |
| language | English |
| last_indexed | 2024-12-13T15:54:46Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthroplasty |
| spelling | doaj.art-bab0e92a47b8426aaecdbb79ddbff0602022-12-21T23:39:20ZengBMCArthroplasty2524-79482020-11-01211610.1186/s42836-020-00051-7A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplastyHenry Dunn0Geoff Rohlfing1Robert Kollmorgen2UCSF FresnoUCSF FresnoUCSF FresnoAbstract Background Leg length discrepancy (LLD) after total hip arthroplasty (THA) is a known source of complications and a leading cause of litigation (J Bone Joint Surg Br 87:155–157, 2005). There are limited studies investigating surgical approach combined with the use of fluoroscopy intraoperatively and their potential effects on LLD after THA. The purpose of this study was to compare the direct anterior (DA) approach utilizing a fluoroscopic overlay technique and anterolateral (AL) approach and their potential effect on LLD. Methods We retrospectively reviewed 121 patients who had undergone primary THA from September 1, 2016 to November 1, 2018 by either DA or AL approach by two separate surgeons. Leg length discrepancies were measured on pre-operative post-anesthesia care unit (PACU) and on post-operative low anterior/posterior (AP) pelvis plain radiographs by two investigators blinded to each other’s measurements. To confirm inter-observer and intra-observer reliability between LLD measurements amongst investigators, a Pearson correlation test was performed. The primary outcome measurement was leg length discrepancy (LLD). Results We observed LLD > 1.0 cm and LLD > 1.5 cm in the DA and AL groups. The DA approach group showed a mean LLD of 4.5 mm against 7.76 mm in the AL group (p < 0.00001). There was a significantly higher rate of LLD in the AL group as compared to the DA group (LLD> 1 cm (28% vs. 8%, p = 0.0037) and LLD > 1.5 cm (7% vs. 0%, p = 0.0096). The LLD measurements showed strong correlation in terms of inter-observer (r = 0.95) and intra-observer reliability (r = 0.99) between the two investigators (p < 0.001). Conclusion In our patient cohort, the DA approach with fluoroscopic overlay technique had less LLD in comparison with the AL approach, suggesting that intraoperative fluoroscopic use does have an impact on LLD.http://link.springer.com/article/10.1186/s42836-020-00051-7Leg length discrepancyDirect anterior approachAnterolateral approachPrimary total hip arthroplastyIntraoperative fluoroscopyOverlay technique |
| spellingShingle | Henry Dunn Geoff Rohlfing Robert Kollmorgen A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty Arthroplasty Leg length discrepancy Direct anterior approach Anterolateral approach Primary total hip arthroplasty Intraoperative fluoroscopy Overlay technique |
| title | A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty |
| title_full | A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty |
| title_fullStr | A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty |
| title_full_unstemmed | A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty |
| title_short | A comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty |
| title_sort | comparison of leg length discrepancy between direct anterior and anterolateral approaches in total hip arthroplasty |
| topic | Leg length discrepancy Direct anterior approach Anterolateral approach Primary total hip arthroplasty Intraoperative fluoroscopy Overlay technique |
| url | http://link.springer.com/article/10.1186/s42836-020-00051-7 |
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