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. 2024 Feb 1;5(2):79-86.
doi: 10.1302/2633-1462.52.BJO-2023-0152.R1.

Leg length discrepancy should be assessed based on the whole length of the lower limb in patients with osteoarthritis secondary to developmental dysplasia of the hip

Ryuichi Sato  1   2 , Hidetoshi Hamada  1 , Keisuke Uemura  3 , Kazuma Takashima  3 , Wataru Ando  1 , Masaki Takao  3 , Mitsuru Saito  2 , Nobuhiko Sugano  1
Affiliations

Leg length discrepancy should be assessed based on the whole length of the lower limb in patients with osteoarthritis secondary to developmental dysplasia of the hip

Ryuichi Sato et al. Bone Jt Open. .

Abstract

Aims: This study aimed to investigate the incidence of ≥ 5 mm asymmetry in lower and whole leg lengths (LLs) in patients with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH-OA) and primary hip osteoarthritis (PHOA), and the relationship between lower and whole LL asymmetries and femoral length asymmetry.

Methods: In total, 116 patients who underwent unilateral total hip arthroplasty were included in this study. Of these, 93 had DDH-OA and 23 had PHOA. Patients with DDH-OA were categorized into three groups: Crowe grade I, II/III, and IV. Anatomical femoral length, femoral length greater trochanter (GT), femoral length lesser trochanter (LT), tibial length, foot height, lower LL, and whole LL were evaluated using preoperative CT data of the whole leg in the supine position. Asymmetry was evaluated in the Crowe I, II/III, IV, and PHOA groups.

Results: The incidences of whole and lower LL asymmetries were 40%, 62.5%, 66.7%, and 26.1%, and 21.7%, 20.8%, 55.6%, and 8.7% in the Crowe I, II/III, and IV, and PHOA groups, respectively. The incidence of tibial length asymmetry was significantly higher in the Crowe IV group (44.4%) than that in the PHOA group (4.4%). In all, 50% of patients with DDH-OA with femoral length GT and LT asymmetries had lower LL asymmetry, and 75% had whole LL asymmetry. The incidences of lower and whole LL asymmetries were 20% and 42.9%, respectively, even in the absence of femoral length GT and LT asymmetries.

Conclusion: Overall, 43% of patients with unilateral DDH-OA without femoral length asymmetry had whole LL asymmetry of ≥ 5 mm. Thus, both the femur length and whole LL should be measured to accurately assess LL discrepancy in patients with unilateral DDH-OA.

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Conflict of interest statement

N. Sugano reported that the grant (paid to Osaka University Graduate School of Medicine) from Kyocera Medical was not related to this study. M. Takao declares payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from DePuy, Zimmer Biomet, Stryker and Daiichi Sankyo; and a leadership or fiduciary role for the International Society for Computer Assisted Orthopaedic Surgery, all of which are also unrelated.

Figures

Fig. 1
Fig. 1
Measurements in this study. Anatomical femoral length (FL) was defined as the distance between the centre of the femoral head (red point) and the knee centre of the femur (yellow point). Femoral length greater trochanter (GT) was defined as the vertical distance from the top of the GT (black point) to the mostdistal end of the intercondylar notch (yellow point). Femoral length lesser trochanter (LT) was defined as the vertical distance from the most medial prominence of the LT (green point) to the most distal end of the intercondylar notch (yellow point). Lower leg length (LL) was defined as the sum of tibial length (TL) andfoot height (FH). Whole LL was defined as the sum of FL and lower LL.
Fig. 2
Fig. 2
a) Placement of a sphere that fits the distal tibial articular surface, and its centre is defined as the ankle joint centre (red point). b) Midpoint of the Akagi line (blue point). c) Straight line passing through the midpoint of the Akagi line (blue point), and the centre of the ankle joint (red point) was defined as the tibial axis.
Fig. 3
Fig. 3
a) Sagittal plane of the foot consisted of the centre of the talus (point 1), the most distal point of the head of the second metatarsal (point 2), and the most proximal point of the calcaneus (point 3). b) Plane perpendicular to the sagittal plane of the foot, including points 2 and 3, was defined as the plane parallel to the horizontal foot plane (yellow dotted line: plane 1). The plane parallel to plane 1 to the lowest point of the plantar surface of the heel was defined as the axial plane of the foot (yellow straight line).
Fig. 4
Fig. 4
a) Anatomical femoral length was defined as the distance between the centre of the femoral head (red point) and the knee centre of the femur (yellow point). b) Femoral length greater trochanter (GT) was defined as the vertical distance from the top of the GT (black point) to the most distal end of the intercondylar notch (yellow point). c) Femoral length lesser trochanter was defined as the vertical distance from the most medial prominence of the lesser trochanter (green point) to the most distal end of the intercondylar notch (yellow point).
Fig. 5
Fig. 5
Comparison of asymmetry in anatomical femoral length (FL), tibial length (TL), foot height (FH), lower leg length (LL), and whole LL between the osteoarthritis secondary to developmental dysplasia of the hip (DDH-OA) and primary hip osteoarthritis (PHOA) groups. *, #, $, & Statistically significant difference (p < 0.05, Fisher’s exact test).
See this image and copyright information in PMC

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