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Review
. 2025 Jun 6;13(12):1358.
doi: 10.3390/healthcare13121358.

Leg Length Discrepancy After Total Hip Arthroplasty: A Review of Clinical Assessments, Imaging Diagnostics, and Medico-Legal Implications

Luca Bianco Prevot  1   2 , Livio Pietro Tronconi  3   4 , Vittorio Bolcato  5 , Riccardo Accetta  1 , Lucio Di Mauro  6 , Giuseppe Basile  7
Affiliations
Review

Leg Length Discrepancy After Total Hip Arthroplasty: A Review of Clinical Assessments, Imaging Diagnostics, and Medico-Legal Implications

Luca Bianco Prevot et al. Healthcare (Basel). .

Abstract

Background/objectives: Total hip arthroplasty (THA) is a widely performed procedure to alleviate pain and improve function in patients with hip disorders. However, leg length discrepancy (LLD) remains a prevalent complication. LLD can cause gait disturbances, back pain, postural imbalance, and patient dissatisfaction, along with significant medico-legal implications. This review examines the evaluation, management, and medico-legal aspects of LLD.

Methods: The review analyzed literature on the prevalence, evaluation methods, and management strategies for LLD in THA. Radiographic and clinical assessment tools were considered, alongside factors such as pelvic obliquity and pre-existing conditions. The importance of preoperative planning, intraoperative techniques (including computer-assisted methods), and comprehensive documentation was evaluated to address both clinical and legal challenges.

Results: The review shows that leg length discrepancy (LLD) following total hip arthroplasty (THA) occurs in 3% to 30% of cases, with mean values ranging from 3 to 17 mm. LLD may result from anatomical or procedural factors, and effective evaluation requires both radiographic imaging and clinical assessment. Preoperative planning plays a critical role in accurately assessing anatomical parameters and selecting appropriate prosthetic components to preserve or restore limb length symmetry. Advanced intraoperative techniques, including computer-assisted surgery, help reduce LLD incidence. While some complications may be unavoidable, proper documentation and patient communication, particularly regarding informed consent, are essential to mitigate medico-legal risks Conclusions: LLD after THA requires a multidimensional approach incorporating clinical, radiological, biomechanical, and legal considerations. Effective preoperative and intraoperative strategies, combined with robust communication and documentation, are essential to minimize LLD and its associated risks. A focus on precision and patient-centered care can improve outcomes and reduce litigation.

Keywords: leg length discrepancy; medico-legal implications; total hip arthroplasty.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Illustration of lower limb length measurement on a full-length radiograph of both legs: a line connects the highest point of the iliac crest (red lines) to the midpoint of the tibio-tarsal joint line (red lines), passing through the femoral head’s center of rotation.
Figure 2
Figure 2
Assessment of discrepancies in lower limb length related to the hip can utilize different reference points: the radiological teardrop.
Figure 3
Figure 3
Assessment of discrepancies in lower limb length related to the hip can utilize different reference points: the bi-ischial line.
Figure 4
Figure 4
A PO angle is the angle between the horizontal plane (blue lines) and the inter-teardrop line. Although the lower limbs are of equal length, as shown by the line connecting the two radiological teardrops, the pelvis appears oblique, as indicated by the angle between the inter-teardrop line and a line parallel to the horizontal plane.
Figure 5
Figure 5
Templating of femoral and acetabular components in anteroposterior view.
Figure 6
Figure 6
Example of long-limb EOS imaging showcasing the various potential sources contributing to leg length discrepancy.
See this image and copyright information in PMC

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