Lower limb length and offset in total hip arthroplasty

• Published in: Orthopaedics & traumatology, surgery & research Vol. 102; no. 1; pp. S9 - S20
• Main Authors: Flecher, X, Ollivier, M, Argenson, J.N
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.02.2016; Elsevier
• Subjects: Arthroplasty, Replacement, Hip - methods; Biomechanics; Femoral offset; Femur - surgery; Hip Prosthesis; Human health and pathology; Humans; Leg length discrepancy; Leg Length Inequality - prevention & control; Life Sciences; Lower Extremity; Mechanics; Orthopedics; Patient Satisfaction; Physics; Postoperative Complications - prevention & control; Preoperative Care - methods; Preoperative templating; Prosthesis Failure; Quality of Life; Recovery of Function; Reoperation; Rhumatology and musculoskeletal system; Surgery; Total hip arthroplasty; Preoperative templating; Leg length discrepancy; Femoral offset; Total hip arthroplasty
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2015.11.001

Abstract Restoration of normal hip biomechanics is a key goal of total hip arthroplasty (THA) and favorably affects functional recovery. Furthermore, a major concern for both the surgeon and the patient is preservation or restoration of limb length equality, which must be achieved without compromising the stability of the prosthesis. Here, definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account. Data on the influence of operated-limb length and offset on patient satisfaction, hip function, and prosthesis survival after THA are reviewed. Errors may adversely impact function, quality of life, and prosthetic survival and may also generate conflicts between the surgeon and patient. Surgeons rely on two- or three-dimensional preoperative templating and on intraoperative landmarks to manage offset and length. Accuracy can be improved by using computer-assisted planning or surgery and the more recently introduced EOS imaging system. The prosthetic's armamentarium now includes varus-aligned and lateralized implants, as well as implants with modular or custom-made necks, which allow restoration of the normal hip geometry, most notably in patients with coxa vara or coxa valga. Femoral anteversion must also receive careful attention. The most common errors are limb lengthening and a decrease in hip offset. When symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration.