Measurement and analysis of leg length in adults with unilateral developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Zhaohui ¹ , YANG Minzhi ¹ , GUO Renwen ¹ , WU Dong ¹ , ZHANG Zhuo ² , CHEN Jiying ² ,  KONG Xiangpeng ² ,  CHAI Wei ²

1. Medical School of Chinese PLA, Beijing, 100853, P.R.China;
2. Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China;

Corresponding author：

KONG Xiangpeng, Email: 18810999609@163.com; CHAI Wei, Email: chaiwei301@163.com

Keywords：

Adult; developmental dysplasia of the hip; leg length measurement; leg length discrepancy

DOI：

10.7507/1002-1892.202010033

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Objective To measure and analyze the radiographic characteristics of the leg length discrepancy in adult patients with unilateral developmental dysplasia of the hip (DDH).Methods The clinical data of 112 patients with unilateral DDH who met the selection criteria between January 2016 and June 2018 were retrospectively analyzed. There were 16 males and 96 females with an age of 20-76 years (mean, 42.9 years). According to the Crowe classification, there were 25 hips of type Ⅰ, 26 hips of type Ⅱ, 15 hips of type Ⅲ, and 46 hips of type Ⅳ (26 hips of type ⅣA without secondary acetabular formation, and 20 hips of type ⅣB with secondary acetabular formation). Full-length X-ray films of the lower limbs in the standing position were used to measure the following parameters: greater trochanter leg length (GTLL), greater trochanter femoral length (GTFL), lesser trochanter leg length (LTLL), lesser trochanter femoral length (LTFL), tibial length (TL), and intertrochanteric distance (ITD). The above parameters on the healthy and affected sides were compared and the difference of each parameter between the healthy and affected sides was calculated. Taking the difference of 5 mm between the healthy side and the affected side as the threshold value, the number of cases with the healthy side was greater than 5 mm and the affected side was greater than 5 mm were counted respectively. The difference of the imaging parameters between the healthy side and the affected side were compared between different Crowe types and between type ⅣA and type ⅣB.Results There was no significant difference in GTLL and LTFL between healthy and affected sides (P>0.05); LTLL and TL of affected side were longer than healthy side, GTFL and ITD were shorter than healthy side, and the differences were significant (P<0.05). The constituent ratio of long cases on the affected side of TL and LTLL was greater than the constituent ratio of long cases on the healthy side, while the constituent ratio of long cases on the healthy side of GTFL and ITD was greater than the constituent ratio of long cases on the affected side; there was no obvious difference in the constituent ratio of long cases on the healthy side or the affected side of GTLL and LTFL. The comparison between different Crowe types showed that only the difference in TL between type Ⅰ and type Ⅳ was significant (P<0.05), the difference of each imaging parameter among the other types showing no significant difference (P>0.05). Compared with type ⅣB, the differences of GTLL, TL, and ITD of type ⅣA were bigger, and the differences were significant (P<0.05); the differences of other parameters between type ⅣA and type ⅣB were not significant (P>0.05).Conclusion In adult unilateral DDH patients, the leg length on the healthy side and the affected side is different, and the difference mainly comes from the TL and ITD, which should be paid attention to in preoperative planning.

Citation： SONG Zhaohui, YANG Minzhi, GUO Renwen, WU Dong, ZHANG Zhuo, CHEN Jiying, KONG Xiangpeng, CHAI Wei. Measurement and analysis of leg length in adults with unilateral developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(5): 533-538. doi: 10.7507/1002-1892.202010033 Copy

1.	Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes. World J Orthop, 2012, 3(5): 42-48.
2.	Ganz R, Slongo T, Siebenrock KA, et al. Surgical technique: The capsular arthroplasty: a useful but abandoned procedure for young patients with developmental dysplasia of the hip. Clin Orthop Relat Res, 2012, 470(11): 2957-2967.
3.	Dallari D, Pignatti G, Stagni C, et al. Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae. Orthopedics, 2011, 34(8): e328-333.
4.	Kiliçoğlu Oİ, Türker M, Akgül T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type Ⅳ congenital hip dislocation. J Arthroplasty, 2013, 28(1): 117-125.
5.	Zhang Z, Luo D, Cheng H, et al. Unexpected long lower limb in patients with unilateral hip dislocation. J Bone Joint Surg (Am), 2018, 100(5): 388-395.
6.	Shi XT, Cheng CM, Feng CY, et al. Crowe type Ⅳ hip dysplasia treated by THA comebined with osteotomy to balance functional leg length discrepancy: A prospective observational study. Orthop Surg, 2020, 12(2): 533-542.
7.	Lang JE, Scott RD, Lonner JH, et al. Magnitude of limb lengthening after primary total knee arthroplasty. J Arthroplasty, 2012, 27(3): 341-346.
8.	Chang MJ, Kang YG, Chang CB, et al. The patterns of limb length, height, weight and body mass index changes after total knee arthroplasty. J Arthroplasty, 2013, 28(10): 1856-1861.
9.	Patterson DC, Grelsamer RP, Bronson MJ, et al. Lawsuits after primary and revision total hip arthroplasties: A malpractice claims analysis. J Arthroplasty, 2017, 32(10): 2958-2962.
10.	Novi M, Vanni C, Parchi PD, et al. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg, 2020, 104(1): 43-48.
11.	Nossa JM, Muñoz JM, Riveros EA, et al. Leg length discrepancy after total hip arthroplasty: comparison of 3 intraoperative measurement methods. Hip Int, 2018, 28(3): 254-258.
12.	Metcalfe JE, Banaszkiewicz P, Kapoor B, et al. Unexpected long femur in adults with acetabular dysplasia. Acta Orthop Belg, 2005, 71(4): 424-428.
13.	Tamura K, Takao M, Hamada H, et al. Femoral morphology asymmetry in hip dysplasia makes radiological leg length measurement inaccurate. Bone Joint J, 2019, 101-B(3): 297-302.
14.	Ergin ÖN, Bayram S, Anarat FB, et al. An analysis of the potential relationship between crowe type and lower extremity morphology in patients with developmental dysplasia of the hip. Hip Pelvis, 2020, 32(2): 85-92.
15.	马海洋, 周勇刚, 郑充, 等. CroweⅣ型髋关节发育不良的新分型. 中国骨伤, 2016, 29(2): 119-124.
16.	吴伟. 下肢全长 X 线检查的临床应用及其精准性的研究进展. 中华骨与关节外科杂志, 2017, 10(1): 84-87, 83.
17.	Sabharwal S, Zhao C. Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg (Am), 2008, 90(1): 43-51.
18.	徐海军, 周一新, 刘庆, 等. 高位脱位髋臼发育不良中不同亚型的股骨形态差异. 中国骨与关节外科, 2010, 3(3): 204-209.
19.	Renkawitz T, Weber T, Dullien S, et al. Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture, 2016, 49: 196-201.
20.	邱旭升. 髋关节正常生长发育的研究进展. 医学综述, 2011, 17(16): 2401-2404.
21.	Rai NN, Siney PD, Fleming PA, et al. Discrepancy in the length of the tibiae in unilateral congenital dislocation of the hip. J Arthroplasty, 1999, 14(7): 867-868.
22.	Du Y, Li T, Sun J, et al. The effect of the false acetabulum on femoral proximal medullary canal in unilateral crowe type Ⅳ developmental dislocation of the hip. Ther Clin Risk Manag, 2020, 16: 631-637.
23.	李锐博, 尹诗九, 杨静. 人工全髋关节置换术下肢长度的平衡策略. 中国骨与关节杂志, 2016, 5(11): 864-867.
24.	张卓, 孔祥朋, 杨敏之, 等. 机器人辅助人工全髋关节置换的短期疗效分析. 骨科, 2020, 11(4): 269-273.

1. Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes. World J Orthop, 2012, 3(5): 42-48.
2. Ganz R, Slongo T, Siebenrock KA, et al. Surgical technique: The capsular arthroplasty: a useful but abandoned procedure for young patients with developmental dysplasia of the hip. Clin Orthop Relat Res, 2012, 470(11): 2957-2967.
3. Dallari D, Pignatti G, Stagni C, et al. Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae. Orthopedics, 2011, 34(8): e328-333.
4. Kiliçoğlu Oİ, Türker M, Akgül T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type Ⅳ congenital hip dislocation. J Arthroplasty, 2013, 28(1): 117-125.
5. Zhang Z, Luo D, Cheng H, et al. Unexpected long lower limb in patients with unilateral hip dislocation. J Bone Joint Surg (Am), 2018, 100(5): 388-395.
6. Shi XT, Cheng CM, Feng CY, et al. Crowe type Ⅳ hip dysplasia treated by THA comebined with osteotomy to balance functional leg length discrepancy: A prospective observational study. Orthop Surg, 2020, 12(2): 533-542.
7. Lang JE, Scott RD, Lonner JH, et al. Magnitude of limb lengthening after primary total knee arthroplasty. J Arthroplasty, 2012, 27(3): 341-346.
8. Chang MJ, Kang YG, Chang CB, et al. The patterns of limb length, height, weight and body mass index changes after total knee arthroplasty. J Arthroplasty, 2013, 28(10): 1856-1861.
9. Patterson DC, Grelsamer RP, Bronson MJ, et al. Lawsuits after primary and revision total hip arthroplasties: A malpractice claims analysis. J Arthroplasty, 2017, 32(10): 2958-2962.
10. Novi M, Vanni C, Parchi PD, et al. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg, 2020, 104(1): 43-48.
11. Nossa JM, Muñoz JM, Riveros EA, et al. Leg length discrepancy after total hip arthroplasty: comparison of 3 intraoperative measurement methods. Hip Int, 2018, 28(3): 254-258.
12. Metcalfe JE, Banaszkiewicz P, Kapoor B, et al. Unexpected long femur in adults with acetabular dysplasia. Acta Orthop Belg, 2005, 71(4): 424-428.
13. Tamura K, Takao M, Hamada H, et al. Femoral morphology asymmetry in hip dysplasia makes radiological leg length measurement inaccurate. Bone Joint J, 2019, 101-B(3): 297-302.
14. Ergin ÖN, Bayram S, Anarat FB, et al. An analysis of the potential relationship between crowe type and lower extremity morphology in patients with developmental dysplasia of the hip. Hip Pelvis, 2020, 32(2): 85-92.
15. 马海洋, 周勇刚, 郑充, 等. CroweⅣ型髋关节发育不良的新分型. 中国骨伤, 2016, 29(2): 119-124.
16. 吴伟. 下肢全长 X 线检查的临床应用及其精准性的研究进展. 中华骨与关节外科杂志, 2017, 10(1): 84-87, 83.
17. Sabharwal S, Zhao C. Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg (Am), 2008, 90(1): 43-51.
18. 徐海军, 周一新, 刘庆, 等. 高位脱位髋臼发育不良中不同亚型的股骨形态差异. 中国骨与关节外科, 2010, 3(3): 204-209.
19. Renkawitz T, Weber T, Dullien S, et al. Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture, 2016, 49: 196-201.
20. 邱旭升. 髋关节正常生长发育的研究进展. 医学综述, 2011, 17(16): 2401-2404.
21. Rai NN, Siney PD, Fleming PA, et al. Discrepancy in the length of the tibiae in unilateral congenital dislocation of the hip. J Arthroplasty, 1999, 14(7): 867-868.
22. Du Y, Li T, Sun J, et al. The effect of the false acetabulum on femoral proximal medullary canal in unilateral crowe type Ⅳ developmental dislocation of the hip. Ther Clin Risk Manag, 2020, 16: 631-637.
23. 李锐博, 尹诗九, 杨静. 人工全髋关节置换术下肢长度的平衡策略. 中国骨与关节杂志, 2016, 5(11): 864-867.
24. 张卓, 孔祥朋, 杨敏之, 等. 机器人辅助人工全髋关节置换的短期疗效分析. 骨科, 2020, 11(4): 269-273.

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