Hip surgeons and leg length inequality after primary hip replacement

Abstract

Background: This study reports the results of 2 separate surveys of British Hip Society (BHS) members relating to leg length inequality (LLI) after primary total hip replacement (THR). Survey 1: Investigates the members’ opinions on the effect of LLI on the outcome of THR and explores the acceptable limits of LLI. Survey 2: Reports on the intraoperative techniques currently used by BHS members to minimise LLI after THR. Results - Survey 1: 97% of all surgeons completing the survey believed that LLI can affect the outcome of THR. Results - Survey 2: All surgeons reported using at least 1 intraoperative technique for assessing leg length with a median of 5 techniques. Over 50% of surgeons use 2 or more tests. Conclusion - Survey 1: 89% of surgeons agreed that 15 mm of LLI after primary uncomplicated THR was always acceptable. 90% of surgeons felt that LLI more than 22.74 mm was never acceptable. Conclusion - Survey 2: Despite the multiple published papers on various methods of assessing leg length intraoperatively, the problem of LLI post THR persists. This study highlights the need for further research to develop a simple intraoperative technique with high accuracy and reproducibility.