Revision surgery for leg length inequality after primary hip replacement

Abstract

Background: We discuss the surgical results of revision surgery for patients with refractory symptomatic leg length inequality (LLI) after primary hip replacement. Methods: This is a retrospective review of 21 patients who underwent revision for LLI after primary total hip replacement. All of them were referred to a tertiary clinic between 2006 and 2015. Leg length was measured, to the nearest mm, using Woolson’s validated X-ray technique which references to centre of femoral rotation, the acetabular teardrop and the midpoint of the lesser trochanter. The post-operative clinical assessment using a modified D’Aubigne and Postel scoring system investigated the pain, function, and satisfaction after surgery. Results: The mean pre-revision LLI was 16.2 mm (8–30 mm). The mean post revision operation leg length inequality was 2.0 mm (12 mm short to 9 mm long). The mean post-operative D’Aubigne and Postel scores, achieved at a mean 12 months (6–30 months), were; pain 5.2 (3–6), function 4.6 (3–6) and satisfaction 4.4 (3–5). Following revision surgery 20 out of 21 (95%) patients were satisfied with the improvement in LLI. Conclusion: Revision surgery for LLI, while it may not resolve all of the pain that the patient presents with, it is a successful treatment for patients who do not respond to conservative management of their LLI.