Leg length discrepancy (LLD) is a known complication of total hip arthroplasty (THA). In select patients, conservative management is unacceptable and revision surgery is indicated to treat the LLD. A lack of literature on outcomes after revision surgery to treat LLD has contributed to hesitancy in offering this surgery. This study evaluates the survivorship, clinical, and radiological outcomes of LLD revision surgery. A total of 75 patients were included who underwent revision surgery to treat LLD via shortening or lengthening. Among these cases, 49/75 (65.3%) were women, mean age at index surgery was 64.7 years (SD 14.7), and mean follow-up was 95.0 months (SD 59.5) (7.9 years). Kaplan-Meier survival analysis was used to evaluate the survival of the LLD surgery, with failure defined as revision for dislocation. At a mean follow-up of 95.0 months (SD 59.5), Kaplan-Meir survivorship for failure due to dislocation was 97.2% (95% CI 93.5 – 100.0) at 2 years, 95.6% (95% CI 91.9 – 99.3) at 5 years, and 92.7% (95% CI 90.0 – 96.4) at 10 years. Survivorship for all-cause failure was 94.6% (95% CI 89.5 – 100.0) at 2 years, 88.1% (95% CI 80.3 – 95.9) at 5 years, and 80.2% (95% CI 69.2 – 91.2) at 10 years. In leg shortening surgery, the mean LLD improved from 8.69 mm (SD 4.89) pre-operatively to 4.18 mm (SD 4.26) post-operatively. In leg lengthening surgery, the mean LLD improved from 18.70 mm (SD 11.41) pre-operatively to 7.12 mm (SD 6.30) post-operatively. There was also significant improvement in functional outcomes with more independent ambulators with normal gait. Total hip arthroplasty leg length revision surgery via both shortening and lengthening for LLD provides favourable mid-term survivorship, clinical, and radiographic outcomes.
Chaudhry et al. (Wed,) studied this question.