Key result
General anesthesia during total hip arthroplasty resulted in significantly greater leg lengthening (19.76 mm) compared to regional anesthesia (3.2 mm).
Why the study?
Soft tissue release in the operating room may mislead assessment of leg length discrepancy after total hip replacement surgery, prompting investigation into the effect of anesthesia type on the amount of leg lengthening.
Does general anesthesia compared to regional anesthesia affect leg lengthening in patients undergoing total hip replacement?
Cohort (n=36)
Yes
Does general anesthesia compared to regional anesthesia affect leg lengthening in patients undergoing total hip replacement?
Absolute Event Rate: 19.76% vs 3.2%
p-value: p=<0.001
General anesthesia is associated with significantly greater leg lengthening compared to regional anesthesia in patients undergoing total hip replacement, likely due to more significant soft tissue relaxation.
Should not alter anesthesia selection for hip arthroplasty; leaves open whether general anesthesia increases leg lengthening risk.
Aim: Leg length discrepancy (LLD), instability and periprosthetic infection are most common reasons patient complaint after total hip replacement (THR) surgery. Degree of soft tissue release in operating room may mislead us about LLD. The objective of this study is to report the effect of the anesthesia type on leg lengthening amount.Material and Method: In this study, 36 primary coxarthrosis patients who underwent THR surgery in two different medical centers under different types of anesthesia during2016-2017 were enrolled retrospectively. Patients are divided into two groups. Group 1 (n:18) who underwent general anesthesia, group 2 (n:18) who underwent regional anesthesia. Distance between greater trochanter-ischial tuberocity (GT-IT) is measured radiologically for leg lengthening, umbilicus-medial malleolus distance is measured clinically for LLD. Harris hip score (HHS) is measured for functional scoring.Results: The average follow-up time was 13 months (12-15 months). No deep infection or neurovascular damage were seen in patients. According to GT-IT distance, leg lengthening was 19.76±9.83 mm in group 1 and 3.2±3.96 in group 2 (p:0.000*). According to 12 month umbilicus-medial malleolus distance, 9 patients experienced leg lengthening (<2cm) and 9 patients had no LLD in group 1 where 3 patients experienced leg shorthening (<1cm), 5 patients experienced leg lengthening (<1cm) and 11 patients had no LLD in group 2. Average HHS was 77.17±4.4 in group 1 where 78.64±5.73 in group 2 (p:0.410). When all patients were considered 12 patients (33%) experienced 1-10 mm lengthening, 4 patients (11%) experienced 10-20 mm lengthening. HHS was 79.62 in patients with no LLD, 77.41 in 1-10 mm LLD, 75.21 in 10-20 mm LLD (p:0.140)Conclusion: In THR surgery, leg lengthening is seen in patients whom underwent general anesthesia more than regional anesthesia patients. We think that this is because soft tissue relaxation is more significant after general anesthesia.
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Yaradılmış et al. (2019) conducted a cohort in Primary coxarthrosis (n=36). General anesthesia vs. Regional anesthesia was evaluated on Leg lengthening measured by greater trochanter-ischial tuberosity (GT-IT) distance (p=<0.001). General anesthesia during total hip arthroplasty resulted in significantly greater leg lengthening (19.76 mm) compared to regional anesthesia (3.2 mm).
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