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Measuring leg length discrepancy using the block method: Level pelvis is achieved by equalization with blocks of 4 cm in total height.
Source publication
Background:
Many people have leg-length discrepancies of greater or lesser severity. No evidence-based studies on the need for treatment are currently available.
Methods:
This review is based on publications retrieved by a selective search in the PubMed database, as well as on published recommendations from Germany and abroad and on the authors'...
Contexts in source publication
Context 1
... a clinical setting, leg length discrepancy can be determined with an accuracy of ± 1 cm (15). Using measuring blocks with defined height, the shortening is gradually corrected until the pelvis is level; from the total height of the blocks, the leg length discrepancy can be inferred (16) (Figure 2). In order to radiographically determine the difference in leg lengths a standing full-leg radiograph with leg length equalization using blocks is obtained. ...
Context 2
... a clinical setting, leg length discrepancy can be determined with an accuracy of ± 1 cm (15). Using measuring blocks with defined height, the shortening is gradually corrected until the pelvis is level; from the total height of the blocks, the leg length discrepancy can be inferred (16) (Figure 2). In order to radiographically determine the difference in leg lengths a standing full-leg radiograph with leg length equalization using blocks is obtained. ...
Similar publications
Leg length discrepancy (LLD) is a common postural deviation of musculoskeletal origin, which causes compensatory reactions and often leads to injury. The aim of the study was to investigate the effect of artificially induced LLD on gait symmetry by means of the spatiotemporal gait parameters and ground reaction forces (GRFs) using a treadmill equip...
Citations
... Gait analyses have indicated that if there is a difference in leg length of more than 1 cm, it can lead to gait asymmetry. As the difference in leg length increases, the asymmetry also increases and limping becomes noticeable [23]. For patients with a moderate LLD of 2 cm to 5 cm, conservative treatment is usually recommended. ...
... Surgical treatment is an alternative option for patients with an LLD of 2 cm or more [23]. After surgery, patients continue to have an uneven distribution of weight on their feet, with the affected limb bearing significantly less weight for a period of time. ...
Background: Slipped capital femoral epiphysis (SCFE) is the most common hip disease during infancy and adolescence. Our study aimed to analyze static plantar pressure in children with surgically treated unilateral SCFE. Methods: Twenty-two children with right SCFE with in situ fixation with one percutaneous screw were assessed by PoData plantar pressure analysis under three different conditions (open eyes, eyes closed, and head retroflexed). Results: The total foot loading was significantly higher on the unaffected limb compared with the affected one for all the three testing conditions (p < 0.05). When assessing the differences between testing conditions, there were no significant differences for the right and left foot loadings, or for the three sites of weight distribution, except for the right fifth metatarsal head (lower loading in eyes-closed condition in comparison to eyes open, p = 0.0068), left fifth metatarsal head (increased loading in head-retroflexed condition in comparison to eyes open, p = 0.0209), and left heel (lower loading in head-retroflexed condition in comparison to eyes open, p = 0.0293). Conclusion: Even after a successful surgical procedure, differences in foot loading can impact the postural static activities in different conditions (natural eyes-open, eyes-closed, or head-retroflexed posture).
... Treatment initially aimed to correct the LLD, using a corrective heel raise of 2 cm (0.8 inches). No larger heel insoles or further shoe raises were proposed since the literature supports gentle and progressive discrepancy correction [16]. With this correction and further infiltrative treatment, the patient's symptoms were satisfactorily relieved. ...
... Moreover, they are often underexamined and largely ignored in the literature when it comes to LLD [26]. Regarding the current patient's treatment, his posture was rebalanced to a 1.5 cm (0.6 inches) residual inequality using a corrective heel raise, which is indicated for LLD < 5 cm (2 inches) [16]. Lidocaine and botulinum toxin-A treatment was alternated on hyperactive muscles, which yielded good results, despite the limited evidence regarding their efficacy in the literature [27]. ...
Background
This report involves the first publication describing a case of parietal abdominal pain due to lower limb length discrepancy.
Case presentation
A Caucasian male patient in his 50s was referred to our rehabilitation department with chronic abdominal pain that began in childhood. This chronic pain was associated with episodes of acute pain that were partially relieved by grade 3 analgesics. The patient was unable to sit for long periods, had recently lost his job, and was unable to participate in recreational activities with his children. Investigations revealed contracture and hypertrophy of the external oblique muscle and an limb length discrepancy of 3.8 cm (1.5 inches) in the left lower limb. The patient was effectively treated with a heel raise, physiotherapy, intramuscular injection of botulinum toxin, and lidocaine. The patient achieved the therapeutic goals of returning to work, and reducing analgesic use.
Conclusions
Structural misbalances, as may be caused by lower leg discrepancy, may trigger muscular compensations and pain. Complete anamnesis and clinical examination must not be trivialized and may reveal previously ignored information leading to a proper diagnosis.
... Theoretically, h-CWHTO is superior to conventional CWHTO in terms of leg length retention after surgery. Leg length change after HTO affects the gait and induces musculoskeletal disorders, however, this phenomenon might not be fully recognized by orthopaedic surgeons [9,10]. Consequently, it is crucial to develop methods to predict these changes before performing surgery. ...
Background: This study aimed to assess the changes in leg length following open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge high tibial osteotomy (h-CWHTO) and whether the change in leg length was associated with preoperative radiographic factors and the change in planned opening or closing width.
Methods: We retrospectively evaluated the data of patients who underwent OWHTO (n=57) and h-CWHTO (n=31) between 2016 and 2019. Standing full-length anteroposterior radiographs were obtained preoperatively and one year postoperatively. Changes in the lower leg and tibial length were measured using radiography, and the planned opening or closing width was decided via operative planning. Flexion contracture was examined preoperatively and one year postoperatively using a goniometer, and the correlation factors and changes in leg length were analyzed using Spearman’s rank correlation.
Results: In the OWHTO group, the lower leg was significantly longer by a mean of 6.0±8.7 mm compared to that preoperatively (p<0.01); however, no significant difference was observed in the h-CWHTO group (mean, -0.56±11.6 mm) (p=0.788). In the OWHTO group, flexion contracture did not improve after surgery, however, in the h-CWHTO group, flexion contracture significantly improved from -7.1±7.0 degrees to -4.7±6.2 degrees postoperatively (p<0.01). No radiographic factors or bone opening or closing width were associated with changes in leg length in both groups.
Conclusion: OWHTO led to a significant elongation of the lower leg while leg length was maintained post-h-CWHTO. However, the changes in leg length following both OWHTO and h-CWHTO were not predictable from preoperative radiographic factors or changes in bone width.
... The evaluation of the physical anthropometric parameters of children facilitates the understanding of the mechanisms of growth and physical development and the identification of the factors that influence and condition the body development. The inequality of the contralateral upper or lower limbs during the growth period represents an important concern of the specialists in order to adapt and implement prophylaxis programs and corrective physical exercises [1][2][3]. The knowledge of how different longitudinal anthropometric dimensions develop and especially the identification of interlimbs asymmetries are relatively known in relation to age and gender due to the specific phenomena of the secular trend [4][5][6] Expanding the knowledge of how inter-limbs longitudinal asymmetries are manifested will facilitate the understanding of their effects on the biomechanics of movements, specific physical or sports performance for different age categories [7][8][9]. ...
The present study pursued the investigation of anthropometric asymmetries regarding the length of the upper and lower limbs and the indices of body proportionality and had the following objectives: identifying the differences between the female and male groups, in the 4 age categories (7, 8, 9 and 10 years old), regarding anthropometric parameters and proportionality indicators; also tried to identify the differences in anthropometric parameters and proportionality indicators between the 4 age categories (7-10 years old) for each gender (female, respectively male). The study included 727 subjects with the age between 7-10 years, of which 383 (52.7%) female and 344 (47.3%) male, the subjects being divided into four groups according to age (7, 8, 9 and 10 years old groups). The measurements aimed at the following longitudinal anthropometric parameters and the calculation of proportionality ratios: height (cm); the length of the right upper limb (cm-LUL Right); the length of the left upper limb (cm-LUL Left); the length of the right lower limb (cm-LLL Right); the length of the left lower limb (cm-LLL Left); ratio of LUL Right X 100 / LLL Right; ratio of LUL Left x 100 / LLL Left; ratio of LUL Right x 100 / height; ratio of LUL Left x 100 / height; ratio of LLL Right x 100 / height; ratio of LLL_Left x 100/ height. Analyzing ccompara-tively the results recorded between the upper and lower right and left segments, we find asymmetry in all samples according to age and gender. The differences between the groups of girls and boys, in all age categories , were statistically significant. The ANOVA analysis reflects statistically significant differences between the 4 age groups (7-10 years) in all anthropometric evaluations. The largest asymmetries between the right and left upper limb were recorded in the age category of 7 years old group; respectively, the largest asymmetries between the lower limbs were recorded in the 10 year old groups depending on gender.
... Interestingly, this may provide therapy opportunities for, e.g., correcting differences in leg length, a widespread problem that has not received sufficient attention (2,3). Currently, small differences in leg length are treated conservatively with insoles, shoe lifts, or orthoses, whereas larger differences require surgical treatment (26). In individuals who are still growing, the latter involves surgical removal of the growth plate in the longer leg, which reduces final height and can change body proportions (26). ...
... Currently, small differences in leg length are treated conservatively with insoles, shoe lifts, or orthoses, whereas larger differences require surgical treatment (26). In individuals who are still growing, the latter involves surgical removal of the growth plate in the longer leg, which reduces final height and can change body proportions (26). ...
Recently, skeletal stem cells were shown to be present in the epiphyseal growth plate (epiphyseal skeletal stem cells, epSSCs), but their function in connection with linear bone growth remains unknown. Here, we explore the possibility that modulating the number of epSSCs can correct differences in leg length. First, we examined regulation of the number and activity of epSSCs by Hedgehog (Hh) signaling. Both systemic activation of Hh pathway with Smoothened agonist (SAG) and genetic activation of Hh pathway by Patched1 (Ptch1) ablation in Pthrp-creER Ptch1fl/fl tdTomato mice promoted proliferation of epSSCs and clonal enlargement. Transient intra-articular administration of SAG also elevated the number of epSSCs. When SAG-containing beads were implanted into the femoral secondary ossification center of 1 leg of rats, this leg was significantly longer 1 month later than the contralateral leg implanted with vehicle-containing beads, an effect that was even more pronounced 2 and 6 months after implantation. We conclude that Hh signaling activates growth plate epSSCs, which effectively leads to increased longitudinal growth of bones. This opens therapeutic possibilities for the treatment of differences in leg length.
... However, unacceptable walking gait and poor function due to the LLD occur frequently in clinical practice. The consensus on the surgical indications of LLD is lacking, but it is generally believed that < 2 cm does not affect the patient's function, 2-4 cm can be corrected by shoe lift, and > 4 cm is suggested to be solved by different limb lengthening methods [18][19][20] . LLD has been one of the most challenging issues for limb salvage surgery with more patients with osteosarcoma achieving long-term survival [21][22][23][24] . ...
Correction of leg length discrepancy (LLD) in skeletally mature patients with osteosarcoma was rarely reported and quite challenging. This study aimed to propose a treatment strategy of staged lengthening and reconstruction with a standard static prosthesis to address LLD and restore limb function. It also evaluated the effectiveness of the strategy in terms of leg lengthening, functional outcomes, and complications. The strategy for lengthening included three stages. In stage 1, the previous prosthesis was removed and an external fixator with a temporary rod-cement spacer was placed. In this stage, the external fixator was used to lengthen the limb to the appropriate length. In stage 2, the external fixator was removed and the old rod-cement spacer was replaced with a new one. In stage 3, the rod-cement spacer was removed and the standard static prosthesis was planted. Nine skeletally mature distal femoral osteosarcoma patients with unacceptable LLD were treated in our institution from 2019 to 2021. We performed a chart review on nine patients for the clinical and radiographic assessment of functional outcomes, LLD, and complications. The mean (range) leg lengthening was 7.3 cm (3.6–15.6). The mean (range) LLD of the lower limbs decreased from 7.6 cm (4.1–14.2) before the lengthening to 0.3 cm (− 0.3 to 2.1) at the final follow-up with statistical significance (P = 0.000). The mean (range) Musculoskeletal Tumor Society score improved from 30.3% (16.7%–53.3%) before the lengthening to 96.3% (86.7%–100%) at the final follow-up with statistical significance (P = 0.000). Three patients (33.3%) had a minor complication; none needed additional surgical intervention. In the short term, the current staged lengthening and reconstruction with standard static prosthesis provided satisfactory functional outcomes and LLD correction with few complications. The long-term effects of this method need further exploration.
... Limb length discrepancies (LLD) may cause long term osteoarthritis, scoliosis, and gait abnormalities [73]. Hinarejos et al. reported that the clinically significant LLD lies at 10 mm [45], while other authors reported that differences of more than 20 mm can be compensated [74]. ...
Proximal tibial osteotomy (PTO) is an effective procedure for active and young adult patients with symptomatic unicompartmental osteoarthritis and malalignment. They were considered technically demanding and prone to various complications related to the surgical technique, biomechanical or biological origin. Among the most important are hinge fractures and delayed or non-healing, neurovascular complications, loss of correction, implant-related problems, patellofemoral complaints, biological complications and changes in limb length. Being aware of these problems can help minimizing their prevalence and improve the results of the procedure.
The aim of this narrative review is to discuss the potential complications that may occur during and after proximal tibial osteotomies, their origin and ways to prevent them.
... Malunion was defined as a separation of more than 2 mm of the articular surface on the last follow-up radiographs or an angulation of more than 5 • in the coronal plane and 10 • in the sagittal plane [17]. Limb shortening was considered present if the extremity was shortened by more than one centimeter [18]. ...
... Clinical and radiographic assessments are essential to evaluate the entity of LLDs in children and to estimate their magnitude at skeletal maturity, by not only considering the final LLD predicted with one of several multiplier methods (such as the White-Menelaus formula, Paley multiplier, or Sanders multiplier), but also the impact of the specific etiology over the acceleration and deceleration of limb growth [5][6][7][8][9]. Children with predicted LLDs longer than 2 cm are at a higher risk of developing severe postural disorders, gait abnormalities, spinal deformities, pain, discomfort, functional limitations, reduced physical activity, and psychosocial problems [10]. ...
... For discrepancies between 2 and 4 cm, growth modulation (epiphysiodesis) with the shortening of the longer side should be considered. When the predicted discrepancy exceeds 4 cm, there is a consensus for lengthening the shorter side, potentially combined with contralateral epiphysiodesis [10,11]. Despite the increasing popularity of intramedullary lengthening nails, procedures in the pediatric population mainly rely on external fixators to avoid physeal damage, with the circular external fixator (Ilizarov or hexapodal) still being one of the most used items [12]. ...
The use of external fixators (EFs) for lower limb lengthening is common for treating lower limb length discrepancy (LLD) in children. The concern at present revolves around extended treatment times, with some suggesting a healing index (HI) > 45 days/cm as a major complication. The aim of this study is to assess the factors affecting bone healing and treatment duration in children who undergo limb lengthening for LLD using circular EFs. A total of 240 lengthening procedures on 178 children affected by congenital or acquired LLDs (mean age at surgery 13.8 ± 2.8 years) were retrospectively evaluated. Complications according to Lascombes’ classification and treatment duration factors were analyzed. Mean HI was 57 ± 25 days/cm for the femur and 55 ± 24 days/cm for the tibia, with an HI > 45 days/cm in 64% of the procedures. A total of 189 procedures (79%) reported complications; 85 had an HI > 45 days/cm as the sole complication. While reducing the frame time is crucial, revising the classifications is necessary to avoid the overestimation of complications.
... There is no established definitive timeframe for performing arthroplasty after septic arthritis. Most experts recommend allowing over 10 years after the infection before attempting total hip arthroplasty to minimize the risk of recurrent infection [17][18][19]. Additionally, comprehensive histological and microbiological sampling is necessary preoperatively to maximize detection of any residual bacteria. ...
Purpose
The aim of this retrospective study was to examine the clinical outcomes and complications of proximal femur reconstruction (PFR) combined with total hip arthroplasty (THA) in patients with high hip dislocation secondary to septic arthritis (SA).
Methods
Between September 2016 to September 2021, we performed a series of 15 consecutive PFR combined with THA on patients with high dislocation of the hip secondary to SA, of these,12 hips were reviewed retrospectively, with a mean follow-up of 2.5 years (range, 1.5-6 years). The mean age of the patients at the time of surgery was 52 years (range, 40–70 years).
Results
All patients were followed up. At 1-year postoperative follow-up, the median HHS increased from 32.50 preoperatively to 79.50 postoperatively. The median VAS decreased from 7 before surgery to 2 at 1 year after surgery. The median LLD reduced from 45 mm preoperatively to 8 mm at 1 year after surgery. The mean operative time 125 ± 15 min (range 103-195 min). Mean estimated blood loss was500 ± 105ml (range 450–870 ml). Mean hospital days 9.5 days (range 6–15 days). Two patients developed nerve injuries that improved after nutritional nerve treatment. One patient had recurrent postoperative dislocation and underwent reoperation, with no recurrence dislocation during the follow-up. There were no cases of prosthesis loosening during the follow-up period. One patient developed acute postoperative periprosthetic joint infection (PJI) that was treated with Debridement, Antibiotics and Implant Retention (DAIR) plus anti-infective therapy, with no recurrence during 2 years of follow-up.
Conclusion
This study indicates PFR combined with THA shows promise as a technique to manage high hip dislocation secondary to SA, improving early outcomes related to pain, function, and limb length discrepancy.
