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Hi guys, Im currently doing a 3rd year Case Study/assignement. Just having some trouble finding some really good articles on Hip replacement surgery causing LLD and other associated information on orthotic intervention.
more specifically:
- LLD causing increased pressures on plantar foot resulting in diffuse HK
- Orthotic intervention for LLD
- measuring LLD
- other interventions for LLD
- SUCCESS rate of treatments.
- standard procedure for the intervention and treatment of LLD
- hip surgery complications on the lower limb

if any one has some good stuff on the above would love to hear from you
cheers,
Jens

Jensy boy!!!

Good luck with the help mate, try reading through some of the associated threads and some interesting articles pop up

Deano

See this thread:
Hip replacement causing leg length difference

Other threads tagged with Leg Length Difference

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LLD are very common. A high percentage of the time the cause is being dominant in the use of one side of the body, as a consequence there is an imbalance between the stabilizer and mobilizer muscle groups.
Iatrogenic causes of LLD do occur. Accidents happen, that is just a fact of life, however the manifestation hinges a lot on the posture of an individual.
An easy way to check how common LLD are, is check your fellow students, by simple getting them to sit against a wall , put your thumbs on their heels push to the wall and check thumb alignment.
Enjoy your studies. The time passes all to quickly

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Have you thought to talk to a surgeon

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David Sutton
C.Ped.CM
My location
www.bilbyshoes.com

Hi must admit I have not read all the tags on LLD but with those scanning or using X-Rays, how far does one go.

Many many years ago I personally saw a Chiro who suggested I had LLD, recommended a full body X-Ray.

From very poor memory, went something along the lines of ""short tibia, opposing femur, longer, pelvic bones rotated and distorted and by the time we got to the what is now the love handles ti had all evened out and a leg lift was not appropriate""

It was an interesting costly experience BUT looking back with the knowledge that I now have a waste of time. (guess X-Rays will be good for old ages comparisons as the arthritic changes continue)

So my Query is how far do the scans x-rays go?
Do those who do go beyond the hip?
Is it beneficial; too do so? Without the pelvis included how do you know what has compensated at a bony level?
Like to see debate between those who do and don't?

Thanks

Cheers

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Heather J Bassett
137 Wheatsheaf Road
Glenroy 3046
Victoria
Australia

Heather

There is no need for a full body x-ray to evaluate for LLD, although it can be convenient for the provider if that office is set up to perform full spine radiography. It also may be as effective initially and it is less invasive than slit scanography. According to the study below full body AP radiography is close to being as accurate as the accepted standard, the scanogram. Their findings appear to support the use of standing full body AP imaging at least initially.

http://www.ejbjs.org/cgi/content/abstract/88/10/2243

Perhaps that Chiro was onto something after all Heather?

I find that it is more important to take a good oral history and rule out congenital and developmental factors, trauma, arthritides, scoliosis, Leg-Calve-Perthes, Blounts Disease, infection, dysplasia and tumor when deciding if there is in fact solid clinical reasoning to support the use of ionizing radiation for the existence of a LLD.

In the absence of the above I rarely encounter a true anatomic LLD but a leg length inequality due to muscular imbalance and axial spine postural rotation/displacement. When I come across a suspected true anatomic LLD, which is uncommon generally, they are sent for recumbent plain film or slit scanography to measure the difference, although I have found that weight-bearing AP films are of a good predictive value initially.

Many Chiropractors do still utilize full spine AP films and I order them when scoliosis is suspected. These are not generally full body films though (although I did find one radiology group will perform a full body scan if you check the scoliosis study box). A great deal of controversy surrounds the usage of such films on a routine basis and I agree.

Back to the original question asked by jensglynne. In my experience having treated numerous patients who have had total hip replacement (and total knee replacement) I have never researched the studies but I can tell you that the patients that I have encountered express significant satisfaction in THR (and TKR) in general. The orthopedic surgeons have really excelled in advances in hardware technology and surgical methods for these conditions and they are precise in measuring leg length into the surgical equation in my experience.

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David G. Wedemeyer, D.C., C.Ped.

Hi Jens,

Here are a couple of references you may find helpful as a start:

Gurney, B. (2002) Leg length Discrepancy. Gait & Posture. 15, p195-206.

O'Toole, G.C. et al. (2003) The effect of Leg length Discrepancy on Foot Loading Patterns and Contact Times. Foot & Ankle International. 24:3. p256-259.

Hope these are useful

Ian

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Thank you all for the reply's
its a great help.

I used to work in a rehab hospital where we got loads of fresh THR and TKR pt's. I think I used to see lots of assymptomatic LLD, short side on the surgical side usually. I think the Victorian orthopods don't check and don't keep figures and don't do 12 month follow ups. They will reassure you that their results are fantastic. My experience is that it usually takes more than 6 months for an iatrogenic LLD to become symptomatic, because they are not usually all that big and for the first few months there is a low mileage during rehab and for a few months at least it is easy to confuse any odd feelings with the whole post surgical recovery picture. I reckon you need to have a good look at least 12 months down the track after they have started to do more mileage again and let the problems and compensation patterns "brew up" for a while, then you see it. And by that stage very few pt's make the link back to the hip surgery.

regards Phill

Greetings,

I can give you a word of mouth (or pers. com.) view
I visited a country orthopaedic registrar and we talked about LLD's v's shoe raises etc. He told me that with a traditional type Charnley hip replacements, the affected side is left "long". This ensures that there is sufficient bone left that will permit a revision. This would indicate a shoe raise on the unaffected side. However, the Orthopod then said that an LLD of 2.5 cm or less is not significant and no adjustment will be necessary.

In the USA, the number one cause for litigation against orthopaedic surgeons following a THR is the resultant LLD.

Also, contemporary hip replacements such as the Birmingham Hip Resurfacing, for younger active older people 56-65, like myself, my surgeon assured me there will be no LLD post surgery. I will still have a CT scan to make sure.

My other research reveals that Chiropracters, Podiatrists, Physiotherapists, Osteopaths, all have different positions on LLD's

I hope this helps

caf002