Leg Length Discrepancy After Total Hip Arthroplasty

Leg length discrepancy after a Total Hip Arthroplasty is a very common problem. It is in fact one of the main reasons for dissatisfaction after a total hip replacement. It is quite easy  to change your limb length and in fact almost inevitable that your limb length will change after your hip replacement.

You may be wondering, how is this possible? When you develop arthritis, it involves the loss of the cartilage that is normally in your hip socket. The cumulative loss of several millimeters of cartilage, followed by erosion of bone, will translate to a loss of length in the entire limb; usually in the order of several millimeters and up to 1 centimeter. The reality is, the surgeon must rely on some kind of landmark in order to restore your leg length to where it was prior to the arthritic changes. Some surgeons rely on no technology, some surgeons rely on extensive technology. There are many devices on the market whose sole purpose is to solve this problem. I have my own proprietary technique learned during my training, however even with this, your leg length will almost certainly be different after surgery.

My goal as a surgeon is to restore your leg length to where it was prior to your arthritic disease — sometimes, this can lead to a temporary feeling of a leg being longer since typically the shortening process has happened over several years, but the restoration process is instantaneous. Many patients feel that they have been walking with a limp, not everybody feels like their leg is shorter. However, if there is arthritis in the hip, there is no doubt that the leg has been shortened over time.

The benefit to hip replacement is that we have the ability to get the length back in the hip and to prevent the uneven feeling that can lead to poor mechanics in the hip and lower back pain. Most patients can tolerate a several millimeter difference between their leg length and not notice it; in fact, many people are walking around with a few millimeter difference and have no idea. If this happens after the hip has been replaced, the options are physical therapy, a shoe lift to equalize the limbs, and perhaps revision surgery in extreme cases.

My opinion on the matter is to avoid these potential problems and be extremely diligent to get it right the first time.