Treatment For Leg Length Discrepancy After Hip Replacement
Overview
The majority of people in the world actually have some degree of leg length discrepancy, up to 2cm. One study found that only around 1/4 of people have legs of equal lengths. LLD of greater than 2cm is relatively rare, however, and the greater the discrepancy, the greater the chances of having a clinical problem down the road. A limp generally begins when LLD exceeds 2cm and becomes extremely noticeable above 3cm. When patients with LLD develop an abnormal gait, one of the debilitating clinical features can be fatigue because of the relatively high amount of energy needed to walk in the new, inefficient way. Poliomyelitis, or polio, as it is more commonly known, used to account for around 1/3 of all cases of LLD, but due to the effectiveness of polio vaccines, it now represents a negligible cause of the condition. Functional LLD, described above, usually involves treatment focused on the hip, pelvis, and/or lower back, rather than the leg. If you have been diagnosed with functional LLD or pelvic obliquity, please ask your orthopaedic surgeon for more information about treatment of these conditions.
Causes
Leg discrepancy can develop from a medical issue in any portion of the femur or tibia. One leg may lengthen, but leg shortening is much more common. Factors that can cause leg length discrepancy include inherited growth deficiencies. Infections. A bone infection can cause delayed growth in the affected limb. Injury. If your child breaks a leg, it may be shorter once it heals. This is most likely to happen if the fracture or break was complicated, an open fracture, or an injury that affected the growth plate near the end of the bone. Alternatively, a break can cause bones to grow faster after healing, making a leg longer. Tumors. Legg-Calve-Perthes disease. This is a condition that affects the ball (femoral head) of the hip joint. The femoral head may be friable and damage easily, sometimes leading to shortening of the thigh bone. Hemihypertrophy. In children with this condition, one side of the body grows more quickly than the other. Vascular malformations. These are abnormal clusters of veins and arteries that can form close to the bone and stimulate growth. Juvenile arthritis. Inflammation from arthritis can stimulate growth in the affected leg and cause discrepancy.
Symptoms
The effects vary from patient to patient, depending on the cause of the discrepancy and the magnitude of the difference. Differences of 3 1/2 to 4 percent of the total length of the lower extremity (4 cm or 1 2/3 inches in an average adult), including the thigh, lower leg and foot, may cause noticeable abnormalities while walking and require more effort to walk. Differences between the lengths of the upper extremities cause few problems unless the difference is so great that it becomes difficult to hold objects or perform chores with both hands. You and your physician can decide what is right for you after discussing the causes, treatment options and risks and benefits of limb lengthening, including no treatment at all. Although an LLD may be detected on a screening examination for curvature of the spine (scoliosis), LLD does not cause scoliosis. There is controversy about the effect of LLD on the spine. Some studies indicate that people with an LLD have a greater incidence of low back pain and an increased susceptibility to injuries, but other studies refute this relationship.
Diagnosis
The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.
Non Surgical Treatment
Heel lifts and sole lifts are simple ways Pedorthists can compensate for leg length deficiencies. These small modifications can make a tremendous difference to a person?s comfort, balance and mobility. Although people do not always know if they have LLD if you have any of the symptoms I have mentioned you should consult a Pedorthist as treating your condition early will reduce the development of serious problems later on.
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Surgical Treatment
The bone is lengthened by surgically applying an external fixation device to the leg. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins, or both. A small crack is made in the bone and the frame creates tension when the patient or family member turns its dial. This is done several times each day. The lengthening process begins approximately five to 10 days after surgery. The bone may lengthen 1 millimeter per day, or approximately 1 inch per month. Lengthening may be slower in a bone that was previously injured. It may also be slower if the leg was operated on before. Bones in patients with potential blood vessel abnormalities, such as cigarette smokers, may also need to be lengthened more slowly. The external fixator is worn until the bone is strong enough to support the patient safely. This usually takes about three months for each inch. Factors such as age, health, smoking and participation in rehabilitation can affect the amount of time needed.
The majority of people in the world actually have some degree of leg length discrepancy, up to 2cm. One study found that only around 1/4 of people have legs of equal lengths. LLD of greater than 2cm is relatively rare, however, and the greater the discrepancy, the greater the chances of having a clinical problem down the road. A limp generally begins when LLD exceeds 2cm and becomes extremely noticeable above 3cm. When patients with LLD develop an abnormal gait, one of the debilitating clinical features can be fatigue because of the relatively high amount of energy needed to walk in the new, inefficient way. Poliomyelitis, or polio, as it is more commonly known, used to account for around 1/3 of all cases of LLD, but due to the effectiveness of polio vaccines, it now represents a negligible cause of the condition. Functional LLD, described above, usually involves treatment focused on the hip, pelvis, and/or lower back, rather than the leg. If you have been diagnosed with functional LLD or pelvic obliquity, please ask your orthopaedic surgeon for more information about treatment of these conditions.
Causes
Leg discrepancy can develop from a medical issue in any portion of the femur or tibia. One leg may lengthen, but leg shortening is much more common. Factors that can cause leg length discrepancy include inherited growth deficiencies. Infections. A bone infection can cause delayed growth in the affected limb. Injury. If your child breaks a leg, it may be shorter once it heals. This is most likely to happen if the fracture or break was complicated, an open fracture, or an injury that affected the growth plate near the end of the bone. Alternatively, a break can cause bones to grow faster after healing, making a leg longer. Tumors. Legg-Calve-Perthes disease. This is a condition that affects the ball (femoral head) of the hip joint. The femoral head may be friable and damage easily, sometimes leading to shortening of the thigh bone. Hemihypertrophy. In children with this condition, one side of the body grows more quickly than the other. Vascular malformations. These are abnormal clusters of veins and arteries that can form close to the bone and stimulate growth. Juvenile arthritis. Inflammation from arthritis can stimulate growth in the affected leg and cause discrepancy.
Symptoms
The effects vary from patient to patient, depending on the cause of the discrepancy and the magnitude of the difference. Differences of 3 1/2 to 4 percent of the total length of the lower extremity (4 cm or 1 2/3 inches in an average adult), including the thigh, lower leg and foot, may cause noticeable abnormalities while walking and require more effort to walk. Differences between the lengths of the upper extremities cause few problems unless the difference is so great that it becomes difficult to hold objects or perform chores with both hands. You and your physician can decide what is right for you after discussing the causes, treatment options and risks and benefits of limb lengthening, including no treatment at all. Although an LLD may be detected on a screening examination for curvature of the spine (scoliosis), LLD does not cause scoliosis. There is controversy about the effect of LLD on the spine. Some studies indicate that people with an LLD have a greater incidence of low back pain and an increased susceptibility to injuries, but other studies refute this relationship.
Diagnosis
The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.
Non Surgical Treatment
Heel lifts and sole lifts are simple ways Pedorthists can compensate for leg length deficiencies. These small modifications can make a tremendous difference to a person?s comfort, balance and mobility. Although people do not always know if they have LLD if you have any of the symptoms I have mentioned you should consult a Pedorthist as treating your condition early will reduce the development of serious problems later on.
heelsncleavage
Surgical Treatment
The bone is lengthened by surgically applying an external fixation device to the leg. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins, or both. A small crack is made in the bone and the frame creates tension when the patient or family member turns its dial. This is done several times each day. The lengthening process begins approximately five to 10 days after surgery. The bone may lengthen 1 millimeter per day, or approximately 1 inch per month. Lengthening may be slower in a bone that was previously injured. It may also be slower if the leg was operated on before. Bones in patients with potential blood vessel abnormalities, such as cigarette smokers, may also need to be lengthened more slowly. The external fixator is worn until the bone is strong enough to support the patient safely. This usually takes about three months for each inch. Factors such as age, health, smoking and participation in rehabilitation can affect the amount of time needed.
