Hitting the Limb Length Target in Total Hip Arthroplasty Requires a Patient-specific Approach

BACKGROUND: Proper limb length restoration after primary total hip arthroplasty (THA) remains challenging. Current imaging and guidance tools do not account for patient-perceived or examination-based limb length differences. This study defined a three-pronged comprehensive approach to setting patient-specific limb length targets: 1) patient preoperative perception of limb length discrepancy (LLD), 2) surgeon objective examination of LLD, and 3) radiographic hip length measurements based on extent of cartilage and bone loss. MATERIALS AND METHODS: A total of 102 patients who had hip osteoarthritis undergoing primary direct anterior approach THA were included. Patient-perceived preoperative limb length was collected. Target hip length was then determined using a radiographic goal for lengthening, preoperative hip pathology, patient perception, and physical examination findings of LLD. The primary outcome was the presence of patient-perceived or surgeon-examined LLD at latest follow-up. Secondary outcomes included patient outcome scores. RESULTS: , respectively. Preoperatively, 32.35% of patients reported perceived LLD. Postoperatively, 99.02% reported no LLD symptoms. Mean Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores improved from 49.41 ± 15.16 preoperatively to 79.34 ± 16.32 at 1 year. CONCLUSION: Appropriate restoration of patient limb length remains an important target and a technical challenge. While different technologies can help surgeons achieve an LLD target, a three-pronged clinical approach to setting target LLD leads to over 99% patient satisfaction with their limb length at 1-year follow-up.