Beneficio de cirugía de revisión en corrección de dismetría en la ATC primaria

12/23/2003
By Emma Hitt, PhD

Limb-length discrepancy following hip arthroplasty can be associated with pain, paraesthesia, and hip instability; however, careful evaluation of the position and orientation of components may reveal the cause of the problem and whether or not revision arthroplasty would be useful, according to the findings of a retrospective review.

Most patients with limb-length discrepancy following total hip arthroplasty have manageable symptoms, but others may be disabled. For these patients, revision arthroplasty may be warranted. Data regarding the outcome of surgical intervention to treat this problem are limited, however.

Javad Parvizi, MD, with the Rothman Institute of Orthopedics, Philadelphia, Pennsylvania, United States, and colleagues retrospectively reviewed the clinical and radiographic records of patients who had undergone revision hip surgery for limb-length discrepancy following a previous total hip arthroplasty.

A total of 21 patients, average age of 66 at the time of revision hip arthroplasty, were included. Over an average follow up of 2.8 years, the indications for revision hip arthroplasty included 11 patients with severe hip and/or back pain, 8 with instability of the hip, 1 with hip pain and ipsilateral limb paraesthesia, and 1 with hip pain and ipsilateral foot drop.

Revision arthroplasty was performed an average of 8 months after total hip replacement. The mean limb-length discrepancy at the time of the revision was 4 cm.

Equalization of the limb lengths was achieved in 15 patients. In the remaining 6 patients, the mean discrepancy had decreased to 1 cm. The mean Harris hip score improved significantly, from 56.5 points before the revision to 83.2 points at the time of the latest follow-up (P < .005).

The researchers report that all but 2 patients were satisfied with the outcome of the revision surgery.

"Although gross malpositioning of the components was usually detectable on the radiographs, the ultimate decision to retain or revise the components was based on intraoperative findings and assessment," Dr. Hozack and colleagues note.

"Despite its limitations, this study confirms that a selected number of patients with symptomatic LLD may benefit from revision of malpositioned components," they add.

J Bone Joint Surg Am 2003;85-A:12:2310-2317. "Surgical treatment of limb-length discrepancy following total hip arthroplasty"