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The Development of Leg Length Difference and Influence on Persistent Dysplasia in Patients with Developmental Dysplasia of the Hip

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Abstract

Introduction

Leg-length difference (LLD) is common in patients with developmental dysplasia of the hip (DDH). LLD of > 1 cm at skeletal maturity is reported in > 40% of patients, with the majority related to ipsilateral overgrowth. A longer DDH leg might lead to excessive mechanical loading at the acetabular margin, resulting in compromised acetabular development. We hypothesised that the LLD would negatively influence acetabular development. If so, it would be advantageous to identify such patients early in the course of follow-up, and address this if necessary.

Methods

A retrospective study was conducted on a consecutive series of DDH patients managed surgically at the Royal National Orthopaedic Hospital, Stanmore, United Kingdom. We included patients with adequate long-leg radiographs at the age of 4–8 years (early-FU) and skeletal maturity (final-FU). Bilateral cases and those who underwent surgical procedures for hip dysplasia during the follow-up period were excluded. Measurements including leg length and centre-edge-angle (CE-angle) were obtained at the 2 time points.

Results

Twenty-seven patients were included, mean age at early-FU 5.7 (± 0.9) years, and 13.9 (± 1.0) years at final-FU. Mean LLD at early-FU was 9.5 (± 7.6) mm and 10.9 (± 9.4) mm at final-FU, p = 0.337. Correlation between early- and final-FU LLD was 0.68 (p < 0.001). The mean CE-angle at early follow-up was 14.6° (± 9.8), this improved to 23.2° (± 8.2) at skeletal maturity (p = 0.003, paired samples t-test). Linear regression analysis showed a non-significant trend towards less CE-angle improvement in patients with more initial residual dysplasia and more initial LLD.

Conclusion

Most leg-length differences can be identified early in the follow-up period, nevertheless, considerable individual changes in LLD are observed on continued follow-up. Furthermore, a trend was observed towards impaired acetabular improvement in patients with more LLD. These findings justify careful clinical and radiological monitoring of LLD from an early stage in the follow-up period.

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Authors and Affiliations

  1. Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK

    Jaap J. Tolk, Rajiv Merchant, Deborah M. Eastwood & Aresh Hashemi-Nejad

  2. Department of Orthopaedic Surgery, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands

    Jaap J. Tolk

  3. Department of Orthopaedics, Great Ormond Street Hospital for Children, London, UK

    Deborah M. Eastwood

  4. Department of Orthopaedic Surgery, Mid and South Essex NHS Trust, Chelmsford, Essex, UK

    Pranai Buddhdev

Authors
  1. Jaap J. Tolk
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  2. Rajiv Merchant
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  3. Deborah M. Eastwood
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  4. Pranai Buddhdev
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  5. Aresh Hashemi-Nejad
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Correspondence to Pranai Buddhdev.

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Tolk, J.J., Merchant, R., Eastwood, D.M. et al. The Development of Leg Length Difference and Influence on Persistent Dysplasia in Patients with Developmental Dysplasia of the Hip. JOIO 55, 1568–1575 (2021). https://doi.org/10.1007/s43465-021-00492-5

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  • DOI: https://doi.org/10.1007/s43465-021-00492-5

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