Role of Iliotibial Band Stiffness in Perceived Leg Length Discrepancy After Total Hip Arthroplasty

The Role of Iliotibial Band Stiffness Assessed by Shear-Wave Elastography in Objective and Perceived Leg Length Discrepancy After Total Hip Arthroplasty

Patients undergoing total hip arthroplasty (THA) may experience objective or perceived leg length discrepancy (LLD/PLLD), which can negatively affect gait, pelvic balance, and patient satisfaction.

The iliotibial band (ITB) plays a critical role in lateral thigh tension transmission, and alterations in its stiffness may influence the perception of limb length discrepancy.

Shear-wave elastography (SWE) is a noninvasive ultrasound-based technique that enables quantitative assessment of soft tissue stiffness.

This cross-sectional observational study aims to investigate the relationship between ITB stiffness measured by SWE and both radiographic and perceived leg length discrepancy in adult patients who underwent unilateral primary THA at least 12 months previously.

Study Overview

• Status: Completed
• Conditions: Arthroplasty, Replacement, Hip; Postoperative Evaluation
• Intervention / Treatment: Diagnostic test: Shear-Wave Elastography (Ultrasound)

Detailed Description

This study will include adult patients aged 18-90 years who underwent unilateral primary total hip arthroplasty at least 12 months prior to enrollment.

Patients will undergo clinical evaluation, functional scoring, radiographic assessment, and bilateral ITB stiffness measurement using shear-wave elastography.

Radiographic leg length discrepancy will be assessed using previously obtained pelvis AP and full-leg length radiographs without additional imaging exposure.

Perceived leg length discrepancy will be evaluated using a block test during standing examination.

ITB stiffness will be measured bilaterally at standardized anatomical landmarks using SWE by two experienced radiologists.

The primary aim is to assess correlations between ITB stiffness and radiographic LLD, as well as perceived LLD. Secondary analyses will evaluate whether ITB stiffness predicts PLLD independently of radiographic LLD.

• Study Type: Observational
• Enrollment (Actual): 68

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Yenimahalle
    • Ankara, Yenimahalle, Turkey (Türkiye), 06170
      • Ankara Etlik City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients who underwent total hip arthroplasty and had a minimum follow-up of at least 1 year were included in the study.

Description

Inclusion Criteria:

Age between 18 and 90 years History of unilateral primary TKA, with no prior revision surgery At least 12 months after surgery and returned to functional weight-bearing No use of walking aids, or use of a cane only for outdoor ambulation

Exclusion Criteria:

Bilateral TKA or severe osteoarthritis in the contralateral hip History of femoral, tibial, or hip surgery resulting in limb length-altering deformity Significant scoliosis (>20° Cobb angle) or pelvic obliquity >5° Neurological disorders (e.g., severe polyneuropathy, hemiparesis) History of lateral thigh surgery (e.g., IT band release, TFL surgery) Body mass index (BMI) >40 (may reduce the reliability of SWE measurements) Suspected prosthetic joint infection or implant instability

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Postoperative Follow-up Cohort; Patients who underwent surgery and were followed as part of routine postoperative care. Clinical scores and radiographic assessments were recorded during follow-up. Non-interventional ultrasound evaluation was performed in patients who had completed at least 12 months after surgery; some patients were assessed at longer postoperative intervals.	Diagnostic test: Shear-Wave Elastography (Ultrasound); Non-interventional ultrasound performed during routine follow-up.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Harris Hip Score		At least 12 months postoperatively
Oxford Hip Score		At least 12 months postoperatively
HOOS score	Hip Disability and Osteoarthritis Outcome Score	At least 12 months postoperatively

Secondary Outcome Measures

Outcome Measure	Time Frame
leg length difference	At least 12 months postoperatively

Other Outcome Measures

Outcome Measure	Time Frame
iliotibial band tension-elastogram	At least 12 months postoperatively

Collaborators and Investigators

• Sponsor: Ankara Etlik City Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 14, 2026
• Primary Completion (Actual): February 12, 2026
• Study Completion (Actual): February 17, 2026

Study Registration Dates

• First Submitted: February 19, 2026
• First Submitted That Met QC Criteria: February 19, 2026
• First Posted (Actual): February 24, 2026

Study Record Updates

• Last Update Posted (Actual): February 24, 2026
• Last Update Submitted That Met QC Criteria: February 19, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Diagnostic Techniques and Procedures; Diagnosis; Diagnostic Imaging; Ultrasonography
• Other Study ID Numbers: AEŞH-BADEK1-2025-581

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No