Double-Stitch Technique: A Simple and Effective Method to Minimize Limb Length Discrepancy after Total Hip Arthroplasty

Rakesh Gupta, Pradeep Pathak, Raj Singh, Krishna P Majumdar, Rakesh Gupta, Pradeep Pathak, Raj Singh, Krishna P Majumdar

Abstract

Background: Significant limb length discrepancy (LLD) after total hip arthroplasty (THA) is associated with limb, unremitting pain, neurological complications, and recurrent dislocations and has been a major cause of patient dissatisfaction and litigation against operating surgeon. The authors present a prospective study involving a double-stitch technique to prevent postoperative LLD after THA.

Materials and methods: Fifty patients undergoing primary THA over a period of 2 years were included in the study and were divided into two groups of 25 each. In Group I, double-stitch technique was used for intraoperative adjustment of preoperative radiological LLD, whereas in Group II, palpation and comparison of level of patella was used for assessment of LLD. Postoperative LLD and hip outcome scores were obtained and compared.

Results: Postoperative radiological LLD (mean ± standard deviation) was 2.72 ± 2.07 mm (range -5 mm to +6 mm) in Group I and +4.28 ± 7.2 mm (range -15 mm to +12 mm) in Group II. Nine patients in Group I and 2 patients in Group II had no true clinical leg lengths discrepancy postoperatively. Postoperative radiological LLD within 5 mm could be achieved in 24 patients in Group I and in 9 patients in Group II.

Conclusion: The study indicates that double-stitch technique is a simple and effective method in reducing postoperative LLD following THA.

Keywords: Double-stitch technique; limb length discrepancy; primary total hip arthroplasty.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A suture (silk no 1) was passed on the skin on the lateral side of the pelvis around 5 cm proximal to greater trochanter along the long axis of the femur
Figure 2
Figure 2
The longer limb of suture was reflected proximally along the axis of femur and the second stitch was applied 5 cm proximal to the first stitch along the same axis tied by double stitch, on a point in line with the long axis of the femur
Figure 3
Figure 3
The longer arm of thread was reflected distally and the tip of the forcep was placed on the greater trochanter area. The point where the tip of the forcep was touching the femur was marked by diathermy

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