Total Hip Arthroplasty and leg length

Total hip arthroplasty, leg lenght discrepancy, Dr Rémi orthopaedic surgeon, Toulouse France Clinic Capio Croix du Sud
Each hip is unique, because of arthritis, fracture, dysplasia, and patient morphology. Each need a prosthesis to adapt and replace it perfectly.

How to adjust exactly a hip prosthesis ?

Hips look like hips, you can confuse with knee or shoulder !

However they are all different because of patient morphology, arthritis, fracture, dysplasia, disease...

A good preparation, and a good execution, are essential to an arthroplasty success.

Irrespective of the surgical approach (if one could offer you something else than anterior approach...), here you find some basic elements to realize correctly the project of a total hip arthroplasty.

PLAN

The theater room is the worst place to cogitate, used to say my master (you have to think before, not in the heat of the moment).

Difficulties, bone cuts, are planned before the surgery. Templates on X-rays allow to anticipate the landmarks one will recognize during the surgery.

total hip arthroplasty leg discrepancy Dr Rémi Toulouse France orthopaedic surgery Clinic Capio Croix du Sud
The placements of the stem and the acetabulum are drawm with templates. The landmarks are noted as to be checked during the surgery.
total hip arthroplasty leg lenght discrepancy Dr Rémi orthopaedic surgeon Toulouse France Clinic Capio Croix du Sud
There is a lot of combination of length, size, neck, head for the femur (across brands). The good mix is identified before the surgery, and not trying every option during the surgery.

CONTROL

During the surgery , the landmarks are noted and compared with the previous ones. Level of the cut of the femoral neck, level of the trochanters, size of the head, depth and external reliefs of the acetabulum,  everything is checked before and after the cuts.

Some adjustments may be required to cope with the friability and softness of the bones. If the numerical values can be questionable sometimes, the relationships between them are still reliable.

THA surgery leg discrepancy Dr Rémi orthopaedi surgeon Toulouse France Clinic Capio Croix du Sud
The level of the future femoral stem is compared with the level anticipated.
THA surgery Dr Rémi orthopaedic surgeon Clinic Capio Toulouse France
The level of the trochanter is checked on the rasp introduced and blocked in the femur.

CHECK

The femoral and acetabular prosthesis are now in place. The hip stability, the leg lenght, come directly from the planning. Rare are the adjustments at this step of the surgery.

total hip arthroplasty leg lenght discrepancy Dr Témi orthopaedic surgeon Toulouse France Capio Clinic Croix du Sud
The surgery is supine, the two legs visibles and palpables. It's easy to check lenght and stability.
Total hip arthroplasty Dr Rémi orthopaedic surgeon Toulouse France Clinic Capio. Croix du Sud
The postoperative x-ray confirms good positioning. The physiotherapist comes for the first getting-up as soon as the patient comes back from the theater room.