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  • Title: Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty.
    Author: Meermans G, Malik A, Witt J, Haddad F.
    Journal: Clin Orthop Relat Res; 2011 Jun; 469(6):1677-82. PubMed ID: 20878559.
    Abstract:
    BACKGROUND: Pelvic radiographs are helpful in assessing limb-length discrepancy (LLD) before and after THA but are subject to variation. Different methods are used to determine LLDs. As a pelvic reference, both ischial tuberosities and the teardrops are used, and as a femoral reference, the lesser trochanter and center of the femoral head are used. QUESTIONS/PURPOSES: We validated the different methods for preoperative radiographic measurement of LLDs and evaluated their reliability. PATIENTS AND METHODS: LLDs were measured on full-leg radiographs for 52 patients (29 men, 23 women) with osteoarthritis (OA) of the hip and compared with different methods for measuring LLDs on AP radiographs of the pelvis. RESULTS: The true LLD varied from -8.0 to 9.1 mm. When the biischial line was used as a pelvic reference, the LLD measured on AP pelvis radiographs was different from the true LLD. No difference was found when the interteardrop line was used as a pelvic reference. There was substantial interobserver agreement when the lesser trochanter was used as a femoral reference (kappa = 0.66-0.70) and excellent interobserver and intraobserver agreement for all other measurements (kappa = 0.84-0.93). CONCLUSIONS: Our data show use of the biischial line as a pelvic reference should be discouraged and the interteardrop line is a better alternative. The center of the femoral head is a more reliable femoral landmark compared with the lesser trochanter.
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