Intraoperative Verification of Templated Leg Length in Direct Anterior Total Hip Arthroplasty.

Abstract

Leg length discrepancy (LLD) after total hip arthroplasty (THA) may compromise surgical outcomes and quality of life. Minimally invasive hip approaches, while increasingly used, limit exposure increasing the risk for postoperative LLD. This study examined the accuracy of a simple intraoperative method to leg-length assessment technique during THA through the direct anterior approach (DAA). A retrospective analysis was conducted on 1385 consecutive THAs performed between 2009 and 2018. Leg length was planned preoperatively and intraoperatively verified by assessing the distance between the lesser trochanter and the stem cone. Radiographic and functional outcomes were analyzed across surgeon experience levels and surgical indications. Postoperative LLD remained below 10 mm in the majority of cases, with a mean LLD of 4.5 mm. No relevant differences were observed between elective and trauma cases or between surgeons of differing experience. LLD exceeding 10 mm was associated with inferior functional outcomes. Intraoperative confirmation of the templated lesser trochanter-cone distance appears to support consistent leg-length restoration in DAA THA. Discrepancies beyond the predefined threshold of 10 mm were linked to worse functional outcomes.