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The association of leg length and offset reconstruction after total hip arthroplasty with clinical outcomes

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)89-95
Number of pages7
JournalClinical Biomechanics
Early online date9 May 2019
DateAccepted/In press - 8 May 2019
DateE-pub ahead of print - 9 May 2019
DatePublished (current) - 1 Aug 2019


BACKGROUND: Restoring native hip anatomy and biomechanics is important to create a well-functioning hip arthroplasty. This study investigated the association of hip offset and leg length after hip arthroplasty with clinical outcomes, including patient reported outcome measures, the Trendelenburg Test and gait analysis.

METHODS: In 77 patients undergoing primary hip arthroplasty for osteoarthritis (age mean = 65 SD = 11 years; BMI mean = 27 SD = 5 kg/m2), hip offset and leg length discrepancy were measured on anteroposterior radiographs. The Western Ontario & McMaster Universities Osteoarthritis Index, the Trendelenburg Test and gait were assessed preoperatively, and at 3 and 12 months postoperatively. An inertial measurement unit was used to derive biomechanical parameters, including spatiotemporal gait parameters and tilt angles of the pelvis. Relationships between radiographic and functional outcomes were investigated, and subgroups of patients with >15% decreased and increased femoral offset were analysed separately.

FINDINGS: Patient-reported function scores and clinical tests demonstrated a few significant, weak correlations with radiographic outcomes (Spearman's ρ range = 0.26-0.32; p < 0.05). Undercorrection of femoral offset was associated with lower patient-reported function scores and with more step irregularity as well as step asymmetry during gait. Postoperative leg length inequality was associated with increased frontal plane tilt angle of the pelvis during the Trendelenburg Test and increased sagittal plane motion of the pelvis during gait. Femoral offset subgroups demonstrated no significant differences for patient-reported function scores and outcomes of the Trendelenburg Test and gait analysis.

INTERPRETATION: Reduced hip offset and leg length discrepancy following hip arthroplasty seem to be marginally associated with worse clinical outcomes.

    Research areas

  • Gait analysis, Leg length, Offset, Patient-reported outcome measures, Total hip arthroplasty, Trendelenburg test

    Structured keywords

  • Centre for Surgical Research



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    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 825 KB, PDF document

    Embargo ends: 9/05/20

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    Licence: CC BY-NC-ND


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