A low-volume surgeon is an independent risk factor for leg length discrepancy after primary total hip arthroplasty: a ca
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ORIGINAL PAPER
A low-volume surgeon is an independent risk factor for leg length discrepancy after primary total hip arthroplasty: a case-control study Yuji Kishimoto 1,2
&
Hiroko Suda 2
&
Takahiro Kishi 2 & Toshiaki Takahashi 2
Received: 1 August 2019 / Accepted: 2 October 2019 # SICOT aisbl 2019
Abstract Purpose Leg length discrepancy (LLD) is one of the bothersome complications that reduce patient satisfaction after total hip arthroplasty (THA). This study aimed to investigate the independent risk factors of LLD after primary THA. Methods This is a case-control study of 163 THAs for 163 patients at our institution between April 2015 and March 2018. The relevant data about the general characteristics of the patients (age, sex, body mass index, and diagnosis), surgery (surgical approach, type of femoral stem fixation, and surgeon volume), and radiological findings (Dorr classification and pre-operative LLD) were reviewed to identify the risk factors of ≥ 5 mm post-operative LLD according to radiological measurement and to calculate odds ratios (OR) via logistic regression analysis. Results The median (interquartile) absolute value of post-operative LLD was 3.9 (2.3–7.4) mm, and 57 (35.0%) patients had LLD of ≥ 5 mm. After controlling for possible confounders, a low-volume surgeon was considered the only independent risk factor of post-operative LLD (adjusted OR: 8.26; 95% confidence interval: 3.48, 19.60; P < 0.001). Among the 103 patients performed by high-volume surgeons, 82 (79.6%) had LLD of < 5 mm, whereas among the 60 patients performed by low-volume surgeons, only 24 (40.0%) achieved LLD of < 5 mm (P < 0.001). Conclusion A low-volume surgeon is associated with an increased risk of a post-operative LLD after primary THA, and the importance of measurements should be recognized to prevent post-operative LLD and achieve optimal outcomes. Moreover, surgeons must inform patients about the risk of developing LLD pre-operatively. Keywords Primary total hip arthroplasty . Leg length discrepancy . Surgeon volume
Introduction Total hip arthroplasty (THA) is one of the most commonly performed and successful orthopaedic procedures to date. In addition to pain relief and improvement of function, ensuring equal leg length is highly desirable but is challenging to achieve. A recent review [1] has reported that the incidence rate of leg length discrepancy (LLD) after THA was up to 50%. Post-operative LLD is associated with limping [2, 3],
* Yuji Kishimoto [email protected] 1
Department of Rheumatology, Tottori Red Cross Hospital, 117 Shotoku-cho, Tottori-shi, Tottori 680-8517, Japan
2
Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori 680-8517, Japan
pain [4], and patient dissatisfaction [2, 4], and it is also one of the main reasons for lawsuits after THA in the USA[5, 6]. To prevent such complications, it is important to predict the risk of developing LLD and inform patients about such risk pre-operatively. Several previous studies [7–9] have reported the risk factors associated with LLD,
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