Postoperative limb lengthening following Total Hip Arthroplasty (THA) through a posterior approach--a challenge for the orthopaedist or physiotherapist?

BACKGROUND: As coxarthrosis progresses, pain and mobility limitation exacerbate, usually presenting as a progressive flexion-abduction contracture. This, combined with the degradation of articular ends of bones, is responsible for anatomical and functional shortening of the limb. The sensation of postoperative leg length difference is a significant problem both for the patient and the operator. A sense of the operated limb being longer may be due to excessive length of the femoral segment following total hip arthroplasty. It may also result from a postoperative abduction or flexion-abduction contracture. The aim of the study was to review the clinical course of total hip replacement surgeries. The focus was on complaints of leg length discrepancy persisting for more than two weeks after ambulation. MATERIAL AND METHODS: We investigated a series of 210 unilateral THA procedures. Swanson's technique through a posterolateral approach was used in all cases. Twelve patients, including 8 women and 4 men (out of the total of 210 patients - 169 women and 41 men), reported a sensation of operated limb lengthening for more than two weeks after ambulation. We reviewed the process of rehabilitation in this group of patients. RESULTS: The rehabilitation procedure presented in this paper eliminated the sensation of limb length discrepancy in all patients who had reported this problem. CONCLUSIONS: 1. Complaints of leg lengthening following total hip arthroplasty were reported by approx. 5% of the THA patients. 2. Consistent physiotherapy involving muscle energy techniques (MET) helped to eliminate the sensation of limb length inequality.