Managing Leg Lengthening Patient Expectations

Leg lengthening remains one of the main reasons for litigation in total hip replacement.1 It’s estimated that between 1 and 27 % of patients experience some degree of leg lengthening.2 As such, surgeons should be prepared to manage these types of concerns as they arise.    

Dr. Keith Berend shared his simple approach for how he manages the issue of leg lengthening with his patients. It all starts with managing the patient’s expectations ahead of surgery. “I have a lot of patients that ask me ‘is my leg length going to be equal?’. I tell those patients the same thing every time. I have three goals with this operation that are going to help eliminate your pain, improve your function, and get your quality of life back. In order to do those things, I have to accomplish three things, and they are, in order:

  1. I need to get fixation. I need the parts to stay in. In order to do that, very occasionally I have to compromise leg length.
  2. I don’t want the ball to pop out. That’s called instability and I need the hip to be stable. In order to do that, occasionally I need to lengthen the leg a little bit, because with stability comes length.
  3. I want to get your legs as equal as possible, because that is going to help your function and it will affect your quality of life.

Dr. Berend went on to say, “Unfortunately, I don’t want number three (leg length) to be [a patient’s] number one goal, because I cannot guarantee that.”  Instead, Dr. Berend tries to focus the patient’s attention on numbers one and two. Both fixation (number one) and stability (number two) require another operation if they aren’t done properly; versus, leg length (number three). “Nobody has ever died from a shoe lift. I’m going to do my best to get them as close as possible, but I cannot compromise number one and number two to get their leg lengths equal.”

  1. Patterson, D., et al. Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis. Journal of Arthroplasty. 32: 2958-2962; 2017.
  2. Desai, A., et al. Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med. 6:336-341; 2013.
  3. Interview with Dr. Keith Berend on file at Zimmer Biomet 2018.
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