Cemented Versus Cementless Primary Hip Replacement: Assessment of Leg Length Inequality

Objective: Following hip arthroplasty surgeries, leg length inequality (LLI) has been reported to be a leading cause of orthopaedic surgery malpractice claims. Most of them developed lengthening of the limb rather than shortening. Small lengthening (≤10 mm) are usually well tolerated by patients and may go unnoticed. In fact, absolute equalisation of limbs length is difficult to achieve and LLI could be minimised but not be avoided. Therefore, this cross-sectional study analysed and compared the LLI between two different techniques of hip arthroplasty (HA); Cemented and cementless. Materials and methods: Twenty-six patients underwent HA within the period from January 2012 to December 2014, 5 (19.2%) of them underwent cemented HA while 21 (80.8%) patients underwent cementless HA. The same principal orthopaedic surgeon has performed all these surgeries to reduce the bias that observed in other similar studies which were conducted by multiple surgeons. The method of measurement depended on the true clinical measurement using the tape measure. Pre- and post- operatively, we measured the length of both lower limbs for each patient and classified into; equal, lengthening and shortening groups by comparing the affected side length to the normal side. Finally, we compared the post operative overall mean LLI between these two techniques. Results: This study revealed that the overall mean of postoperative LLI in the cemented group was – 2.00 while in the cementless group was 3.81. There was no significant statistical difference between LLI developed in these two groups (P value, 0.361). Conclusion: We concluded that, in this study, the utilization of cement in HA surgeries has no impact on the incidence of postoperative LLI.