With a true leg length difference, there will be actual difference in the length of the bones in the pelvis, in the thigh, or possibly in the lower leg. CT studies can be used to calculate LLD in the presence of contractures. One type is structural, where there is an actual, physical difference between the same bones in each limb. Apparent discrepancy is due to an instability of the hip, that allows the proximal femur to migrate proximally, or due to an adduction or abduction contracture of the hip that causes pelvic obliquity, so that one hip is higher than the other. What are the causes of an apparent leg length discrepancy? Leg length discrepancy after total hip arthroplasty: a review of the literature. Larger leg length discrepancies become more significant. The other kind of leg length discrepancy is called a functional discrepancy. Diagnostic Considerations • History may reveal one or more of the following causes or risk factors: There is a difference of 2 cm in my Apparent Limb Lengths of the two legs. Background and purpose: The associations between leg length discrepancy (LLD) and patient-perceived inequality and functional outcomes after total hip arthroplasty (THA) are unclear in the literature. True or apparent leg length discrepancy: which is a better predictor of short-term functional outcomes after total hip arthroplasty? As the amount of discrepancy increased, there … • Muscle contractures or bony deformities around the hip may produce a pelvic tilt that causes an apparent leg-length discrepancy. The leg length discrepancy (LLD) is a biomechanical impediment which is a potential factor in affecting the musculoskeletal disorders in the rest of the life, such as scoliosis, osteoarthritis and muscle tightness or even tenderness in lumbar and pelvis area. Leg length differences can cause hip, knee and back pain. Apparent shortening occurs when one leg appears to be shorter than the other but there is no loss of bone length and the apparent discrepancy is due to a defect in the pelvis or the spine. Leg length discrepancy after total hip arthroplasty. – fracture malunions. It can affect the patient’s gait and result in … Hence the discrepancy. The population who obtained leg length discrepancy has symptoms in gait, running, standing There are two – 2 types of leg length discrepancy. This is often called a "functional leg length discrepancy." Patients with leg-length discrepancy (LLD) can also have angular and torsional deformities as well as soft tissue contractures of the ipsilateral or contralateral extremity that may influence their functional leg lengths. Congenital – With congenital cases, limb length discrepancy is apparent at birth. apparent leg length discrepancy measurement test. Supine to sitting leg length measurement. Technique The patient begins lying supine with his or her hip flexed to 45º, the knee flexed to 90º, and both feet lined up next to each other with medial malleoli and 1st MTP joints touching. For example, a femur or other specific bone may actually be shorter in one leg than in the other. There’s two different types, apparent and true leg length discrepancies. KW - Perceived inequality of leg length. What are the Signs and Symptoms of Leg Length Discrepancies?Affected posture. ...Problems with gait (manner of walking) Two different leg lengths can lead to your entire body being off-balance. ...Your rib cage or hips are forward on one side more than the other. ...Loss of muscle tone in one leg. ...Pain in the lower back, hip, ankle or knee. ...Pain being more severe on one side of the body than the other. ... Leg length discrepancy has many causes, which can be divided into four main groups: Congenital – With congenital cases, a leg length discrepancy is apparent at birth. THA Leg Length Discrepancy is a common finding following THA that may be transient due to weakness of the abductors or permanent due to intentional limb lengthening. Anatomical is when there is a true difference in the length of the tibia/fibula or the femur bone, or both. Limb length discrepancy (LLD) can be congenital or acquired. Leg Length Discrepancy is a common condition that may be caused by a congenital defect, disruption of the physis, or a paralytic disorder and presents with limb length asymmetry of varying magnitude. Overview Many people undergo surgery for various reasons - arthritis, knee replacement, hip replacement, even back surgery. KW - Physical performance. Leg length discrepancies are a situation where people have different lengths in legs or apparent lengths in legs. Apparent discrepancy is due to an instability of the hip, that allows the proximal femur to migrate proximally, or due to an adduction or abduction contracture of the hip that causes pelvic obliquity, so that one hip is higher than the other. Surgical lengthening of the shorter extremity (upper or lower) is another treatment option. What is Leg Length Discrepancy? Oct-Dec 2013;36(4):169-74. doi: 10.1519/JPT.0b013e318282d2f1. – Apparent Leg Length Discrepancies A lateral pelvic tilt is often confused with another condition known as leg length discrepancy. Physical therapy is often effective for restoring proper alignment of the muscles and joints to correct the issue. – bone loss from osteomyelitis or tumor resections. Generally, the length of the discrepancy is greater, and it increases progressively over time. Some causes of congenital LLD include fibular hemimelia, tibial hemimelia, congenital femoral deficiency, hemihypertrophy or other limb hypoplasias. Developmental – Caused by childhood illness or a growth plate injury, developmental cases result in a discrepancy that appears over time, as the injury or illness slows the growth of one leg. In fact … (Left) A discrepancy in leg length most often involves the femur or tibia. Overview. I am a basketball player and want to continue playing basketball. What are the causes of an apparent leg length discrepancy? This difference may simply be a mild variation between the two sides of the body. Anatomical is when there is a true difference in the length of the tibia/fibula or the femur bone, or both. A difference in leg lengths is more likely to be noticed and to affect activities of daily living. Patient lies supine with legs in neutral position. LLD may be classified as a structural or functional discrepancy, depending on the source. The apparent leg length can be measured from the umbilicus to the medial malleolus while the true leg length is measured from the anterior superior iliac spine to the medial malleolus [4]. Re: Apparent leg length discrepancy? Conclusion: Apparent LLD can be a better predictor of patientperceived inequality and physical performance than true LLD. For many people, an apparent leg length difference is the result of a small bone length difference (or none) that appears much worse because asymmetrical muscle activity is twisting and holding the pelvis in a twist and/or tilt. Evaluation includes determination of whether shortening is true or apparent. This is especially true if the infection happens in infancy. • Leg-length discrepancies may be real or apparent (Figure 60-1). Unequal distances signify an apparent leg length discrepancy, usually due to pelvic obliquity or from adduction or flexion deformity in the hip joint. Overview. KW - Total hip arthroplasty (THA) KW - … Leg length discrepancy is assessed by comparing the position of the medial malleoli. Apparent Leg Length Discrepancy Examination. Like the other long bones in the body, the femur and tibia do not grow from the center outward. Symptoms Inflammation of joints during growth may cause unequal leg length. Nearly everyone on earth has a leg length discrepancy. The patient begins lying supine with his or her hip flexed to 45º, the knee flexed to 90º, and both feet lined up next to each other with medial malleoli and 1st MTP joints touching. A leg length discrepancy (LLD) exists when one leg is longer than the other with respect to the same individual. However, patients with low back pain and patients with herniated disc showed significant differences between the actual size and apparent size of the leg (Table 1). 12 There have been many previous studies 8, 11, 13 on true LLD assessed by hip radiography, but few studies on apparent LLD after THA. Spinal causes, for example scoliosis, are more common than true pelvic deformity. Leg length difference (LLD) is primarily when the hips are not level, causing a limp from side to side. Defined as difference in rate of growth between two limbs: – usually due to abnormal physeal growth. Real And Apparent Leg Length Discrepancy. The bone is lengthened by surgically applying an external fixator to the extremity in the operating room. This can be compared to the apparent limb length as measured from the umbilicus to the medial malleolus with the legs straight parallel to the trunk, which is therefore affected by pelvic obliquity. A small leg length discrepancy of a quarter of an inch or less is quite common in the general population and of no clinical significance. Positive test: Inequality of leg lengths on sitting. A limb length discrepancy (LLD) is when one arm or leg is longer than the other arm or leg. For many people, an apparent leg length difference is the result of a small bone length difference (or none) that appears much worse because asymmetrical muscle activity is twisting and holding the pelvis in a twist and/or tilt. However, the underlying cause of leg length inequality still remains. Doc told me one of my pelvis is tilted marginally up. J Arthroplasty 2004;19(4, suppl 1):108-110. Purpose: To assess the contribution of the sacroiliac joint to an apparent leg length discrepancy. Accurate imaging methods of LLD have made it possible to study the biomechanical effects of mild LLD (LLD of 20mm or less). One is called functional or ‘apparent‘ leg length difference, the other is called a natomical or ‘true‘ leg length difference. Acquired LLD is usually due to an insult to the growth plate by trauma, infection, radiation, or tumor. A limb length discrepancy (LLD) is when one arm or leg is longer than the other arm or leg. Leg length discrepancy is an orthopedic problem that usually appears in childhood, in which a child’s two legs are of unequal lengths. Generally, the length of the discrepancy is greater, and it increases progressively over time. Leg Length Discrepancy. The examiner holds the patient’s feet to the table, instructs the patient to raise his or her pelvis off the table … 4/27/2015. It can affect the patient’s gait and result in knee, ankle, and hip dysfunction. KW - Apparent leg length discrepancy. A difference in leg lengths is more likely to be noticed and to affect activities of daily living. Maloney WJ, Keeney JA. Performing the Test: The examiner grasps the patient's legs above the ankles and fully flexes them, then extends them. Have the patient sit up, while keeping the legs extended. The examiner then compares the two medial malleoli to see if a difference in position is present. Apparent shortening occurs when one leg appears to be shorter than the other but there is no loss of bone length and the apparent discrepancy is due to a defect in the pelvis or the spine.