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BACKGROUND Few existing studies have examined the relationship between lower extremity bone length and quadriceps strength. PURPOSE/HYPOTHESIS To evaluate the relationship between lower extremity, tibia and femur lengths, and isometric quadriceps strength in patients undergoing knee surgery. The null hypothesis was that there would be no correlation between lower extremity length and isometric quadriceps strength. STUDY DESIGN Cross-sectional study METHODS Patients with full-length weightbearing radiographs that underwent isometric quadriceps strength testing after knee surgery were included. Using full-length weightbearing radiographs, limb length was measured from the ASIS to the medial malleolus; femur length was measured from the center of the femoral head to the joint line; tibia length was measured from the center of the plateau to the center of the plafond. Isometric quadriceps strength was measured using an isokinetic dynamometer. Pearson's correlation coefficient was used to report the correlation between radiographic limb length measurements. A Bonferroni correction was utilized to reduce the probability of a Type 1 error. RESULTS Forty patients (26 males, 14 females) with an average age of 25.8 years were included. The average limb, femur, and tibia lengths were not significantly different between operative and non-operative limbs (p>0.05). At an average of 5.8±2.5 months postoperatively, the peak torque (156.6 vs. 225.1 Nm), average peak torque (151.6 vs. 216.7 Nm), and peak torque to bodyweight (2.01 vs 2.89 Nm/Kg) were significantly greater in the non-surgical limb (p<0.01). Among ligament reconstructions there was a significant negative correlation between both limb length and strength deficit (r= -0.47, p=0.03) and femur length and strength deficit (r= -0.51, p=0.02). The average strength deficit was 29.6% among the entire study population; the average strength deficit was 37.7% among knee ligament reconstructions. For the non-surgical limb, femur length was significantly correlated with peak torque (r = 0.43, p = 0.048). CONCLUSION Femur length was significantly correlated with the isometric quadriceps peak torque for non-surgical limbs. Additionally, femur length and limb length were found to be negatively correlated with quadriceps strength deficit among ligament reconstruction patients. A combination of morphological features and objective performance metrics should be considered when developing individualized rehabilitation and strength programs. [ABSTRACT FROM AUTHOR]

Background: Achieving appropriate limb length and offset in total hip arthroplasty (THA) is challenging. Target limb length and offset may not always mean equal radiographic measurements bilaterally. The goal of this study is to introduce a method for determining as well as achieving target limb length and offset using digital radiographic measurements.Methods: One hundred and two consecutive patients with unilateral hip osteoarthritis undergoing primary THA in the lateral decubitus position were included. Limb length and offset were measured on anterior-posterior pelvic radiographs preoperatively, intraoperatively, and postoperatively. Offset was defined as the length of a line parallel to the inter-teardrop line, extending from the edge of the ischium, at about the lower border of the ipsilateral obturator foramen, to the edge of the femoral cortex, usually at, or just below, the neck resection level. Target limb length was determined for each patient based on patient perception and severity of disease. Target offset equaled the contralateral limb. Using intraoperative digital radiography, adjustments were made until targets were achieved and the hip was stable. Patients were followed for an average of 4.2 years postoperatively.Results: Limb length was within 5 mm of target measurements in 100% of patients and offset was within 5 mm of targets in 97.1%. Target measurements differed by >5 mm from the contralateral side in 2.0% of limb length and 2.9% of offset measurements. There were no significant differences between intraoperative and postoperative limb length (P = .261) or offset (P = .747) measurements. At final follow-up, there were no dislocations or reoperations and average Hip disability and Osteoarthritis Outcome Score for Joint Replacement was 95.78.Conclusion: Target limb length and offset goals can be determined for most patients undergoing THA. Targets are not always equal to the contralateral side. Intraoperative digital radiography can allow surgeons to accurately achieve target limb length and offset to within 5 mm in a homogenous cohort of patients with unilateral hip osteoarthritis with excellent clinical outcomes. [ABSTRACT FROM AUTHOR]

Long-term durability after Roux-en-Y gastric bypass is challenging in the super-obese population. Although lengthening of biliopancreatic limb (BPL) is associated with higher rates of weight loss, shortening of common limb (CL) is related to higher risk of malabsorption. In this study, we aimed at evaluating the importance of the total alimentary limb length by creating a 2-m BPL diversion with varying CL lengths. High-volume bariatric center, Norway. Three groups of patients (N = 187) with different limb lengths were included in this retrospective cohort-analysis as follows: group 1 (n = 69; Roux limb = 150 cm, BPL = 60 cm), group 2 (n = 88; BPL = 200 cm, CL = 150 cm), and group 3 (n = 30; BPL = 200 cm, CL = 200 cm). Weight loss, regain, and failure were analyzed along with malabsorption issues. Preoperative body mass index (BMI) was higher in group 2 (58.5, P <.001) and 3 (57.4) versus group 1 (54.6, P =.011). No other clinically significant differences between the groups were noted. Follow-up rate was 95% at year 2, 74% at year 5, and 52% at year 10. At 10-year follow-up, excess weight loss and total weight loss was higher in group 2 (70.4%; 40.3%) and 3 (64.0%; 35.9%) compared with group 1 (55.9%; 29.2%). Excess weight loss failure was higher in group 1 versus 2 (30% versus 8.3%, P <.001). No difference in short- or long-term complications was seen except higher occurrence of internal hernia in distal Roux-en-Y gastric bypass groups (11.4%, 6.7%). Vitamin and mineral deficiencies occurred more frequently the shorter the CL was. Sustainable weight loss in a long-term follow-up is achieved by shortening the total alimentary limb length with a 2-m BPL diversion that should not be attached <200 cm from the ileocecal junction owing to higher rates of internal hernia and vitamin and mineral deficiencies. • Weight loss is determined by the length of the total alimentary limb length • Biliopancreatic diversion is essential for durable long-term results in superobese • Length of the biliopancreatic limb should correspond roughly to one third of the total length of the small bowel • Common channel should not be shortened to less than 200 cm due to higher frequency of malnutrition and internal hernia. [ABSTRACT FROM AUTHOR]

Background: There is a lack of prospective studies investigating the additive effect of both acetabular and femoral reconstruction parameters on the functional outcome following total hip arthroplasty (THA).Methods: The aim of this prospective cohort study was to determine the combined influence of hip geometry reconstruction and component positioning on the clinical outcome following primary THA for unilateral osteoarthritis. We prospectively assessed the clinical outcome and radiographic parameters for hip geometry reconstruction, component position, and orientation using validated measurements for the operated hip compared to the contralateral native hip in a consecutive series of 113 patients with primary unilateral cementless THA. The correlation of reconstruction parameters was investigated using a multivariate polynomial regression model for the dependent variable ΔHHS (difference between the Harris hip scores preoperatively and 2.0-4.8 years postoperatively). Target zones for hip reconstruction and component positioning were investigated for an association with superior clinical outcome.Results: The regression model demonstrated a significant correlation for the ΔHHS and both hip offset (HO) reconstruction and leg length difference. Patients with accurate to slightly increased HO reconstruction combined with balanced leg length demonstrated a significantly higher ΔHHS than patients outside this zone (HO: 5 ± 5 and LLD: 0 ±5 mm, P = .029). This finding could be confirmed for 2 enlarged zones (zone 1: HO, 7.5 ± 7.5 and LLD, 2.5 ± 7.5 mm, P = .028; zone 2: HO, 7.5 ± 7.5 and LLD, 7.5 ± 7.5 mm, P = .007).Conclusion: HO and leg length reconstruction demonstrated an additive effect on clinical outcome and surgeons should aim for high accuracy in the reconstruction of both factors. [ABSTRACT FROM AUTHOR]

The article presents a study on the effectiveness of femoral head allograft combined with intramedullary rods in treating cases of tibiotalocalcaneal (TTC) arthrodesis. Topics included are the compilation of the hindfoot and ankle patient Retrograde Arthrodesis Intramedullary Nail (RAIN) database, the determination of limb functionality and ambulation in shoes and the preference of fusion with intramedullary nailing to fusion with external fixation.

Abstract: The objective of this retrospective review of 466 patients was to document changes in limb length, leg length discrepancy (LLD), height, weight, and body mass index (BMI) 1year after TKA and the patterns of height, weight, and BMI during 5years. To determine change patterns over 5years, the data of 291 patients were analyzed and compared with those of age and gender-matched normal subjects. Limb length, height, and weight increased, BMI remained unchanged, and LLD decreased 1year after TKA. The bilateral group had a greater height increase and lower rate of LLD. Preoperative mechanical tibiofemoral angle was related to limb length increase, and patients with a smaller preoperative BMI showed more weight gain. During the 5years, weight and BMI at 1year were maintained, but height diminished, while the healthy population showed a decreasing trend in weight. [Copyright &y& Elsevier]

Abstract: We hypothesized that use of a novel fluoroscopic grid would decrease operative time and component positioning variability during anterior supine total hip arthroplasty (THA). We reviewed 99 anterior supine THAs: 39 using a fluoroscopic grid, and 60 using fluoroscopy alone. Goals were cup abduction of 40° ± 10° and limb length and hip offset within 10 mm of the contralateral side. Surgical time was decreased in the study group (79 vs 94 minutes, P = .002). In the study group, more components met the goal for cup abduction (97% vs 83%, P = .046), limb length (100% vs 88%, P = .04), hip offset (85% vs 67%, P = .047), and all 3 combined (82% vs 52%, P = .002). We demonstrated decreased component positioning variability during anterior supine THA with assistance of a fluoroscopic grid. [Copyright &y& Elsevier]

Abstract: Patients will often perceive a change in lower limb length after total knee arthroplasty (TKA). From this observed finding, we asked how frequently does a change in limb length occur after TKA. Preoperative and postoperative full-length standing radiographs were obtained for 102 knees in 98 patients who underwent TKA. Digital radiography software was used to measure the mechanical axis and limb length of the operative and nonoperative legs. Overall, 83% of the knees measured showed an increase in limb length after TKA. Preoperative varus alignment was associated with an average lengthening of 5.2 mm. Preoperative valgus alignment was associated with an average lengthening of 8.4 mm. Patients with a valgus deformity greater than 10° demonstrated the greatest average lengthening. It is the conclusion of this study that limb lengthening occurs frequently after TKA, back to a length similar to the nonoperative limb. [Copyright &y& Elsevier]

Several studies contend that anthropometric factors, such as disproportionate length of the limbs relative to the trunk, may influence the results of the sit-and-reach test. Although, modified backsaver sit-and-reach (MBS) test is the best protocol for hamstring flexibility assessment in school age students, it does not consider limb length differences. This study was designed to study the relation between limb length with classical sit-and-reach (CSR) and MBS tests in student' boys. A total of 210 boys participated in this study (body mass 57.1 ± 12.4 kg, height 166.4 ± 10.8 cm, age 15.4 ± 1.3 yr). Participants performed 3 trials of the CSR and MBS test on the right and left sides. All anthropometric characteristics were measured prior to flexibility test. A significant correlation (p<0.05) was found between sit-and-reach tests and all anthropometric measures, but, with controlling other factors, only the partial correlation between MBS (right or left) with Arm span, and CSR with Sum of trunk and arm lengths were significant (p=0.05). Also, there was a significant correlation between CSR and Sum of trunk and arm lengths I leg length ratio, but no significant relation between CSR and MBS tests with other upper limb length I leg length Ratios. Limb length explained 21% of shared variance of the MBS test for right and left side. The Beta Coefficient only for arm span was significant (P=0.05). For CSR test, Limb length explained 18% of shared variance of the scores, Sum of trunk and arm lengths had significant Beta Coefficient (P=0.05). The results of this study suggest that the proportion of upper (arm and trunk lengths) and lower limb may be decreasing the effect of limb length on sit-and-reach tests. Also we need to modify the effects of limb length bias for MBS as a CSR test. [ABSTRACT FROM AUTHOR]

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