Leg length discrepancy complications from osteotomy procedures in pediatric developmental dysplasia of the hip: A systematic review

Background

In pediatric patients with developmental dysplasia of the hip (DDH), leg discrepancy may occur from treatment complications or from the treatment itself. Surgeons should be mindful that performing osteotomies with the purpose of providing better pelvic joint fit comes with risks of unequal bone growth. This article aimed to systematically review the reported leg length discrepancy (LLD) as a potential complication from osteotomy procedures in surgical treatment of pediatric patients with DDH.

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. The study protocol was registered on the International Prospective Register of Systematic Reviews. A comprehensive search was performed on PubMed (MEDLINE), Scopus, the Cochrane Library and Europe PubMed Central in March 2022. Studies reporting outcomes of leg length discrepancy after osteotomy was performed were the main inclusion criteria. Quality and risk of bias assessment were performed by individual reviewers.

Results

From existing literatures, a total of eight studies were included in the review. From the data extracted, a total of 94 cases of DDH reported various LLD from 836 published cases with mean incidence of 11.2%. According to the patients’ age when the operation was performed, LLD of 2.20 cm was reported from the youngest patient operated on at 1.6 years old and LLD of 1.50 cm from the oldest patient operated on at 18 years old. The median LLD across the included studies was 1.30 cm. Limitations to this systematic review include study risk of bias, LLD reporting inconsistencies and assumptions when extracting the data which might have caused abnormal data distribution. Since no agreement exists regarding how much discrepancy between limb lengths is considered pathological, reports of cases and management of LLD vary widely. These results underline the importance of creating specific criteria to classify LLD severity and recommend appropriate treatment. WC:298.