Journal Article

Postoperative longer leg on surgical side and high riding greater trochanter worsen forgotten joint score after unilateral total hip arthroplasty

Hamai, Satoshi, Nakashima, Yasuharu, Kawahara, Shinya, Hara, Daisuke, Yamate, Satoshi, Sato, Taishi, Motomura, Goro, Konishi, Toshiki

2025

Overview

Leg length discrepancy (LLD), offset, and anatomical abnormalities such as a high-riding greater trochanter are key factors that may influence the outcomes of total hip arthroplasty (THA). Understanding how these factors affect patient-reported outcomes (PROs) is crucial for optimizing surgical techniques and improving patient satisfaction. This study investigated whether preoperative and postoperative LLD, offset, and a preoperative high-riding greater trochanter influence PROs in unilateral THA. A questionnaire survey was conducted targeting 1,010 individuals who underwent primary THA. Of the 652 respondents (62%), 203 with healthy contralateral sides were included. PROs were assessed using the Forgotten Joint Score-12 (FJS-12), Oxford Hip Score (OHS), and Visual Analogue Scale (VAS)-Satisfaction. Anteroposterior radiographs taken before and one week after surgery were used to measure LLD, femoral offset, acetabular offset, global offset, and articular trochanteric distance (ATD). A high-riding greater trochanter was defined as an ATD < 0 mm. Multivariable analyses revealed that a longer leg on the surgical side postoperatively ( P  = 0.0004) and a preoperative high-riding greater trochanter ( P  = 0.01) were negative factors for FJS-12. Older age ( P  = 0.0004) and higher body mass index ( P  = 0.04) were negative factors for OHS. Male sex negatively affected VAS-Satisfaction ( P  = 0.04). This study is the first to reveal that a longer postoperative leg on the surgical side and the presence of a high-riding greater trochanter leads to a decrease in the FJS-12 score independently. Therefore, to improve joint stability, it may be more beneficial to increase offset rather than extend leg length.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 692/1807/410 / 692/308/409 / 692/698/1671/63 / Acetabulum / Adult / Aged / Arthroplasty, Replacement, Hip - adverse effects / Arthroplasty, Replacement, Hip - methods / Body mass index / Female / Femur - diagnostic imaging / Femur - surgery / Forgotten joint Score-12 / High-riding greater trochanter / Hip / Hip Joint - surgery / Humanities and Social Sciences / Humans / Joint replacement surgery / Leg / Leg length discrepancy / Leg Length Inequality - etiology / Male / Middle Aged / multidisciplinary / Oxford hip score / Patient Reported Outcome Measures / Patient Satisfaction / Postoperative Period / Satisfaction / Science / Science (multidisciplinary) / Surveys and Questionnaires / Total hip arthroplasty / Trochanter