Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method

BACKGROUND

Inequalities in leg length result in functional disorders, as they impair the biomechanics of the musculoskeletal system, significantly reducing the quality of life (QoL). This study used the WHOQoL-BREF questionnaire in patients with varying degrees of lower leg shortness who had undergone treatment by the Ilizarov method, compared to a healthy control group.

METHODS

Fifty-eight patients treated with the Ilizarov method for discrepancies in lower limb length were grouped by degree of limb equalization (group 1, 37 treated individuals with limb length discrepancy < 1 cm; group 2, 21 individuals with discrepancy ≥ 1 cm but not more than 4 cm). The control group 3 contained 61 healthy individuals. Patient quality of life (QoL) was assessed using a shortened version of the WHOQoL-BREF questionnaire, at least 24 months after the end of Ilizarov therapy.

RESULTS

Control subjects obtained higher scores in all domains than subjects in both treatment groups, as well as significantly higher self-assessed QoL, and health, in the physical, psychological, social, and general lifestyle domains, as compared to those with inequalities ≥ 1 cm. Furthermore, patients with inequalities ≥ 1 cm had higher odds ratios of low self-assessment (3.28 times; p = 0.043), low self-assessment of health (4. 09 times; p = 0.047), and low physical and psychological domains (respectively 6.23 times; p = 0.005 and 8.46 times, p = 0.049) compared with patients with inequality < 1 cm. The shortened version of the WHOQoL questionnaire was used.

CONCLUSIONS

After at least 24 months of treatment with the Ilizarov method, patients with limb length discrepancy < 1 cm did not differ significantly from healthy individuals in the WHOQoL self-assessment of mental functioning, social, or life satisfaction.

Optimizing leg length correction in total hip arthroplasty

PURPOSE

Residual feeling of leg length discrepancy (LLD) is a common cause of patient dissatisfaction following total hip arthroplasty (THA). The purpose of this study is to propose a method for determining an optimal leg length correction goal in THA.

METHODS

We conducted a retrospective study of 132 patients to examine the radiographic LLD (R-LLD), perceived LLD (P-LLD), and whether or not the patient has an uncomfortable feeling about the leg length after THA.

RESULTS

The residual discomfort rate in all patients was 9.1% (12/132 patients), and ten of these 12 patients felt uncomfortable due to a longer leg length. When R-LLD was within 7 mm, the rate was 6.8% (8/118 patients), which is nearly equal to the rate of 7.8% (5/64 patients) in cases in which R-LLD was within 2 mm. On the other hand, when R-LLD was 8 mm or more, the rate was 57.1% (4/7 patients).

CONCLUSIONS

The results of our study show that 7 mm may be a reasonable threshold for reducing the residual discomfort. However, even with little or no R-LLD, some patients will continue to experience discomfort. We think that this is because of pre-operative differences between R-LLD and P-LLD in such cases. If the patient has a pelvic declination on the affected hip side and a lumbar scoliosis angle that is convex toward the affected hip side before surgery, the ideal length may be a little shorter than the radiographic isometry, since such patients are likely to feel a longer leg length than that shown radiographically.

The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: A Prospective Cohort Study

We investigated whether patients with lengthening (> 9 mm), restoration (between 9 mm lengthening and 5 mm shortening) or shortening (> 5 mm) of the operated leg after total hip arthroplasty (THA) had different function (WOMAC score), quality of life (EQ-5D), residual hip pain, use of shoe lift and walking aid and leg length discrepancy (LLD) awareness, 12-15 months postoperatively. All patients had a significant postoperative improvement in WOMAC and EQ-5D regardless the LLD. However, the lengthening group showed less improvement in WOMAC, more use of shoe lift, residual hip pain and LLD awareness compared with the other two groups. No differences in EQ-5D were found. In spite of the improvement in function and quality of life, lengthening had adverse effects and should therefore be avoided.

[Incidence and effect of leg length discrepancy after total hip arthroplasty]

INTRODUCTION

In coxarthrosis pain relief and the restoration of function including leg length are achieved with total hip arthroplasty. Sometimes achieving stability makes it impossible to achieve equal leg length.

OBJECTIVE

To determine the incidence of pelvic limb length discrepancy, its effect on function and its emotional effect in a group of patients who underwent total hip arthroplasty.

MATERIAL AND METHODS

A total of 252 patients with a diagnosis of grade IV coxarthrosis were assessed. They underwent unilateral primary total hip arthroplasty with a direct lateral approach; 190 were uncemented and 162 hybrid. Limb length was measured from the anterosuperior iliac crest to the medial malleolus of both legs. Patients were divided into four groups depending on leg length discrepancy: A) equal length; B) less than 10 mm; C) more than 10 mm, and D) more than 20 mm.

RESULTS

A total of 252 arthroplasties were performed in 252 patients; 194 females (76.98%) and 58 males (23.01%). In 115 patients (45.63%) had a discrepancy < 10 mm; 71 patients (28.17%) > 10 mm; 60 patients (23.80%) did not have length discrepancy, and six patients had > 20 mm of discrepancy with lengthening of the operated limb.

CONCLUSIONS

Length discrepancy of the operated limb is reported in the literature. It is a common outcome of primary total hip arthroplasty, and is usually < 10 mm, as reported in world literature.

Perception of leg length discrepancy after total hip replacement and its impact on quality of life

OBJECTIVE

To assess the leg length discrepancy (LLD) in the patients who underwent primary total hip replacement both the actual inequality (anatomical LLD) and the perceived feeling of inequality (perceived LLD). Moreover the impact of the perceived LLD on quality of life was evaluated.

MATERIAL AND METHOD

From January 2011-January 2012, 151 hips from 151 consecutive patients were studied about the post-operative LLD by measuring the post-operative radiographs at follow-up time. Questionnaires concerning the perception of LLD and the Harris hip score (HSS) were completed. Assessing the postoperative quality of life with the EQ-5D patient self-rating tool also was done.

RESULTS

Seventy nine patients had anatomical LLD and 41 patients could perceive LLD. Age, gender, post-operative time at follow-up and the HSS were not significantly different between both perceived LLD and non-perceived LLD patients. After 12 months post-operatively all non-anatomical LLD patients perceived no LLD. Only the EQ-5D of non-perceived LLD group was significantly better.

CONCLUSION

Perception of LLD after total hip replacement is a significant factor that influences the patients quality of life. However, this frustration could resolve or improve with time.

The analysis of self-esteem based on patients` self-perception after Ilizarov limb lengthening treatment

In the article there is shown the analysis of patients self-perception after the Ilizarov limb lenghening treatment due to inequality. 150 patients both sexes (78 girls and 72 boys) were tested between 1992 and 2003 in our center. The average age for girls at the time of follow-up was 19.5 years and 18.5 years for boys. In the survey there was used four point-scale SES by Irena Dzwokowska, Kinga Lachowicz-Tabaczek and Mariola Łagun which was based on Rosenberg work. The results were divided into two groups: low or high score. It was evaluated according to the table of standards which included people age and sex. Then the score was transformed into standard ten. For statistical calculations was used MicroSoft Excel spreadsheet. In the case of statistical studies was used Spss v.17.0. It was found that among survey respondents regardless of gender and age after the satisfactory completion of Ilizarov treatment patients gain a high level of self-assessment at 7 standard ten. The high self-esteem can predict the level of patients` comfort in many aspects of their lives. People with such a hight self-perception will experience more positive emotions and will be healthier and more active.

Neurological and psychiatric aspects of corpus callosum genesis

This article reports the case of a patient with partial agenesis of the corpus callosum manifested with corpus callosum syndrome together with signs of brain hemispheres dysfunction: mental impairment, epilepsy and pyramidal signs. The patient's malformation is combined with left-handedness while signs of callosal disconnection are not present. Mild cognitive impairment and late epilepsy onset require a multidisciplinary approach since the patient also displays elements of central nervous system malformations.

Does leg lengthening pose a threat to a child's mental health?: An interim report one year after surgery

Previous studies suggest that children react with functional and psychological disturbances after leg lengthening (LL). Long-term effects are not known, and there is a lack of prospective studies. The aim of this interim prospective study was to investigate the psychological impact of the Ilizarov technique on a sample of children 1 year after surgery.

METHODS

: The subjects were 27 patients aged 6 to 16 years treated using the Ilizarov technique at the Pediatric Orthopaedic Department, Uppsala University Hospital, between 1997 and 2005. A control group of healthy children matched for age and sex were also included.Semistructured interviews and psychometric measures (anxiety, depression, self-esteem, behavior) were administered to patients and parents before surgery and 1 year after. Psychological measures were correlated with medical records (days of hospitalization, gained length, etc). The control group was examined at initial assessment only.

RESULTS

: Before reconstructive surgery, the LL group had a significantly lower self-esteem compared with the control group. Aggressive behavior, attention and externalization problems, anxiety, and depression were significantly reduced after LL. Parents' state anxiety was also reduced. There were no differences in trait anxiety between the parents of patients and the parents of the control children.

CONCLUSIONS

: Patients reported pain, psychological discomfort, complications, and restrained function during LL. However, there were no adverse psychological effects at 1-year follow-up; rather, there were signs of improved mental health. No single psychological parameter could predict the outcome after LL.

The effect of limb length discrepancy on health-related quality of life: is the '2 cm rule' appropriate?

The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhance the quality of life of patients by improving their function, gait, appearance, and pain secondary to compensation for the limb length discrepancy. While many surgeons use a cutoff point of 2 cm as an indication for intervention, little attention has been given to the effect of limb length discrepancy on quality of life. Therefore, the purpose of this study was to determine the relationship between limb length discrepancy and health-related quality of life and to assess whether the commonly accepted 2 cm cutoff serves to predict patients with and without quality of life perturbations. The Child Health Questionnaire was used to collect information from the parents of 76 children diagnosed with limb length discrepancy, and these data were compared with data from scanograms. Differences in quality of life became more apparent with increasing limb length discrepancy, especially among psychosocial health domains. As expected, patients with a limb length discrepancy of 2 cm or below generally fared better than patients with larger discrepancies, but no discrete cutoff could be identified within this group.

Living with the Ilizarov frame: adolescent perceptions

INTRODUCTION

The Ilizarov technique has become an established method in the treatment of children with serious skeletal disorders. Whilst the technique is acknowledged for solving difficult conditions, the application of the external fixator marks the beginning of an arduous treatment programme. Research has suggested that undergoing such treatment can negatively impact upon the physical and psychological well-being of the young person. Yet limitations in research design reduce the usefulness of the findings, given in that most of the previous studies have used retrospective, quantitative data collection approaches, often with a heterogeneous sample population. We wished to gain a richer insight into the experiences of adolescents living with the frame by drawing on both qualitative and quantitative approaches.

AIMS

To explore adolescents' perceptions of the anticipated and actual impact of the Ilizarov frame on aspects of daily activity.

DESIGN

A mixed-method approach, using a prospective and longitudinal study design.

METHOD

Fifteen adolescents undergoing the Ilizarov treatment were contacted at several predetermined time-points during the course of their treatment to share their perceptions of living with the frame. At several of these points semi-structured interviews were used to ascertain their perceptions, whilst quantitative data were gained at all time-points by adolescents completing a range of psychometric measures.

FINDINGS

Adolescents found that life with the frame was not as bad as anticipated, and they adopted a pragmatic approach, appreciating that this was something they 'just had to get through'. Peers had a substantial role in supporting their friend to adjust and cope with the frame. Psychometric scores were largely within normal limits.

CONCLUSION

This study suggests that, while the Ilizarov treatment is demanding for adolescents, it is one that they can tolerate without sustained adverse psychological impact.

The orthotic management of the congenitally short lower limb--a new appliance

AIM

To describe an appliance used for equalisation of severe congenital lower limb length discrepancy for patients who refuse to undergo any operative correction but wish to walk and look better.

METHOD

The appliance which is a combination of an ischial bearing brace and a below knee prosthesis was fitted to four patients, aged between 12 and 31 years, with congenital shortening of the lower limb ranging between 17 to 27 centimetres. The diagnosis was proximal femoral focal deficiency in 2 patients, hypoplastic femur in 1 and tibial hemimelia in the fourth patient. The appliance could accommodate existing deformities of the knee, ankle and foot without any operative correction as well as equalise the lower limb length. It is modular in construction and could be easily assembled from off-the-shelf components.

RESULT

The appliance improves the gait as well as the appearance, could be fitted to the patient without the prior need of operative correction and could be well disguised under any loose fitting garment. Four patients with severe congenital shortening of the leg have used it for over three years and are pleased with it. It requires little maintenance.

CONCLUSION

The appliance is useful for patients with severe congenital shortening of the lower limb who refuse to undergo operative correction.

The psychological and social functioning of 14 children and 12 adolescents after Ilizarov leg lengthening

We studied the psychological and social impact of the Ilizarov leg lengthening procedure in 26 patients (aged 6-17 years), who had completed the treatment at least 2 months previously. Measurements of depression and anxiety were performed preoperatively and at follow-up. Questions about functioning at school, daily life activities and treatment-related experiences were answered by the patient and his/her parents. The school or work results showed no significant decline during the lengthening procedure. Serious sleeping problems occurred during the procedure. There was no subjective improvement in physical skill after the procedure and almost one-fourth of the children still had complaints about their leg. We conclude that the Ilizarov procedure caused no serious psychological disturbances.

The Ilizarov method for correction of complex deformities. Psychological and functional outcomes

We reviewed the psychological profile and functional ability of forty-five children (fifty-two extremities) who had had correction of deformities of the lower extremities with the Ilizarov method. Psychological changes were evaluated with the Post-Hospitalization Behavior Questionnaire and the Children's Depression Inventory, and the functional status was measured with the Children Health Information Service Rand Scale. The over-all satisfaction of the patient with regard to the outcome of the operation was assessed as well. The operations were performed between 1988 and 1992. The average age at the time of the operation was twelve years (range, three to eighteen years), and the average duration of follow-up was thirty-six months (range, twenty-four to seventy-two months). The lengthening index, duration of lengthening, and average number of complications were similar to those reported in other studies. All of the children had a normal psychological score, forty-two had no limitations in daily activities, and thirty-seven were satisfied with the over-all result.

New rationale in management of tibial agenesis type II: a maturity review of its functional, psychological, and economic value

It is now 3 years since we published a new surgical approach to type II tibial agenesis. All three patients have reached the end of growth, and we have been able to conduct a maturity review of the functional, psychological, and economic value of this method of treatment. All three patients were very satisfied with the treatment they had received, although it was long and often arduous. We have attempted to compare the costs of primary amputation without complication in the first year of life, followed by supply of at least 10 prostheses, until age 18 years, with that of the reconstructive technique, which is liable to require five operations and considerable periods of inpatients and outpatient care until age of 18 years.

Multiple phantom limbs in a child

This case report describes multiple phantom feet in a child after amputation of a leg. The subject is a 16-year-old girl who was born with a right leg 10 cm shorter than the left and who at the age of 6 was amputated below the right knee so that she could wear a prosthesis that would give her normal mobility. The girl reports that she subsequently experienced 2 phantom feet and 3 sets of phantom toes which have persisted to the present time. Each phantom has a distinct size, length and position in relation to the others and each is also the site of vivid sensations such as heat, tickle, and fatigue as well as voluntary and involuntary movement. She also describes sensations that resemble sensations experienced before the amputation: one of her phantom feet feels flat and locked into a forward position which corresponds with the actual shape and position of her congenitally deformed amputated foot. The implications of multiple phantoms are discussed with reference to recent concepts of phantom limbs.

Ilizarov external fixation. Surgical principles, nursing implications

The role of the perioperative nurse in caring for a patient with an innovative procedure such as the Ilizarov device is challenging. Because of the problem fracture, the patient usually has had multiple unsuccessful surgical experiences and may express considerable concern and anxiety. As perioperative patient advocates, nurses must encourage patients to be their own spokespersons and to ask questions when they do not understand. The patient advocacy role becomes even more important when the patient undergoes a new procedure. It is our experience with this procedure that both patients and professional staff have many questions during the postoperative period. It is essential that the perioperative nurse establish a communication climate among the patient and members of the interdisciplinary team that promotes collaboration and problem solving on behalf of the patient undergoing this unique surgical procedure.