Preserving medial iliofemoral ligament avoids excessive leg lengthening in total hip arthroplasty using anterolateral-supine approach

Hiroaki Kurishima; Norikazu Yamada; Atsushi Noro; Hidetatsu Tanaka; Shusuke Takahashi; Kyota Tsuchida; Yu Mori; Toshimi Aizawa

doi:10.1016/j.jor.2024.09.004

Preserving medial iliofemoral ligament avoids excessive leg lengthening in total hip arthroplasty using anterolateral-supine approach

J Orthop. 2024 Sep 6:60:29-34. doi: 10.1016/j.jor.2024.09.004. eCollection 2025 Feb.

Authors

Hiroaki Kurishima¹, Norikazu Yamada¹, Atsushi Noro¹, Hidetatsu Tanaka^{1

2}, Shusuke Takahashi¹, Kyota Tsuchida¹, Yu Mori², Toshimi Aizawa²

Affiliations

¹ Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan.
² Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.

PMID: 39345678
PMCID: PMC11437599 (available on 2026-02-01)
DOI: 10.1016/j.jor.2024.09.004

Abstract

Background: In this study, we compared postoperative leg length discrepancy (LLD) after total hip arthroplasty using the anterolateral-supine approach (ALSA THA) with or without medial iliofemoral ligament (mILFL) preservation and examined the effect of the remaining mILFL on postoperative LLD.

Methods: This was a single-center, retrospective case control study. Unilateral primary THA with a preoperative LLD <15 mm, in which the contralateral side was intact, was included. After ALSA THA, we compared the absolute values of postoperative LLDs and examined the ratio of postoperative LLD >5 mm with and without mILFL preservation. Demographic data, clinical scores, and operative data were collected. Statistical significance was set at p < 0.05.

Results: We included 341 hips (preservation group: 283 hips; resection group: 58 hips). The mean (range) absolute values of the postoperative LLDs were 2.3 (0-15.9) mm and 3.4 (0-14.8) mm, respectively. There was no significant difference between the two groups (p = 0.36). The proportion of postoperative LLD >5 mm differed significantly between the groups (4.4 % and 20.0 %, respectively; p < 0.01). Multiple logistic regression analysis showed that resection of the mILFL was the only significant factor that caused excessive leg lengthening (odds ratio, 5.28; 95 % confidence interval, 2.12-13.10, p < 0.01). Significant differences were reported in surgical time (81 (38-132) and 96 (54-157), respectively; p < 0.01) and intraoperative blood loss (297 (50-1170) and 388 (100-1150), respectively; p < 0.01). However, no significant differences in clinical scores, dislocation (including instability), or reoperation rates were observed between the two groups.

Conclusion: In patients with a preoperative LLD <15 mm, preserving the mILFL in ALSA THA avoids excessive leg lengthening and may lead to shorter LLD without any difficulties.

Keywords: Anterolateral-supine approach; Leg length discrepancy; Medial (inferior) iliofemoral ligament; Total hip arthroplasty.