Parental perspectives on leg length discrepancy

Parental perspectives on leg length discrepancy

KM Lee, MD, CY Chung, MD, KH Sung, MD, JH Cho, MD, TW Kim, MD, and MS Park, MDKM Lee, MD, CY Chung, MD, KH Sung, MD, JH Cho, MD, TW Kim, MD, and MS Park, MD

Seoul National University Bundang Hospital

Introduction• Leg length discrepancy (LLD)

- 40 to 70% of population

- associated with low back pain, hip pain, stress fracture

• How much LLD triggers intervention

• How to treat with a certain level of LLD

• Patient’s and parent’s opinion and interest in health related quality of life, dissatisfaction and discomport

• LLD of 2cm

- generally accepted guideline for treatment

• LLD of 2cm in pediatric patients

- shorter leg length

- amount of LLD change in growing children

- difficult to predict subjective psychological impact of LLD

Purpose of study

• To examine the parental perspectives on their

child’s LLD along with the affecting factors

including the amount of LLD, patients’

demographics, functional states and health

related quality of life

Methods

• Consecutive patients with chief complaint of LLD over age of 5

• Exclusion

1) neuromuscular disease, joint contracture, deformity of leg

2) patient who had undergone surgery for LLD

• Two groups

- posttraumatic LLD and idiopathic LLD

- LLD<2% and LLD ≥ 2%

• Pediatric outcomes data collection instrument (PODCI) and LLD questionnaire by parents

• Teleroentgenograms to measure LLD

• Through panel discussion and agreement

• 34 items for the questionnaire• 6 domains: parents’ satisfaction, effect of LLD,

preferred treatment, parents’ mood, concern, and expectation regarding treatment

• 5-point Likert scale: ‘not at all’, ‘slightly’, ‘somewhat’, ‘very’, and ‘extremely’

• Additional question for willingness to seek treatment

LLD questionnaire

• Standing anteroposterior teleroentgenogram

• Length of both legs: between the summit of the femoral head and the distal articular margin of the tibia

• Divide the amount of LLD by the long leg length for standardization (%)

Radiographic measurement

• Descriptive analysis • Spearman’s correlation coefficients : correlation between the LLD and PODCI

• t-test or Mann-Whitney U test : comparison between the two groups

• Logistic regression analysis : identification of the significant contributing factors to

the willingness to seek treatment

Data analysis

Results

Table 1. Comparison between idiopathic LLD and posttraumatic LLD

Idiopathic LLD Posttraumatic LLD P value

No. 29 29 -

Mean age 11.8 (3.8) 12.4 (2.7) 0.475

M : F 17 : 12 18 : 11 0.788

LLD (%) 2.5 (1.3) 2.1 (1.3) 0.153

PODCI

U/E & physical fxn 99.4 (2.1) 98.9 (3.0) 0.418

Transfer/basic mobility 99.7 (1.1) 98.2 (4.5) 0.093

Sports/physical fxn 96.9 (7.4) 91.4 (14.8) 0.082

Pain/comfort 93.6 (11.3) 82.6 (21.3) 0.018*

Happiness 87.2 (20.0) 80.0 (26.5) 0.249

Global functioning 97.4 (4.5) 92.7 (9.0) 0.015*

Table 2. Comparison between LLD≥2% and LLD<2% groups

LLD<2% group LLD≥2% group P valueNo. 29 29 -Mean age 11.8 (3.4) 12.3 (3.2) 0.526M : F 17 : 12 18 : 11 0.788LLD (cm) 1.1 (0.4) 2.4 (1.0) <0.001PODCIU/E & physical fxn 99.0 (2.5) 99.3 (2.6) 0.686Transfer/basic mobility 98.7 (3.5) 99.3 (3.2) 0.456Sports/physical fxn 92.7 (12.8) 95.6 (11.1) 0.366Pain/comfort 86.7 (18.7) 89.4 (17.1) 0.565Happiness 80.0 (27.8) 87.2 (18.1) 0.250Global functioning 94.2 (8.1) 95.9 (6.7) 0.391

LLD Questionnaire Effect on walking ability 3.0 (1.4) 3.8 (1.2) 0.039* Effect on need for surgical Tx. 2.4 (1.1) 3.3 (1.0) 0.001* Effect on happiness 2.5 (1.3) 3.6 (1.2) 0.003* Preference for surgical Tx. 2.5 (1.1) 3.2 (0.6) 0.011* Parental guilty feeling 3.3 (1.3) 4.0 (0.9) 0.039* Concerns over possible operation 3.2 (1.4) 4.1 (0.8) 0.010*Data are presented as mean (SD)

• Between the LLD≥2cm and LLD<2cm group

• Significant differences in their appearance (p=0.012), preference for surgical treatment (p<0.001), effect on happiness (p=0.004), and concerns over possible operation (p=0.010)

Table 3. ‘Willingness to seek treatment’ evaluated by logistic regression analysis

Exp (B) 95% CI P value

Global Fxn (PODCI) 1.04 0.941 - 1.148 0.444

Age 1.02 0.802 - 1.294 0.882

Gender 0.240 0.047 - 1.221 0.086

LLD (%) 0.231 0.086 - 0.620 0.004*

Responder (father/mother) 0.195 0.015 - 2.590 0.216

Idiopathic vs posttraumatic 1.087 0.266 - 4.438 0.907

Constant 0.509 - 0.894

CI, confidence interval

Conclusion

• ‘2cm rule’ can be used to evaluate the parents’ perspectives

• Difference in the health related quality of life between idiopathic LLD and posttraumatic LLD

• Understanding the parents’ psychological aspects on children’s LLD might enhance communication between surgeons and parents during the decision making

Thank you !