Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2010 Mar 2;152(5):287-95.
doi: 10.7326/0003-4819-152-5-201003020-00006.

Association of leg-length inequality with knee osteoarthritis: a cohort study

William F Harvey  1 , Mei Yang, Theodore D V Cooke, Neil A Segal, Nancy Lane, Cora E Lewis, David T Felson
Affiliations
Multicenter Study

Association of leg-length inequality with knee osteoarthritis: a cohort study

William F Harvey et al. Ann Intern Med. .

Abstract

Background: Leg-length inequality is common in the general population and may accelerate development of knee osteoarthritis.

Objective: To determine whether leg-length inequality is associated with prevalent, incident, and progressive knee osteoarthritis.

Design: Prospective observational cohort study.

Setting: Population samples from Birmingham, Alabama, and Iowa City, Iowa.

Patients: 3026 participants aged 50 to 79 years with or at high risk for knee osteoarthritis.

Measurements: The exposure was leg-length inequality, measured by full-limb radiography. The outcomes were prevalent, incident, and progressive knee osteoarthritis. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade 2 or greater, and symptomatic osteoarthritis was defined as radiographic disease in a consistently painful knee.

Results: Compared with leg-length inequality less than 1 cm, leg-length inequality of 1 cm or more was associated with prevalent radiographic (53% vs. 36%; odds ratio [OR], 1.9 [95% CI, 1.5 to 2.4]) and symptomatic (30% vs. 17%; OR, 2.0 [CI, 1.6 to 2.6]) osteoarthritis in the shorter leg, incident symptomatic osteoarthritis in the shorter leg (15% vs. 9%; OR, 1.7 [CI, 1.2 to 2.4]) and the longer leg (13% vs. 9%; OR, 1.5 [CI, 1.0 to 2.1]), and increased odds of progressive osteoarthritis in the shorter leg (29% vs. 24%; OR, 1.3 [CI, 1.0 to 1.7]).

Limitations: Duration of follow-up may not be long enough to adequately identify cases of incidence and progression. Measurements of leg length, including radiography, are subject to measurement error, which could result in misclassification.

Conclusion: Radiographic leg-length inequality was associated with prevalent, incident symptomatic, and progressive knee osteoarthritis. Leg-length inequality is a potentially modifiable risk factor for knee osteoarthritis.

Primary funding source: National Institute on Aging.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Diagram of a bilateral standing full limb radiograph depicting the measurements of leg length inequality (A), Mechanical axis alignment (B).
Figure 2
Figure 2
Graphical depiction of selected results (from Table 2a) showing the associations of leg length inequality (LLI) and Knee Osteoarthritis (OA).
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Woerman AL, Binder-Macleod SA. Leg length discrepancy assessment: acuracy and precision in five clinical methods of evaluation. J Orthop Sports Phys Ther. 1984;5:230–238. - PubMed
    1. Carlson M, Wilkerson J. Are differences in leg length predictive of lateral patello-femoral pain? Physiother Res Int. 2007;12:29–38. - PubMed
    1. Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983;8:643–51. - PubMed
    1. Giles LG, Taylor JR. Low-back pain associated with leg length inequality. Spine. 1981;6:510–521. - PubMed
    1. Golightly YM, Allen KD, Renner JB, Helmick CG, Salazar A, Jordan JM. Relationship of limb length inequality with radiographic knee and hip osteoarthritis. Osteoarthritis Cartilage. 2007;15:824–29. - PMC - PubMed

Publication types