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Background: Leg length discrepancy due to proximal migration of the femur commonly presents with a short leg gait and symptoms of hip and low back pain. The most common causes are chronic hip dislocation due to developmental dysplasia or the late sequelae of neonatal hip sepsis. It is usually recommended that the hip is stabilised prior to performing limb lengthening, and various techniques have been described. Unfortunately, these methods are not without complications, such as anatomical distortion making future arthroplasty more complex. We recognised a subgroup of these patients in whom the hip appeared unstable on plain film radiography, but in whom there was no proximal migration on weight bearing. Methods: We report on three of these patients who underwent limb lengthening with an intramedullary device, without prior stabilisation of the hip. Results: The desired length (range 55 to 60 mm) was achieved in all patients without further migration of the proximal femur. In all cases shoe raises were discontinued, and patient satisfaction was high. There was an improvement in gait in all patients. Conclusion: Femoral lengthening is possible without prior stabilisation of the hip in certain so called ‘unstable’ hip situations. The proximal femoral anatomy is not further altered and future salvage procedures such as a total hip replacement are not compromised. Level of evidence: Level 4

Intramedullary femoral lengthening with an 'unstable' hip without prior stabilisation: preliminary results of a case series