Reactive scoliosis: a challenging phenomenon in adolescent patients with hip arthritis

Functional limb length discrepancy (LLD) in adolescents can result from soft tissue contracture following long-standing hip disease. We present a case of a 13-year-old girl with difficulty in ambulation due to right hip pain and LLD. Radiographs revealed severe arthritis of right hip with signs of avascular necrosis of the femoral head. The patient had developed reactive scoliosis of lumbar spine along with pelvic obliquity. After failing conservative management, total hip arthroplasty (THA) without attempting to equalize LLD was performed. At 6-month follow-up, patient was pain free with full range of motion and her functional LLD was completely resolved. In such adolescent patients, reactive scoliosis of spine is reversible, and with no evidence of true LLD, THA without correcting LLD should be the right choice.