A Smart Tool for Intraoperative Leg Length Targeting in Total Hip Arthroplasty: A Retrospective Cohort Study

Paul Grosso1, 2, Matthew Snider1, 2, Jeffrey M. Muir3, *
1 McMaster University, Department of Surgery, Division of Orthopaedics, 1280 Main St. West, Hamilton, ON L8S 4L8, Canada
2 Grand River Hospital, 835 King Street West, Kitchener, ON N2G 1G3, Canada
3 Intellijoint Surgical, Inc., 60 Bathurst Dr., Suite 6, Waterloo, ON N2V 2A9, Canada

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© Grosso et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Intellijoint Surgical, Inc., 60 Bathurst Dr., Suite 6, Waterloo, ON N2V 2A9, Canada; Tel: +519 342 3178; Fax: 226 317 0471; E-mail:,



Leg length discrepancies following total hip arthroplasty (THA) may necessitate subsequent interventions, from heel lifts to revision surgery. Current intraoperative methods of determining leg length are either inaccurate or expensive and invasive.


The objective of the current study was to investigate the ability of a novel, intraoperative smart tool (Intellijoint HIP®, Intellijoint Surgical®, Inc., Waterloo, ON) to provide accurate, real-time leg length measurements during THA.


We retrospectively reviewed the medical records of 25 patients who underwent THA utilizing the Intellijoint HIP smart tool between February and August 2014. Intraoperative leg length data was compared with radiographic leg length calculations. Two observers blinded to the Intellijoint HIP findings independently assessed all post-procedure radiographs.


The mean difference between smart tool and radiographic measurements was 1.3 mm [CI: -0.1, 2.7]. 88% (22/25) of intraoperative measurements were within 5 mm of radiographic measurements; 100% (25/25) were within 10 mm. A Bland-Altman analysis showed excellent agreement, with 96% (24/25) of measurements within the statistical limit for acceptable agreement, and 84% (21/25) within the clinically acceptable range (± 5 mm). Removal of the first 13 procedures (surgeon training) decreased the mean difference between methods to 0.6 mm [-0.6, 1.9]. All post-training procedures were associated with a difference of <5 mm. There were no reported adverse events related to the use of the smart tool.


The Intellijoint HIP smart tool is a safe and accurate tool for providing intraoperative measurements of leg length in real-time.

Keywords: Cup position, Intraoperative, Intellijoint HIP, Leg length discrepancy, Navigation, Total hip arthroplasty.