2nd THR: Question about fixing LLD

[Tiffany57]

My first THR 27th October 2015 (Hippy Birthday tomorrow!) was an absolute game-changer for me, I'm thrilled to say. But it, necessarily, because of the wearing down of my un-op'd hip joint, meant that I had an 11mm LLD....meaning I don't walk barefoot even around the house and have been getting by with heel-raisers stuck into the few pairs of shoes I can actually wear.

Initially, a day or so after the first op. I was informed the LLD was 6mm....and that was only after I kept badgering on about how I felt there was a marked difference in length. He seemed to make a visual assessment by looking at how my ankle bones matched up when I'm laying down.

6 weeks later I went to a podiatrist for an accurate measurement, on my GP's advice, because I felt that 6mm heel raisers weren't high enough. She did a series of measurements to determine it was actually an 11mm LLD, and heel raisers to that height certainly felt like I was walking on an even keel again.

My OS assures me he will be able to even things up with the 2nd THR, but I can't help wondering how realistic that is? How is that done in surgery?

Is it likely that the LLD becomes more marked over time with further deterioration?
Should I go see the podiatrist again just to check if the LLD is still 11mm or could it be determined by X-ray?

I have another question about any anaesthetics which could help with avoiding the awful nausea I experienced immediately post-op last time. I had Fentanyl last time, but was still very sick, despite assurance that nausea was less likely.

 

[Jaycey]

My OS assures me he will be able to even things up with the 2nd THR, but I can't help wondering how realistic that is?

If your OS says they can correct your LLD then just let him do his thing. My LLD was corrected with the second THR. Lots of stretching on that side and most of my post op pain was the muscles now being asked to work in a different way. Your OS will use your X-ray to measure any LLD - please don't worry.

I have another question about any anaesthetics which could help with avoiding the awful nausea I experienced immediately post-op last time.

Ask for anti-nausea meds before and after your op. I always take these as I tend to react to medication. Did you have general anaesthetic? A spinal and sedation is much easier to recover from and rarely results in nausea.

 

[Tiffany57]

Thanks for the reassurance, Jaycey
I did have general anaesthetic; they don't do spinal at this hospital as OS likes patients to get up within hours. ( I wasn't able to due to low blood pressure) I did have anti-nausea meds to no avail.
I will ask about Exparel, but it hadn't been approved for use in Australia a year ago.

 

[Miss Muffet]

Hi @Tiffany57 - I had spinal and sedation and was up on my feet within hours, and also had anti-nausea drugs which worked fine for me. I was nervous of spinal and sedation but am a total fan now. No grogginess, nausea or after effects but I know everyone is different. Do you have a date yet?
PS - I love your avatar

 

[Tiffany57]

21st November pending all clear tomorrow after stepping on a rusty nail a couple of weeks ago! For one night, my foot hurt so much it made my hip pain disappear completely! OS changed my anti-inflam meds from Celebrex to Arthrexin...I don't know if they are stronger, but hip pain has decreased so much that I keep thinking I really don't need this 2nd surgery!
I had spinal for a caesarean years ago...and threw up the entire time.....lol!



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[Tiffany57]

PS I will ask about spinal at my appointment tomorrow

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[Miss Muffet]

When my OS looked at the x-ray of both my hips he announced I'd need the second one done and could do this 3-6 months later. At the time I thought I'd defer that decision to go ahead. However, this OA thing bites - and hard - and once it sets in it doesn't give up, it only gets worse. He knew what he was looking at and was right on the button. I'm desperate to get my second one done (less than 2 weeks) and the pain seems to be increasing by the day.
Good luck at your appointment.

 

[sinijoma]

@Tiffany57. I had spinal and sedation, surgery started at 7:30 AM and I was on my feet walking the halls at 1:30. PM. By the time I was in my room after leaving post-op recovery, the spinal had completely worn off. No nausea. I did have some episodes of low blood pressure though.


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[Josephine]

Initially, a day or so after the first op. I was informed the LLD was 6mm....and that was only after I kept badgering on about how I felt there was a marked difference in length. He seemed to make a visual assessment by looking at how my ankle bones matched up when I'm laying down.
6 weeks later I went to a podiatrist for an accurate measurement, on my GP's advice, because I felt that 6mm heel raisers weren't high enough. She did a series of measurements to determine it was actually an 11mm LLD

Different methods of measuring produce different result. Mostly LLD pre-op is due to pelvic alignment rather than actual leg length. You should read this from the Forum Library - you'd be amazed at the stuff we have in there! Leg length differential - LLD

My OS assures me he will be able to even things up with the 2nd THR, but I can't help wondering how realistic that is? How is that done in surgery?

He checks on the xrays and by examining you if there is any genuine leg length differential. But since there usually isn't, he does check several times during the surgery that the legs are in good alignment, doing one final check when the op is finished and the dressings applied and just before you are woken up!

Is it likely that the LLD becomes more marked over time with further deterioration?

It will but it is most likely to be the apparent LLD, caused by you favouring one leg over the other.

 

[Tiffany57]

Thanks for the link Josephine. Reading through confirms that my LLD is real, not apparent...my OS measured by looking at my ankles as in Picture 1.
The podiatrist measured as described as being the only measurement to be totally accurate exactly as in the illustration. Actually she took those measurements 3 times to be sure and the result was the same each time ....11mm. She also made the heel raisers for me and watched my gait with them fitted.

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[mopster]

I had LLD diagnosed first about 8 yrs ago (no arthrosis of the joint then), at that time it was said to be 1,5cm (15mm!) - and I got those ridiculusly high heel raisers, which in hindsight was a clearly stupid solution to a questionable diagnosis (afterwards one alwys knows better...). I dumped these raiser about 8 months later since they were causing excrutiating pain in the sole of the corrected foot. Since I had no other troubles or pains, I thought "so... that went well" and did not think about it for several years.

8yrs later and 2 months prior to THR the LLD was re-measured by X-ray and manual diagnosis and said to be about 8mm to 10mm by all 3 OS I went to see before surgery. This means that after all of the cartilage was gone and I was bone on bone the LLD was LESS than as measured when all was "in order" within the joint. All three OS said that a LLD of about (+/-) 5mm is quite normal and is usually just ignored (not even corrected by heel raisers) if it's not causing any specific troubles.

I got 8mm heel raisers for 2 months pre-OP to check if a correction would affect the balance of pelvis and spine (which it didn't), so my "final" OS corrected most of the "leftover" LLD by using a 5mm offset implant, but of course the muscles are still misaligned after all these years and will need time to adjust - looking forward to rehab to start working on this.

 

[Tiffany57]

Hi mopster. That's quite a difference to go from 15mm to 8mm and then a 5mm correction in your THR! Interesting to hear that your 8mm raisers failed to balance pelvis and spine. I suppose everyone is different, but for me the 11mm raisers brought instant relief.
An update from my appointment today: The nail wound has healed with no sign of infection, so I'm set to proceed with LTHR on November 21st. Sent off for standing X-rays.....I asked which leg I should have straight and we went with the L un-op side, meaning that I had to bend my R knee to enable my L foot to be flat on the platform. The resultant X-ray showed a marked pelvis tilt. Next I was sent off for a CT scan to measure LLD, and the set of X-rays to make the implant.
I have a further appointment on November 7th to have a look at the results and compare to pre-op X-rays.
BTW, OS noted that Left hip is bone on bone, whereas a year ago it was only 'virtually' bone on bone.
Oddly, I have less pain with this hip ......but not complaining!

 

[mopster]

Hah - I put it wrong. The 8mm raisers were tested to check if the raise would cause problems in the lower spine or sacroilial joint (i.e. pain). And it didn't. So that was a good idea to do pre-OP. How it went from the 15mm diagnosis down to 8-10mm ... who knows? But the latter was surely a correct measurement.

Since the correction with raisers went well (no pain) - the surgeon was positive to go for the correction. I think, more than 5mm stem offset would have been overkill for my still slight degree of LLD and would also have required a modular stem/neck implant (mine is still monolithic with the 5mm offset) - but that's what I think by looking at my implants datasheets and by his assessment that from his perspective I'm now "corrected".

I was bone on bone (at least partially) and almost in no pain in the weeks pre OP - but just as long as I mostly abstained from activity. When moving around too much, usually pain came on.

 

[Tiffany57]

The CT scan LLD measurements hadn't been done at my appointment on Monday and I had to phone for them yesterday...well, it was certainly a surprise to learn that it's 20mm, not 11mm as I've been compensating for the past year! I think that may take some getting used to, but I'm looking forward to being able to walk barefoot again ♥
I didn't get to speak with my OS, only his receptionist, and I'm having a bit of a panic that I may not get to see him again til I'm prepped up on the trolley in 10 days!
My pre-op with the (same) anaesthetist revealed that I had been given Morphine last time (plus heaps of anti-nausea meds) So this time it'll just be Fentanyl and anti-nausea meds. He said it's often our female hormones that give us ladies the bad reaction. (My OS doesn't do spinal with THR)

 

[Tiffany57]

Quick update: 7 days post op and thrilled to say I am walking barefoot again at last!
Now to start my post op thread.....

 

[Miss Muffet]

That's great news - will look out for your postOp thread