myglasshalffull
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THR Balancing Exercise & Hip Health Prior to Revision Surgery
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I had my 6-week post-op right hip revision checkup with my surgeon Mr. Steele yesterday, and to be honest, it went beyond my wildest dreams.
He was very pleased with my progress, and lifted all restrictions. He was encouraged by my comprehensive indoor standing and floor exercise routine, as well as my indoor Zwift cycling. For my outdoor walking, the 1-mile cap and the requirement for poles are gone. He gave me the green light to tackle hills gradually as I see fit, and suggested introducing resistance bands to some of my indoor strength work.
The "Challenging" Left Hip What was especially heartening was his feedback on my left hip (which underwent a traumatic revision 8 months ago). No X-ray was taken yesterday, but he reviewed the one taken 6 weeks ago (the day after my right hip revision) and said it looked very good. I mentioned again that the recovery from that left revision had been challenging, to which he candidly replied that performing it had been challenging too—which means something coming from a high-volume revision surgeon.
The left hip has actually continued to gain function during my right hip's rehab over the last 6 weeks. It can now easily handle substantial reps of single-leg stance drills acting as the contralateral anchor leg—something that would have been impossible 6 or 7 weeks ago.
Future Road Cycling Goals Another big win was that he positively affirmed my plan to return to long-distance road cycling in Spring 2027. I asked if the long Stryker Restoration stem in my left hip might increase my fracture risk if I had a cycling fall, but he noted that a long stem can actually be protective by distributing the forces within the femur. Furthermore, he reassured me that from his extensive experience, a fall-mediated periprosthetic fracture tends more likely to be surgically manageable rather than catastrophic.
Navigating the 13mm LLD We did have to address the leg length discrepancy (LLD) he forewarned me about right after the right hip revision surgery 6 weeks ago. Yesterday he assessed it at 13mm, favoring the right leg (the LLD arose as a consequence of his prioritising the integrity of the right hip revision, and complicated by the early post op subsidence of the left hip’s revision stem). He gave me a temporary heel insert to wear until my next checkup six months hence. Interestingly, the insert immediately ameliorated the stubborn right glute ache I've been experiencing on outdoor walks since the right hip revision, so that is a huge plus. Because I hope to be hiking again soon, I have already purchased a Clearly Adjustable Leg Length Discrepancy Insole to use in my boots, hoping a full-length lift will minimize any foot-slant or altered gait over long distances.
I did point out to him that I was diagnosed with a 1cm LLD by a physio after my original 2002/2003 primaries; I was given a lift then, but ditched it almost immediately and walked with zero issues for 23 years. Additionally, when my left revision stem subsided by 1cm late last year, I still managed to build up to 10-mile hikes by March 2026 with no insert and no issues. I told him I hoped my body might naturally accommodate this current 13mm LLD over time without an insert again. He said that was possible, but by no means guaranteed. But to be completely frank, the insert instantly balances me out symmetrically when standing and walking right now.
A question re the LLD If I wear the insert/full-length lift insole continuously for the next six months, will that completely stop my body from even attempting to naturally accommodate the 13mm LLD over the long term?
Summing up Overall, it was a very encouraging checkup. My overwhelming feeling today is one of profound gratitude, and a sense that my life and athletic agency are being slowly reclaimed.
But regardless of the green lights, the old dictum still applies: slowly slowly catchy monkey!
PS the uploaded X-ray is dated 14 May 2026, the day after the right hip revision surgery. It is evident from the image that the right hip revision was significantly less complex then the left one.
He was very pleased with my progress, and lifted all restrictions. He was encouraged by my comprehensive indoor standing and floor exercise routine, as well as my indoor Zwift cycling. For my outdoor walking, the 1-mile cap and the requirement for poles are gone. He gave me the green light to tackle hills gradually as I see fit, and suggested introducing resistance bands to some of my indoor strength work.
The "Challenging" Left Hip What was especially heartening was his feedback on my left hip (which underwent a traumatic revision 8 months ago). No X-ray was taken yesterday, but he reviewed the one taken 6 weeks ago (the day after my right hip revision) and said it looked very good. I mentioned again that the recovery from that left revision had been challenging, to which he candidly replied that performing it had been challenging too—which means something coming from a high-volume revision surgeon.
The left hip has actually continued to gain function during my right hip's rehab over the last 6 weeks. It can now easily handle substantial reps of single-leg stance drills acting as the contralateral anchor leg—something that would have been impossible 6 or 7 weeks ago.
Future Road Cycling Goals Another big win was that he positively affirmed my plan to return to long-distance road cycling in Spring 2027. I asked if the long Stryker Restoration stem in my left hip might increase my fracture risk if I had a cycling fall, but he noted that a long stem can actually be protective by distributing the forces within the femur. Furthermore, he reassured me that from his extensive experience, a fall-mediated periprosthetic fracture tends more likely to be surgically manageable rather than catastrophic.
Navigating the 13mm LLD We did have to address the leg length discrepancy (LLD) he forewarned me about right after the right hip revision surgery 6 weeks ago. Yesterday he assessed it at 13mm, favoring the right leg (the LLD arose as a consequence of his prioritising the integrity of the right hip revision, and complicated by the early post op subsidence of the left hip’s revision stem). He gave me a temporary heel insert to wear until my next checkup six months hence. Interestingly, the insert immediately ameliorated the stubborn right glute ache I've been experiencing on outdoor walks since the right hip revision, so that is a huge plus. Because I hope to be hiking again soon, I have already purchased a Clearly Adjustable Leg Length Discrepancy Insole to use in my boots, hoping a full-length lift will minimize any foot-slant or altered gait over long distances.
I did point out to him that I was diagnosed with a 1cm LLD by a physio after my original 2002/2003 primaries; I was given a lift then, but ditched it almost immediately and walked with zero issues for 23 years. Additionally, when my left revision stem subsided by 1cm late last year, I still managed to build up to 10-mile hikes by March 2026 with no insert and no issues. I told him I hoped my body might naturally accommodate this current 13mm LLD over time without an insert again. He said that was possible, but by no means guaranteed. But to be completely frank, the insert instantly balances me out symmetrically when standing and walking right now.
A question re the LLD If I wear the insert/full-length lift insole continuously for the next six months, will that completely stop my body from even attempting to naturally accommodate the 13mm LLD over the long term?
Summing up Overall, it was a very encouraging checkup. My overwhelming feeling today is one of profound gratitude, and a sense that my life and athletic agency are being slowly reclaimed.
But regardless of the green lights, the old dictum still applies: slowly slowly catchy monkey!
PS the uploaded X-ray is dated 14 May 2026, the day after the right hip revision surgery. It is evident from the image that the right hip revision was significantly less complex then the left one.
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Thank you DEB!
As for many of us, it has been a bit of a trek to reach this far, and I'm well aware that my hips are both works in progress at the moment. But to mangle a phrase, travelling hopefully is as good as arriving!
As for many of us, it has been a bit of a trek to reach this far, and I'm well aware that my hips are both works in progress at the moment. But to mangle a phrase, travelling hopefully is as good as arriving!
@hipcycle Hopefully, at some time in the not so distant future, you will reach the milestone of doing something you truly enjoy - or just need to get done - and forget completely that the hips are not original equipment!
I remember that moment for me on my hip replacement journey (did both hips at once). I had to take my 2 big Maine Coon cats for a grooming session. Caught the smaller one and got her into her crate with no problem. But sister saw that process and fled. Chased her upstairs, into the guest room and saw her disappear under the bed. Had to get down onto my stomach, pull her out from under the bed, stand up carrying 20lbs of loudly protesting feline then carry her down my winding stair case. All while cat was wiggling, yowling, and me trying not to step on her tail. MCs are big - both heavy and long. She was about 5' from nose to tail tip and I'm only 5'1" tall. Got her into her crate and only then realized I'd done all of that without think of having had bilateral hip replacements. That episode was over 14 years ago and these days I rarely think of the hips at all ... until I sign in here
I remember that moment for me on my hip replacement journey (did both hips at once). I had to take my 2 big Maine Coon cats for a grooming session. Caught the smaller one and got her into her crate with no problem. But sister saw that process and fled. Chased her upstairs, into the guest room and saw her disappear under the bed. Had to get down onto my stomach, pull her out from under the bed, stand up carrying 20lbs of loudly protesting feline then carry her down my winding stair case. All while cat was wiggling, yowling, and me trying not to step on her tail. MCs are big - both heavy and long. She was about 5' from nose to tail tip and I'm only 5'1" tall. Got her into her crate and only then realized I'd done all of that without think of having had bilateral hip replacements. That episode was over 14 years ago and these days I rarely think of the hips at all ... until I sign in here
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myglasshalffull
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@hipcycle
Great update with your surgeon. Seems like you are on the right road to resuming all that you love.
Regarding the leg length difference mine adjusted itself after a few months. It wasn’t a huge issue but I knew my right leg seemed a little shorter after the surgery.
If the lift is helping your glute pain then I guess it’s good to have.
Keep up the great progress.
Great update with your surgeon. Seems like you are on the right road to resuming all that you love.
Regarding the leg length difference mine adjusted itself after a few months. It wasn’t a huge issue but I knew my right leg seemed a little shorter after the surgery.
If the lift is helping your glute pain then I guess it’s good to have.
Keep up the great progress.
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@myglasshalffull
Hi MGHF,
I was quite nervous going for the checkup, which I think is better than going in all gung-ho! But yes, it was a good checkup. I am however fully aware that there is still lots of healing to do, but the proof of that happening is my gradual progression in what I can do, BUT STILL BE MINDFUL OF NOT OVERDOING IT!!!!!!!!
Excellent to hear the feedback re your eventually resolved LLD, but as you suggest, if the heel lift is working for me at the moment, and I think it most definitely is, go with it. Before I started using the heel lift on Tuesday, a mile long walk with poles incurred not inconsiderable right hand side glute ache. With the heel lift, the ache is substantially reduced, and today for example, I walked 3.6 miles with no poles, and the only explanation I have for such a jump in distance in a matter of a few days is the heel lift.
Finally, hope all well with you!
Hi MGHF,
I was quite nervous going for the checkup, which I think is better than going in all gung-ho! But yes, it was a good checkup. I am however fully aware that there is still lots of healing to do, but the proof of that happening is my gradual progression in what I can do, BUT STILL BE MINDFUL OF NOT OVERDOING IT!!!!!!!!
Excellent to hear the feedback re your eventually resolved LLD, but as you suggest, if the heel lift is working for me at the moment, and I think it most definitely is, go with it. Before I started using the heel lift on Tuesday, a mile long walk with poles incurred not inconsiderable right hand side glute ache. With the heel lift, the ache is substantially reduced, and today for example, I walked 3.6 miles with no poles, and the only explanation I have for such a jump in distance in a matter of a few days is the heel lift.
Finally, hope all well with you!
Just a note of caution about using an insert this early in recovery: It can be counterproductive and actually delay your recovery.
Many of us experience what we perceive to be leg length difference after surgery. (I certainly did!) But it isn't actual LLD -- just soft tissues that are out of alignment from the many months of compensating for the bad hip. The sensation can take 5 to 6 months to resolve, but usually goes away on its own.
By using a lift too soon, you prevent the body from correcting itself. You should wait a minimum of six months to allow the body time to recover on its own.
I encourage you to read this educational article:
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@benne68
That is definitely much food for thought B68. When my then physio diagnosed my circa 10mm LLD post my primary THRs in 2003, I didn't feel lopsided then, hardly ever used the 10mm heel lift he gave me, and was fine for the next 23 years. Please note however that my surgeon back in 2003 never diagnosed me with an LLD himself, and this was purely a physio diagnosing it at a different hospital, his means of diagnosis being something I can't recall. Therefore, perhaps I should place less credence on that diagnosis than I have been doing recently.
However, this time, things are a bit different - I actually felt a bit lopsided without the heel lift when walking, before I was given the heel lift Tuesday. Plus there was the interminable rhs glute ache on walking, now much ameliorated with the lift, and my walking distance has increased from a grinding mile with poles last Sunday, to 3.6 miles without any walking aids today.
To recap, firstly there was the circa 11mm left revision stem subsidence that took place a few weeks after the left hip was revised end October 2025. My surgeon Mr Steele then was debating how to minimise LLD when revising my right hip. This revision of course was done 6 weeks ago, and a few hours after the surgery Mr Steele said he estimated a circa 10 to 15mm difference favouring the right leg, and stated he had made the decision to tolerate that rather than compromise the right hip revision by trying to eliminate LLD. Also, please note that he is very happy with my prostheses now, the left hip stem subsidence stable for 6 months, functioning extremely well, as is the just revised right hip ie there are no placement issues etc at all.
Also, to clarify, my surgeon estimated the LLD on Tuesday using the block method - placing wooden blocks under my short left leg's foot until the pelvis was palpably level (via manual palpation of the iliac crests) - this gave the estimated 13mm LLD figure.
So, I am still undecided as to the best course of action, but won't jump the gun just yet. Also, just arrived in the post is my new Clearly Adjustable Leg Length Discrepancy Insole, which could if I so desired dial down the level of lift as the months roll by, if my LLD happens to ameliorate of its own accord. I could also walk without any lift indoors or on shorter walks outside, to assess how I am getting on. And then of course see what Mr Steele says in 6 months' time also, when I see him next.
Any thoughts on all this would be greatly appreciated.
That is definitely much food for thought B68. When my then physio diagnosed my circa 10mm LLD post my primary THRs in 2003, I didn't feel lopsided then, hardly ever used the 10mm heel lift he gave me, and was fine for the next 23 years. Please note however that my surgeon back in 2003 never diagnosed me with an LLD himself, and this was purely a physio diagnosing it at a different hospital, his means of diagnosis being something I can't recall. Therefore, perhaps I should place less credence on that diagnosis than I have been doing recently.
However, this time, things are a bit different - I actually felt a bit lopsided without the heel lift when walking, before I was given the heel lift Tuesday. Plus there was the interminable rhs glute ache on walking, now much ameliorated with the lift, and my walking distance has increased from a grinding mile with poles last Sunday, to 3.6 miles without any walking aids today.
To recap, firstly there was the circa 11mm left revision stem subsidence that took place a few weeks after the left hip was revised end October 2025. My surgeon Mr Steele then was debating how to minimise LLD when revising my right hip. This revision of course was done 6 weeks ago, and a few hours after the surgery Mr Steele said he estimated a circa 10 to 15mm difference favouring the right leg, and stated he had made the decision to tolerate that rather than compromise the right hip revision by trying to eliminate LLD. Also, please note that he is very happy with my prostheses now, the left hip stem subsidence stable for 6 months, functioning extremely well, as is the just revised right hip ie there are no placement issues etc at all.
Also, to clarify, my surgeon estimated the LLD on Tuesday using the block method - placing wooden blocks under my short left leg's foot until the pelvis was palpably level (via manual palpation of the iliac crests) - this gave the estimated 13mm LLD figure.
So, I am still undecided as to the best course of action, but won't jump the gun just yet. Also, just arrived in the post is my new Clearly Adjustable Leg Length Discrepancy Insole, which could if I so desired dial down the level of lift as the months roll by, if my LLD happens to ameliorate of its own accord. I could also walk without any lift indoors or on shorter walks outside, to assess how I am getting on. And then of course see what Mr Steele says in 6 months' time also, when I see him next.
Any thoughts on all this would be greatly appreciated.
I'm sorry you are dealing with this concern, @hipcycle , but am glad you are relying on your surgeon rather than a physio for this diagnosis. Getting an accurate measurement can be difficult, but it sounds like he has used one of the most accurate approaches.
If he is recommending using the lift, I would follow his instructions. If not, do keep in mind that soft tissues take 12 weeks to recover from the trauma of surgery, so you might want to give things a little more time.
Please keep us posted on what you decide and how you are feeling as your recovery progresses. Your story will be most helpful to other members since LLD is an concern that comes up often.
I hope you don't mind me adding the following information to your thread, but I thought it might be helpful for other BoneSmart members who are reading here because they are concerned about LLD.
What is Leg Length Discrepancy?
LLD is having one leg longer than the other. Mild discrepancies are extremely common. In fact, studies suggest that only 10% of the population has exactly equal lower limb lengths. For most people, LLD is congenital and the discrepancy is 10mm or less, which is usually well tolerated -- and often unnoticed. LLD can also be the result of trauma to the bones -- like a fracture, surgery or bone disease.
Perceived LLD vs Actual LLD
Many THR patients experience perceived leg length differences after surgery. But it isn't actual LLD -- just soft tissues that are out of alignment from compensating for the bad hip. The sensation can take 5 to 6 months to resolve, but usually goes away on its own.
When is LLD a problem?
The differences in leg length can range from a fraction of an inch to several inches. The greater the difference, the more likely it is that the person will experience issues with gait, posture, and pain. There seems to be a consensus if the discrepancy is greater than 20mm, intervention is needed.
How it is properly measured:
It's best to have a qualified doctor (rather than a physical therapist) diagnose leg length discrepancy. It is assessed, using a tape to measure the lengths of both legs either:
- True Leg Length: Measured from the anterior superior iliac spine to the medial malleolus.
- Functional (Apparent ) Leg Length: Measured from the umbilicus to the medial malleolus, which accounts for pelvic alignment.
- Often, standing X-rays are used for the most accurate comparison.
If he is recommending using the lift, I would follow his instructions. If not, do keep in mind that soft tissues take 12 weeks to recover from the trauma of surgery, so you might want to give things a little more time.
Please keep us posted on what you decide and how you are feeling as your recovery progresses. Your story will be most helpful to other members since LLD is an concern that comes up often.
I hope you don't mind me adding the following information to your thread, but I thought it might be helpful for other BoneSmart members who are reading here because they are concerned about LLD.
What is Leg Length Discrepancy?
LLD is having one leg longer than the other. Mild discrepancies are extremely common. In fact, studies suggest that only 10% of the population has exactly equal lower limb lengths. For most people, LLD is congenital and the discrepancy is 10mm or less, which is usually well tolerated -- and often unnoticed. LLD can also be the result of trauma to the bones -- like a fracture, surgery or bone disease.
Perceived LLD vs Actual LLD
Many THR patients experience perceived leg length differences after surgery. But it isn't actual LLD -- just soft tissues that are out of alignment from compensating for the bad hip. The sensation can take 5 to 6 months to resolve, but usually goes away on its own.
When is LLD a problem?
The differences in leg length can range from a fraction of an inch to several inches. The greater the difference, the more likely it is that the person will experience issues with gait, posture, and pain. There seems to be a consensus if the discrepancy is greater than 20mm, intervention is needed.
How it is properly measured:
It's best to have a qualified doctor (rather than a physical therapist) diagnose leg length discrepancy. It is assessed, using a tape to measure the lengths of both legs either:
- True Leg Length: Measured from the anterior superior iliac spine to the medial malleolus.
- Functional (Apparent ) Leg Length: Measured from the umbilicus to the medial malleolus, which accounts for pelvic alignment.
- Often, standing X-rays are used for the most accurate comparison.
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@benne68
Thanks very much for that B68. I think what differentiates me is the 11mm left hip revision stem subsidence, which has now followed through post the right hip revision, as a consequence of my surgeon prioritising structural integrity re the right hip revision rather than LLD resolution. Whether I want my spine/pelvis etc to accommodate that, or even the 13mm my surgeon measured Tuesday is the question really, because that actual LLD is hip/prosthesis mediated, and not going away.
Also, where I had the surgeries is a centre of excellence orthopaedic hospital, and my surgeon a high volume THR and THR Revision specialist, so I am minded to follow his guidance in the end analysis. And as an aside, with the heel lift, i have walked 6 miles today with no poles, whilst as recently as Monday before receiving the lift, I was struggling to walk a mile, with poles, before the right hand side glute pain became too bothersome.
But even saying that, you have as I said provided much food for thought! And yes, appending the information is no issue at all
Thanks very much for that B68. I think what differentiates me is the 11mm left hip revision stem subsidence, which has now followed through post the right hip revision, as a consequence of my surgeon prioritising structural integrity re the right hip revision rather than LLD resolution. Whether I want my spine/pelvis etc to accommodate that, or even the 13mm my surgeon measured Tuesday is the question really, because that actual LLD is hip/prosthesis mediated, and not going away.
Also, where I had the surgeries is a centre of excellence orthopaedic hospital, and my surgeon a high volume THR and THR Revision specialist, so I am minded to follow his guidance in the end analysis. And as an aside, with the heel lift, i have walked 6 miles today with no poles, whilst as recently as Monday before receiving the lift, I was struggling to walk a mile, with poles, before the right hand side glute pain became too bothersome.
But even saying that, you have as I said provided much food for thought! And yes, appending the information is no issue at all
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@Legseleven
Thank you very much for that L11, and yes, I have great confidence in my surgeon and his team, having been a patient of the hospital for 26 years now - showing my age!
When I was forewarned of the perhaps possible LLD even months before the right hip revision 6 weeks ago, it filled me with trepidation, but to be honest, once i have started to use the heel lift, and that only since Tuesday, it is starting to look like very much less of a big deal, especially with my daily walking distance having nearly sextupled since Monday, the lift having been given me Tuesday. Doesn't absolutely prove anything, but it does seem pretty convincing to me that the heel lift plays a major part in this.
Thanks again
Thank you very much for that L11, and yes, I have great confidence in my surgeon and his team, having been a patient of the hospital for 26 years now - showing my age!
When I was forewarned of the perhaps possible LLD even months before the right hip revision 6 weeks ago, it filled me with trepidation, but to be honest, once i have started to use the heel lift, and that only since Tuesday, it is starting to look like very much less of a big deal, especially with my daily walking distance having nearly sextupled since Monday, the lift having been given me Tuesday. Doesn't absolutely prove anything, but it does seem pretty convincing to me that the heel lift plays a major part in this.
Thanks again
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@myglasshalffull
Absolutely MGHF, especially when the confidence is well-earned.
As to listening to my own body, I have been pleasantly surprised by how attentive I have been this time around, so far at least, as if fitted with some miraculous body hearing aid!!!
Thank you!!!!!
Absolutely MGHF, especially when the confidence is well-earned.
As to listening to my own body, I have been pleasantly surprised by how attentive I have been this time around, so far at least, as if fitted with some miraculous body hearing aid!!!
Thank you!!!!!
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The great thing about experiencing the replacement and getting through recovery for any of us is the ability to know when we need to take a break, ice, chill then continue on our recovery path. Took me awhile but even now there are days when I decide it’s a “chill” day in more ways than one!
Continued good wishes.
Continued good wishes.
