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[REVISION THR] Constant pain continuing 1 year after THR<^

Marvy

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Hi All,
I had a Left THR (posterior) in November 2016. I know that my doctor said that it can take 6-12 months for the muscles and soft tissues to heal, I'm wondering if at this point mine ever will.

Also, unfortunately now, my operated leg is noticeably shorter than the non operated leg :sad: I have been to physical therapy and both they and my doctor said I should wear a heel lift in my shoes. I bought one that was 3/8" and I can tell that even though it helps somewhat, it is still not thick enough. If I stand barefoot, I can feel my hip tilt down on the left side. I can't wear any type of open shoe without the lift as I definitely limp, because of the leg length issue.

I have read on here where there is a real and perceived difference. My therapist said it was definitely real. My doctor seems to not care about it. I've been trying to do stretching and exercises to help strengthen my glutes and ab/ad-ductor muscles. I just don't think that the LLD is going to correct itself. I was very active before surgery and the LLD is really affecting me more than having the surgery itself.

At what point does LLD really become an issue where it should be corrected? I guess my question too is should it be corrected or is this just the way it is going to be from now on? Is there a certain measurement of discrepancy where it should be corrected?

Also, I still have a lot of pain on the side about 1 inch below my incision. There is a definite "bulge" on my thigh. My physical therapist was quite puzzled over this and really didn't know what it was. My doctor, just like with the LLD, doesn't seem to care. He said the implant looks good and doesn't really care about the tissue/muscle type concerns of mine. I'm thinking that the "bulge" on my thigh is around the bottom of where the stem would be, so XL1B/YL1B area? - not on the back of my leg, but just posterior to what would be the side-center of my thigh. Hope that makes sense? It is not red or discolored, it is just like a fluid-type bulge that is very sore - to the touch and I can't really lie down for very long on my side because of this. Does anyone have any ideas about this?

Thanks so much for reading!

 

Jaycey

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@Marvy Welcome to BoneSmart! Sorry you are struggling with LLD. I had this issue post my LTHR. It is frustrating!

I was told to wait 3-4 months before getting a lift. At that point I had a podiatrist measure me and I bought a lift. You are right, the LLD won't disappear this far out from surgery. But you can indeed get back to the activities you enjoyed before all this happened. I suggest you visit a good podiatrist, get measured and get their suggestions for a lift. I had one that I could even wear with sandals.

Unfortunately exercises and stretches won't correct this. My LLD was corrected when I had my second THR and this can only be done if the LLD is minimal.

Regarding your pain near your incision site, I'm going to tag @Josephine our medical expert to comment on this.
 

Josephine

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so this lump is about here then?

marvy.jpg


Do you have an xray you can post and/or a photo of this lump?
 
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Marvy

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Thanks @Josephine ! I don't have a photo - I can try and take one to see how it shows up. The tender area/lump is about 2-3" below the bottom of my bum (the horizontal line between W-X ). It's been there since surgery, but it isn't getting any better. My hip joint is fine when I walk, but this area, the more I walk, the more it seems to get irritated. Also, when walking up stairs, it is this area that I notice pain in - not the joint itself.

I've attached 2 x-rays - both were taken the same day March 10. The radiology report indicates that everything is OK and shows no sign of loosening.

I hope this helps!


hip2.jpg
hip3.jpg
 

Josephine

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Marvy

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Thank you @Josephine. It's frustrating that I never had any of these issues prior to surgery...Could the LLD have caused this (or at least was a factor in this?) I don't have any pain at the point of the hip. I've attached an image where the "area" is (the red circle)....the vertical line would be if someone drew a line down the center of my body..
 

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Josephine

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Could the LLD have caused this (or at least was a factor in this?) I don't have any pain at the point of the hip.
It's very common after major surgery on the leg. Most common after THR but no, neither the LLD nor the surgery is involved in this. Did you read the articles?
 

Clipper

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@Marvy - You didn't say what the LLD was. Mine is 2cm (about 3/4") and causes me to walk with an up/down, up/down gait if I don't wear an elevated shoe on my shorter right leg. Getting the soles on my right shoes lifted 2 cm (the whole length of the sole) has helped me level out my gait. I now religiously walk 2 miles every day without pain thanks largely to my modified shoes. If yours is only a quarter inch or so, a heel lift may be enough.

The other problem with LLD is it causes your pelvis and spine to tilt. The pelvis sits atop the femoral heads and will be level if both legs are the same length (both femoral heads at the same elevation). If one leg is shorter, the pelvis will tilt downward toward the shorter leg. My LLD of 2 cm causes my pelvis to tilt at 3.7 degrees from horizontal. This assumes my femoral heads are 12 " apart. Since I can't tell exactly how far apart they are, the distance might only be 10" apart which would mean the tilt is 4.5 degrees instead of 3.7. So the tilt lets say is about 4 degrees at an LLD of 2 cm. This pelvis tilt also causes the base of my spin to tilt at 4 degrees from vertical. I think these tilts over time have contributed to my hip joint wear and OA. Getting both sides of the pelvis at the same elevation by correcting the LLD has helped me.

Best of luck!
 
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Pumpkln

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Mavey,
Please post a photo of you standing, waist to floor, so we can see your LLD, and Josephine can have a look.
Thanks
 

Jamie

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How long have you been wearing the lift? If you've had it in your shoe pretty much from the beginning of your recovery, then it is possible that your pelvis didn't have time to adjust to your new hip. Have you had your other hip evaluated for arthritis? As Jaycey mentioned, many times both hips are arthritic and when the second one is replaced, alignment is restored.
 
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Marvy

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@Jamie I've been wearing the heel lift for about 1 1/2 weeks. My OS said that my other hip looks OK. I can ask him again, but when he looked at my x-rays, he never mentioned any surgery on the other hip was in the (near) future. I do not have any pain or symptoms in my right hip either (yet...?)

@Clipper I can't remember exactly what the LLD was, but I think he said it was a little more than 1/2". Like you, I feel as though I have that "up/down" pattern to my gait. Did your surgeon ever mention to you about doing a revision surgery to equal the leg lengths?

I will have to find someone to take a picture as I am by myself. I do know (don't know if this helps ) that if I lie down on the floor on my back with my knees bent, my left knee is noticeably lower than my right as in the attached picture (these are not my knees). My left knee is actually lower than the one in the image.
 

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Pumpkln

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Marvy,
Are you working with either a PT or a podiatrist for your LLD and gait training?
Together you should be able to find the appropriate lift for your LLD.
 
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Marvy

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@pumpkin, I'm not working with a PT currently as they discharged me saying I had improved enough that I did not need to keep coming back. They never even did any type of gait training or analysis either. Even though they mentioned a heel lift, they never said what size I should get. It was more of a casual conversation and "have you ever considered a heel lift?" vs. doing measurements, etc.

I will search out a podiatrist. Since I have never been to one, is there anything in particular I should look for in one?
Thanks!
 

Pumpkln

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For a podiatrist, ask your friends for a recommendation. When you call the offices tell them you have a LLD.

Try another PT office, tell them you have a LLD and want to be evaluated for a lift and receive gait training. Then ask to speak to a PT, interview them before choosing one.
 

Jamie

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Good suggestions from Pumpkln. Since you have had at least 4 months with no lift and your other hip is not a problem, then you need to do what is going to make you comfortable with your gait.
 

Clipper

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@Marvy - Before I had my shoes modified by a shoe repair shop, I bought a gizmo on-line called 'Evenup' which was recommended by my PT. It cost about $35 with shipping. I think it's made somewhere in Ga. It fits over your existing shoe and comes with a lift of 1/2", and 1" so you can try both. I have one on a pair of crocs I walk in every day. I use the 1" lift. It's been on my croc now for 6 months and still going strong. Before thinking about lifts, it would probably help to first now the magnitude of your LLD.

As Pumpkin and Jamie suggested, a podiatrist can measure it. Some PT's are also trained to measure LLD.

As far as revision surgery to fix my LLD, I would never consider it. My elevated shoes work just fine.

Best of luck!
 
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Marvy

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I know that everyone is different, but how long did it take anyone to be able to walk up stairs with alternating legs? I still am having issues going up stairs. It seems I have to hold on to the railing and almost pull myself up if I want to do alternating legs.

If I don't hold on to the railing, my left leg will almost give out on me. I'm not sure how much this has to do with the leg length discrepancy or if it is all just a strength issue as I cannot even step up onto a curb with my left leg. If I step up, my left leg wants to give out on me. :sad:
 

Clipper

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I had my last hip replaced November 14, 2016. I walk up and down stairs un aided without much problem. It's taken me time and effort to build my muscle strength after being crippled by OA for several years. I still do leg strength exercises every day along with walking (2 miles / day - 350 miles since Nov surgery). Building strength takes time, effort, and patience. Doing physical therapy increases muscle strength faster than not doing PT. So it will just take longer and more patience to regain your strength if you don't do PT exercises.

If you hold onto the stair rail for more than maintaining balance, it's probably a lack of muscle strength issue. If you started walking up and down stairs several times every other day or so, you would soon notice it gets easier as your muscle strength increases. Just my thoughts.

Best of luck!
 
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moodybluestoo

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Hi Marvy: I had a TRHR in May 2011 and had 4 complications, one of them being LLD of about 1 inch. It was too much of a difference to put a lift inside the shoe. I went to a shoe repair store and he was able to split the sole of a running shoe and add a piece into the sole and then put the bottom treads back on. It worked well and gave a lot of relief on my back and knees. Later that year I had to have a second surgery on the same hip to reattached the muscle that was pulled off during the first surgery, and occification removed , so he changed out the joint components and evened off the leg length so I no longer need the shoe. Good luck with finding a solution. Moody
 

Clipper

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@moodybluestoo - My LLD is 3/4" and I also had several shoe soles split and lift sections added as a sandwich. This has evened out my pelvis and gait and has made a big improvement in my life. Glad to hear you were able to get your LLD corrected. I'm OK with my situation now.
 

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