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How many of you have a leg length discrepancy following THR?

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tooYoung4Hip

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OMG, I am soooo thrilled to have found this forum! I had a THR 8 weeks ago and now have a 3/4" difference in my leg lengths! This is causing all kinds of problems with my back and my gait. I just left the doctors office and he finally validated my concerns! As far as I am concerned, a heel lift is not an option. I am a young vibrant woman with lots of pretty dressy shoes that I am not about to give up! I do not understand why I should have to wear a heel lift now when I have never needed one before! Had I known the surgery would result in this difference, I would have postponed the surgery until I was much older! Has anyone discussed the results with an attorney?
 

Josephine

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Well, some things you need to consider first. And the first one is that when your hip gets to a condition where it needs replacing, then all the balance and structure of your pelvis goes out of sync. It adapts to the diseased joint and this often means the pelvis ends up tilted. The along comes the surgeon and restores it to a near normal anatomy, there is bound to be an apparent difference in length.

Has a surgeon or doctor actually measured your legs and discerned if this difference is real or apparent? And what does your surgeon have to say about it? I take it you have talked it over with him.

I'm so sorry this has happened to you. Such a sad outcome when you had such high expectations.
 

tooYoung4Hip

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Thanks for responding.
Actually, I was born with hip dysplasia that went undiagnosed until I was about 2. At that time, I had a pin placed in the joint and was immobilized for 9 months to allow the joint to heal. Since then, I have had some arthritic pain that has grown worse over the years. I had tried the cortisone shots but it seemed like I was just buying some time when there was a permanent solution. So we went ahead with the surgery, although I know regret that decision. My surgeon agreed today that there is an ACTUAL discrepancy as he measured from the 'trochanter' on each side and even showed my the xray. The difference is clear. I did not have a difference prior to the surgery and at no time was I informed that this was a possible result. Although I often walked with a limp due to pain, I personally don't feel that it was ever as prominent as it now is. Additionally, I never had back pain or knee pain and I am having those issues now as well. Sooo frustrating. I am happy to continue with Physical Therapy and hope that at 6 months, the difference will be negligible.
 

Josephine

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Oh dear! Then it looks like there are two options here - as you say, hope the PT will adjust it over time and/or live with it.

If the latter, you also have two choices - a revision and/or see an attorney.

I don't know of anyone else in here what has gone that route, not that springs to mind, anyway. See if anyone else chimes in.
 

ruthz

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Hi TooYoung4Hip:

I have worked with a pilates client who has a leg length discrepency following a total hip replacement - I believe it is about as much as your's is. She found that if she wore a lift in her casual shoes (she invested in a very good pair of sports type walking shoes) and wore those shoes most of the time, then she could wear her dressier shoes when she wanted to, with more success.

Another thing she says has really helped her is the work that is done on the pilates reformer. She feels it allows her pelvis to be as balanced as possible and gives her feedback on what correct alignment is for her in her situation. She's a real hard worker - always on time, never misses a session. She just last year walked a 1/2 marathon.

Take good care and please let me know if I can give you any more information about the pilates reformer work.

Ruth Z
bilateral hip resurfacing 4/6/06

(Oh, by the way I forgot to mention that when done with a trained physical therapist or certified pilates instructor under the direction of a physical therapist, it is possible to start doing the pilates reformer work soon after surgery. I began my out patient rehab on the reformer at 18 days post op)
 

mssully

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You may want to check what you signed before surgery. I had to sign something saying that there could be a difference in length after surgery.
 

2hips

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I learned something new in this thread. Didn't know that LLD can fix itself in time. I also just take for granted that with Hip replacement the Dr. would correct the LLD if there was one.
I complained of back pain way before surgery. My Dr. explained this pain was caused by the way I walked (limped actually). Dr. said after the surgery and pt I wouldn't have the back pain anymore.

One leg was an inch longer but my Dr. told me he would make sure both legs were even when he did the 2nd replacement and he did.

So if your Dr. left you with a LLD I hope that time and pt will help get everything even.

Deborah
 

Karen

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Not been on here in such a long while.

Some interesting reads recently but this one is very close to heart.

I too have a LLD since my last revision, approx 3/4" and the point of me responding to this thread is I too never wanted to hear this & don't really want that raise.

BUT I know it will be the best thing for me; I had trouble years ago before any of my ops when, as a teenager, I refused to wear my raise & as a consequence suffered so much with my back, neck & shoulders etc - I still have some difficulties today & I'm now 52! I never listened to my Physio then & should have! There is no way I want to start with back problems again - this last op has freed me from the severe hip pain I was having & its so nice to be pain free!

I think now more people look at me because I limp - if I didn't limp they would never really look at my shoe - they would have no reason to. I still need to use a stick outside but bought myself a funky looking thing (visit http://www.stickandcaneshop.co.uk)

Problem I have is that I am nealry 9 months post op & it's was clear at 6 months there was a difference and my OS advised a raise on my shoe on 23rd May this year. I am still awaiting referral to orthotics for this, nearly 3 months down the line! My OS knows I need a raise, my Physio does and I do too - BUT that's not good enough for the orthotics department; due to our new English NHS Patient Choice and filtering systems I have to be assessed by a Muteo Skeletal Podiatrist first!- it's so frustrating. I feel I am waisting so much NHS time, and it's obvious I will have to be referred to Orthotics (don't know what you feel about that Josephine?). I'm hoping that I'll get my raise soon, NHS will only provide 1 or 2 I expect. If I find that it helps I'm prepared to pay for any other shoes I would need - will just have to be sensible about it & be selective. I wouldn't want to be swapping from raise to no raise as I think it could be detromental, my spine would never know where it was.

Another post mentioned about Pilates - My PT referred me for this a long time ago AND IT IS REALLY HELPING. I have found that if I put a block under one foot, or under my knee if on all fours, my hip balance is much better & the moves become easier. Pilates is hard for me as my muscles are so weak due to years of bad use - it's coming very slowly. I honestly beleive that the raise will aslo help, I'll stop compensating & twisting my body.

Someone also mentioned about a Pilates Reformer - what's that?

PLEASE - if you know you need a raise, try not to be too vain, get get your shoe built up it'll be worth it. Sorry it's such a long post, but I felt I needed let you know how not wearing a raise can affect you; remember this is only my opinion, maybe Josephine would have the best advice.

I'm back at work part time, my reason for not getting on the forum so often, but will keep in touch now & again.

Karen 52 (4th revision)
 

ruthz

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Hi Karen:

The Pilates reformer is a standard piece of exercise equipment used in most Pilates studios here in the States. I am certified to guide clients through specific exercises on this piece of equipment. It consists of a carriage, with springs of varying tensions, a bar on which to place your feet or your hands according to the exercise, and long ropes with loops on the ends in which to place your feet or your hands, according to the exercise. The real beauty of this machine is that a lot of the exercises are done while lying on the carriage - so ... things like bad backs, knees, necks, hips, etc. can get a very good work out with safety built in. In my training, I can get a further certification in what's called "Special Populations" (ie. those people with injuries, other conditions, etc.) I'm sure if you do an internet search on "Pilates reformers" and "Pilates reformer exercises" you'll find some sites that show both. I know that my training organization, Stott Pilates, is based in Canada and has certified trainers all over the world. I hope this helps.

Take good care,
Ruth Z
bilateral hip resurfacing 4/6/06
 

dcdowden

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tooYoung,

I have now had both hips replaced and I don't seem to have a significant difference in leg length. Before the first surgery, I did have a discussion about that issue with my OS since he was explicit about stating that risk among others. He said that the length difference is more common with shorter women - under 5'2". I don't understand why exactly. I am a 6'4" man, so I was on the opposite end of the scale. After my first surgery, I talked to my OS about how weak my abductor muscles were even after six weeks of PT. He said that was very common given the trauma of the surgery. He also said that these weak abductors affect how people walk and often make them feel like they have a significant leg length difference. You might want to talk to your therapist about working the abductors more. I noticed how weak mine were when I tried doing leg lifts of my operated leg while lying on my opposite side - I think they call it side lying abduction. I could barely lift my leg up which surprised me because I had been doing standing abduction with resistance bands as well as abduction while lying on my back for a long time.
Good luck,
Doug
 

KKR1743

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I too ended up with between about 3/8 LLD. Unfortunately, I also have scoliosis and the leg length descrepancy is torture on the back. (It's the wrong leg to have long because it makes the curvature worse.) I have had physical therapy, but the best thing I did was purchase lifts for my shoe. I am correcting 1/4 inch, which seems to make it tolerable. Additionally, I find I can wear the lifts in most of my shoes without any problem. I tack them down with double sided carpet tape so they don't shift when I walk up or down hills.
I am now 5 months post op and finally feeling almost normal again. I still limp, but I think it's really more my back than my hip. I can now spend much longer on my feet than before the surgery. Even with the LLD and the need for a lift, although I would have prefered no LLD, I'll take it over the pre-surgery pain!
 

westexas

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Well I guess the guy upstairs answered some of my prayers. I am at 61/2 months and was getting very depressed and about to PM Josephine.
I have a 1/2 inch leg discrepancy that I just thought would disappear. And, believe me, I am doing PT and working that thigh muscle and all around it like crazy. My PT told me that by now, it should have become better but it has not.

I also have Scoliosis upper and lower. I finally realized that this is a bigger problem than expected. And yes, I am 50 and VAIN when it comes to shoes. But, I am limping so bad and just adding more pressure on the other arthritic hip with pain in my back, thigh and hips so two days ago I went to the shoe store where they are experts at lifts. It will be costly but I will not be able to tell much in the change and appearance of the shoes. They take the soles off, put in an insert and reattach the sole. I will know but no one else would really know. And, I cry at what I payed for all these shoes but it is either limp or walk normally.

As for my doctor, he is one of the best and did exactly what he needed to do. I am just one of the unfortunate ones to have all the other problems to go along with it. To regret the operation, no way....I would rather have a limp than not be able to walk at all.


One saving grace I hope, is that when I have the other hip replacement, things will hopefully even out...And there are the chances, it may not...I just have to be positive....Patty
 

Josephine

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Bless you, hun! It's one of those things folk have to endure sometimes. As you say, probably the lesser of two evils....
 

jessie

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I also have a 1" LLD. I'm going to have my work boots lifted (both) in order to add a rocker bottom to both. The rocker will go at the Trans-metatarsal toe break area of the shoes. (I'm a Paramedic) The rocker makes you stand with better posture and gives a normal gait even tho the sole is thick. I will have some beach shoes done the same way. You don't have to be limited to ugly shoes. There are many shoes that you can add inserts to. I wouldn't recommend just a heel lift. That puts too much pressure on your forefoot. Contact a Prosthetic/Orthotic company in your town or city. Just go talk to them and get ideas that you can present to your PT or PCP, who ever you see for prescriptive devices. I was once a Prosthetics/Orthotics dept head. Due to my active profession, I'm also going to have a hip support made. Look up Above Knee suspension devices. This only provides support but has a velcro band that can be tightened up. But that's just a plan for now. When I get this stuff done, I'll write back and give a thumbs up or down.
 

westexas

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Thanks for the reply as I have my 1/2 inch inserts in my tennis shoes. I wore them yesterday with my son through WallyMart and was so sore on the new hip side last nite. Plus the PT added exercises the day before. I'll ask her tomorrow what those two were and post on your gym thread. Now off for more school supplies.

Jessie,
Sewell(Judy) and I are still waiting your reply on the New Issues thread. As two 50 year olds, we want to know how you are bouncing back so quick...Let us hear from you...Patty
 

JudyS

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Hey Patty,
When I was first prescribed orthotics, I had a schedule for how long to wear them each day. Maybe that is why you hurt after wearing them the first day.

OK Jessie , what is the secret
Judy
 

1jt@atime

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Patty, Can I ask about what you had to pay to have the sole built up in a pair of shoes? My lld is now 28 mm which is down by 3 mm since my second knee replacement. 25 mm is an inch. I'm hesitant to invest in building up shoes because I'll most likely have my hip replaced in the about a year. Unfortunately, it's the hip with the long leg and I'm hoping my OS can make the leg shorter with this surgery. I'm worried though, since everyone talks about their legs getting longer but I think the OS can purposely make it shorter. For now, I use a heal lift and some felt that my OS gave me. I think it totals about 3/4 of an inch. Can't fit anymore in the shoe. I really need to break down and get a pair or two built up for now but I'm tired of doctors, doctors, doctors and just keep putting off making that call to the orthotics specialist.

I wear the Dansko shoes we've been talking about in the other thread and they have the hard, rocker type soles, sort of like Jamie mentioned. That's what I would have built up.
 

westexas

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Hey 1jt,

Well, the guy told me about $40 a pop....Remember, I like the QVC RYKA"S and I understand they have outlet malls all over the US. I also love my Clarks...And yes, they are all good shoes. It is killing me to know I need to fix them all but just like today, I have on my New Balance tennis shoes which the guy inserted a 1/2 inch lift Monday to try. They are a little looser since I wore them yesterday and this afternoon. I am not as sore. Been limping for so long now.....

But, bottom line, I do not go back to my OS until January. So, I have to do something now. I know that after I have the other hip replaced things will change and so will all the shoes. That is a LONG time until then...I do not want to limp....so I need to shut up and cough up the bucks to get me back to me....Patty
 

jessie

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OK, I have no good answer. I'll tell you this. When I was in the USAF, I was shot in the face from about 2' away, lost my right eye and have a bullet next to my brain. Went to Iraq for 17 months as a contractor (Paramedic) and flew all over the country taking care of 13 clinics throughout Iraq. Came home and damned if I didn't have a hemorrhagic stroke, (Sub-arachnoid hemorrhage) . That was in Oct '06. Started back to work in January and finally had to cry "Uncle" and underwent the THR. I have no reason to be walking or talking to begin with. I just wake up and am better than the day before. I should be off my cane in a day or so. I think it helps that I have a job that requires strength and agility. Lifting people all day makes for some rock hard quads. As any of my friends will tell you "that girl ain't right".
 

westexas

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O.K. then you need to start a thread on all you have been through girlfriend and let us be the judge of that. You sound like a tough cookie and as an American I am the first to say, YOU GO GIRL...We may not be in the shape you are but it is something to strive for. You just keep on inspiring all of us....Patty

By the way, we are on a CornBread kick on the other forum and you seem to be a good food critic....Chime in anytime...
 
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