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

Discussion in 'Hip Replacement Recovery Area' started by phoggie, Apr 11, 2008.

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  1. Tommy Utah

    Tommy Utah member

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    Here's the other thing, I find myself favoring standing on the leg with the new hip, and to stand much taller/straighter on that leg. It is almost a reflex I cannot help???!!?!?
     
  2. rejoyce318

    rejoyce318 member

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    Questions about tilted pelvis & LLD: Does the tilted pelvis eventually correct itself once an LLD has been corrected? If so, how do I speed the wheels of progress, so to speak - stretching? core strengthening? strengthening/improving hip stability in operated leg? Keep using the cane?

    I don't see the OS again till end of Jan. - PTs have been telling me that OSs often prefer post-surgical issues to self-correct as much as possible before prescribing lifts, etc.

    I saw the tilted pelvis in the x-ray from my post-surgery appt. @ 3 weeks, but didn't ask the OS because I wasn't sure I wanted to hear the answer. I also still seem to have an LLD in the operated leg - but it didn't feel that way right after surgery, it felt EVEN for the first time in my life.
    SIGH.

    Joyce
     
  3. JudyS

    JudyS alpha

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    Joyce I would call my surgeon's office. Or with me I ususally just go in. I have seen my surgeon enough that yesterday he said I should have a reserved seat in the waiting room.
    I am also seeing a spine doc in the same office.
    I don't like wondering what to do and waiting so long. He or she may tell you to wait longer, but at least you know!!
    Judy
     
  4. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Why not try Pilates? That's pretty good for adjusting the balance.
     
  5. MsSplenda56

    MsSplenda56 member

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    Hello Everyone,

    I was seen by my surgeon yesterday. He went over the scan-o-gram with me. He pointed out the difference in leg length and showed me the 0.5 cm. (It feels like more than this to me) I stood up and he immediately noticed the pelvic tilt. He continued by saying he thought it would have cleared up by now and was hopeful that it would. He wanted to give an injection for the pain but I told him about acupuncture and wanted to continue this way. He approved by saying he had been in a bad accident and paralyzed on his right side. He couldn’t move his arm or hand until a friend recommended acupuncture only after a few treatments he was able to use his hand again and the pain is gone. He didn’t believe in it before but he does now and thinks it is a good thing for me. He also wants me to ride my bike and walk more to build muscles. He wants to re-check me in six months.

    Happy Tuesday!

    Shirley
     
  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Wow! an enlightened surgeon. That's unique!
     
  7. KKR1743

    KKR1743 new member

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    Shirley -
    You are blessed to have such a thoughful surgeon! My discrepancy is about 3/8 to 1/2 inch or about 1 cm. (Double yours!) This was diagnosed by my physical therapist. My surgeon says it was always that way and his technique was perfect. My closet full of pants say otherwise! Anyway, he nearly threw the xrays at me and told me to get another opinion.
    I am now six months into healing and even with a lift in my shoe, I am not comfortable. The descrepancy is taking a toll on my knee because I am not walking correctly...still. I am still limping because it still hurts.

    If the length still bothers you, a lift in the shoe makes a tremendous difference. It's amazing what even a half a cm will make!
     
  8. westexas

    westexas graduate

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    Just wanted to let everyone know....I head back to my OS tomorrow after 81/2 months and we will discuss the 1/2 inch leg length discrepancy...I will let everyone know what I find out....I too...at 50 do not want to limp forever...Patty
     
  9. MsSplenda56

    MsSplenda56 member

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    Hello Everyone,

    I am still in so much pain after having acupuncture for 11 weeks. I am unable to walk long distances before I began to feel the sciatic nerve. I faxed my surgeon asking several questions with hope of his responding. In the mean time I had an appointment with my neurologist who I forgot to tell about the LLD. He listens and gave me a strength test. He had ordered a MRI of my lower back in August which showed no changes since the last MRI in 2004. He told me he was sorry he couldn’t help me because all my problems are coming from the LLD. I told him how the surgeon wasn’t a communicator; and not responding to me. I had sent him a fax on October 15 with questions and concerns it was Monday, October 20. He told me to move on… Get another doctor to look at you if you keep going like this you will have to have back surgery. I called the formal OS office speaking to the office manager I told her I how frustrated I was and I wasn't going to pay the OS and beg him to take care of me. I told her of the fax send on October 15 and it's now October 20 and I haven't heard from him. She told me she would call me back as soon as she found my fax. She found my fax and my file on the surgeon desk scheduling me for an injection without answering my questions or contacting me. She told they had a new person on their team that takes care of these problems. Did I want to go through with it? I told her I would call her back. I did and told her thanks but not thanks!
    I called my primary care doctor and told him of my frustration; he told me he didn’t know what happened with the surgeon he had recommended because he had other patients to go to him and everything was find; when all I have is problems. He gave me a referral to two other OS’s I could make a choice of which one I would go to. When I called the former OS office manager and told her where to send my file she asked if she could make a recommendation. She recommended a doctor she once worked with and highly recommended. So I didn’t go with the doctors my PCP recommended; I decided to take it from a woman’s point of view. She gave me the office manager’s number and told me to requests an appointment as soon as possible. I did! I will be seen by the new OS on Monday. NO MORE SURGERY! NO WAY! NO HOW!

    If I had to do this all over again, I would do more research on the surgeon. It will be one year on November 8 and I have not enjoyed my new hip yet. I am in pain the majority of the time due to the LLD.

    I will post again after my appointment; if any of you can avoid what I have gone through is my reason for keeping you informed.

    Josephine: Do you know what was done to cause a pelvis tilt?

    Happy Friday!
    Shirley aka MsSplenda56
     
  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    You do seem to be getting the run around, Shirley. I feel for you! However, I doubt the solution to this problem is going to be achieved by anything less than a revision, so far as I can see. I know that's not what you want to hear but it's a fact, nonetheless.

    As far as the pelvic tilt is concerned, it depends upon the angle.

    Side tilts are caused by leg length discrepancy (surprise, surprise!) but also by an imbalance in the strength of the muscles bewteen one side and the other or a sideways deformity of the lumbar spine.

    ai33.tinypic.com_2rmuu0o.jpg



    Anterior tilts are usually caused by an abnormal curvature of the lumbar spine that puts the body in a kind of 'bum out, tummy out' kind of position otherwise known as lordosis. In women this can often be started during pregnancy but can also be caused by obesity and an imbalance of strength
    muscles such as the psoas.

    awww.t_nation.com_img_photos_07_135_training_image025.gif
     
  11. MsSplenda56

    MsSplenda56 member

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    Josephine,

    What is the recovery time for a revision?

    Can the less minimum invasive procedure be used on a revision?

    You mentioned muscles imbalance on one side or the other. I have had the following surgeries:

    2/10/04 Gastric bypass--procedure performed (Roux-en-y laparoscopically) Gall bladder also removed during this procedure due to gall stones. Maintaining a 120 lbs weight loss
    •9/19/06 Uterine Fibroid Embolization (UFE)
    •9/8/06 Hernia Repair (open) Emergency in nature

    9/28/06 Infected in Hospital with Clostridium Difficile Colitis (C-Diff) total of 20 days hospitalized

    I have always been a walker; before I hip surgery walking 25/30 miles a week.

    Would these surgeries have a factor with the muscle imbalance?

    By the way I am 57 years old.

    Happy Friday!
    MsSplenda56
     
  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Roughly the same as with a primary THR.


    Fraid not - would be totally impossible to do.


    I wouldn't have thought so. Tends to be on account of something like a diseased joint, such a hip or a knee or even a foot problem, a spinal deformity or even just long term low back pain. In fact, anything that causes the person to walk with an unbalanced stature.

    But you asked me what causes pelvic tilt, in answering I wasn't infering that any of these are the issue in your case.


     
  13. westexas

    westexas graduate

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    Jo and Shirley,
    Went to my OS last Tuesday and came back just as frustrated as before. His righthand nurse got married the weekend before and was on her honeymoon. Mr. Nurse substitute was an idiot and had nothing straight in my file. The doctor came in and discussed my MRI on the new hip and the knee problem. He said it was the Patella???that was bothering me. And, any more questions...I was not happy at this point. The 1/2 inch LLD and what to do about it. Get lifts and walk a lot for the atrophy in my muscles. I kept my cool and said, I do not want to limp the rest of my life. I am only 50. He said it would be corrected when I have the other hip replaced. I then brought up that issue. He wanted to see me in 6 months but finally something got through to him. He said, your arthritis has really come on strong in your other hip from what I can gather. We will discuss this extensively in January. So, on my own, I too feel like having the Scoliosis and presuming a tilted pelvis has contributed to the leg being longer and what if my other hip had been just fine...What then..... I will be interested to hear how TommyUtah fairs with the second one and the LLD he had previously.
    Shirley, I know how you feel....It is extremely depressing and frustrating. I cannot wait to e-mail the OS's nurse about all this..She should be back in the office tomorrow...Until then....Patty
     
  14. JudyS

    JudyS alpha

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    Patty,
    I am sorry this was so frustrating for you. Kind of like my back for me. I feel the scoliosis has to be playing a huge part. Doc says it is not enough to be causing symptoms. My herniations in my thoracic spine he thinks are also not enough to be causing symptoms. I am getting epidural injections on Wed. and he did say he will have to burn the nerves if it doesn't work. Yesterday on my hike I took a percocet when it started bothering me. Then 2 hours later followed it with vicodin as the week before I was in agony hiking down.

    My right knee has chondromalacia grade 4 (which is the end stage). I have had 4 of the 5 hyalgan injections. No difference. Hurts going up or down, hurts riding a stationary bike. I am sure the left knee has the same. Some steps are excrutiating. My hip doc, who is treating me, said the next step will be arthroscopic surgery to see what else may be going on. He will release some tissue, wash it out and do microfracture. He said he would put me in a cast for 6-8 weeks, then rehab.
    I see him tomorrow am and will ask if the cast conversation was real or he was teasing me. I am thinkiing with a cast on my right knee, I will not be able to drive or walk. My muscles are still atrophied on that side, not a good thing.

    Back to you. You have to travel so far. I would be ready to scream at that doc. Did he actually measure or compare your legs? How about going to a foot doc to get his opinion on getting orthotics?
    These bodies are too challenging .
    Judy
     
  15. westexas

    westexas graduate

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    Judy,
    He just did not seem to think the LLD was any big deal. At 50 that is a big deal..I have 1/2 inch lifts in my tennis shoes from the PT and orthotist measuring me a month or so ago. I will choose the shoes I will be wearing a lot like with jeans or warmups to have the lifts done. Just more $$$$...whatever.....

    Ouch on your knee....What part of the knee is that?
     
  16. JudyS

    JudyS alpha

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    Patty,
    That is the patella or kneecap. I asked him if he could replace the pattelo-femoral part . He said that replacemnet is not for active people. He said it is not as sturdy as a hip and it would possibly become loose in a short time and I would be in trouble. He did not think I would be happy with a total knee.,
    Judy
     
  17. westexas

    westexas graduate

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    Judy,
    As I said on the other thread, you try to make one joint stronger while damaging another and that would be our knees....And, no I do not wish a TKR on anyone unless all is bad and no cures.....
     
  18. MsSplenda56

    MsSplenda56 member

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    But you asked me what causes pelvic tilt, in answering I wasn't infering that any of these are the issue in your case.

    Jo, I asked that question because of the chiorpractor and acunpturist seemed to think this was the issue. The chiorpractor did tell me I had a functional LLD on the left side. The THR is on the right side. I will post after my appointment on tomorrow.

    Thanks for all your help! No revision! Emotionally not ready for another surgery.

    Happy Sunday!
    MsSplenda56
     
  19. MsSplenda56

    MsSplenda56 member

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    Good Morning Everyone,

    I was seen by the new OS on yesterday he did the following:

    Watched me walk
    Lie down and sit down to see the leg length difference
    If your turn your point finger to the side this is the amount of the LLD
    (This is good news for me because it started out ¾)
    Looked at the surgical site


    • He said the following:
    • Surgery may or may not correct the problem
    • If I had surgery and he replaced the stem it is subject to cause dislocation
    • Put a lift on the outside of the shoe
    • The surgeries I had did not affect the imbalance
    • I probably won’t be able to walk the way I use too
    • I can ride my stationery bike, and walk on the treadmill all I want
    • Do not jump on my trampoline
    • He ordered X-rays of the spine and hip
    • I will see him again with the X-rays on November 20
    • He ordered PT only because I asked because the acupuncturist made the request
    I like this guy I had a paper in my hand with 11 questions; he said let me answer your questions. I am pleased! He is handsome and young with a good sense of humor. I called my formal OS Office Manager and thanked her for the referral.

    Happy Tuesday!

    MsSplenda56
     
  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Great news, MsSplenda. Bet you're a much happier bunny today!
     
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