Hemi-Arthroplasty Lateral pelvic tilt and real LLD (7mm)

Age28March2022

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Today is exactly day 26 post surgery of my partial left hip replacement. I have been blessed with little pain and that's a good thing. Currently have slight lower back pain when I wake up but it only lasts for like 15 mins or so.



The only thing I have been told and bother me is that I have real LLD of 7mm, in which my OP leg is 7mm shorter than my good leg after surgery as confirmed by X-Ray. The femur bone (between my knee and hip) is 7mm shorter.



I have been told to use insole for the rest of my life as the bone won't grow anymore. I would like to know if 7mm is a huge discrepancy? I worry about barefoot walking on the beach and whether it would cause me back pain or hurt my good hip in the future if I don’t use insole? I have read all LLD thread in here and since most are apparent and not real LLD and the general consensus is to not wear insole for 3-4 months and see how it goes.



I told the ortho that I wanted both of my legs to be of same length before the surgery. He told me that this is the most he could do because there is so much you can lengthen due to the stretching of the nerve. Is he right about that?



Long story short, I had skiing accident in March 2021 with fractured femoral neck and had titanium rod inserted 24 hours later. The femoral head slowly deteriorated over time and was told to go for partial hip replacement in March 2022.



I have X-ray pictures right after my skiing accident and before the titanium rod insertion, and also the X-ray pictures before and after hip replacement surgery.



I don’t remember having LLD before my skiing accident. After the insertion of titanium rod in March 2021, I was good but with the deterioration of my femoral head my left leg became shorter (around 17mm) and walked with slight limp and now with hip replacement the surgeon lengthened it by around 10mm which makes it 7mm shorter than my good leg now.



Several questions
  1. Should I be wearing insole? And if I don’t wear insole, will lateral pelvis tilt hurt my good hip (right) and cause back pain in the future?
  2. Is 7mm of real LLD significant? I am short (5’4) by the way.
  3. Was my surgeon right about the nerve thing and that’s the most he could lengthen? Or a more experienced surgeon could make both of my legs the same length?


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@Age28March2022 Welcome to BoneSmart!
I would like to know if 7mm is a huge discrepancy?
No it is not. And in many cases this discrepancy eases as the pelvic area balances post op. I had a much larger LLD post LTHR and did wear a lift in the short side. But I waited 3-4 months before the LLD was confirmed. You might want to wait and see if this eases a bit.

I'll leave your guidelines for you.
Pain management and the pain chart
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Pain and swelling control: elevation can help
Using Ice

Recovery Aids
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Accepting Help
 
Thanks for replying.

Do you suggest I shouldn’t wear insole now and wait for 4 months and have it measured again?

In order to compensate for the LLD, I think my pelvic might tilt lower to the shorter side (in my case left lateral tilt) and it will cause undue stress on my spine at the back?
 
Do you suggest I shouldn’t wear insole now and wait for 4 months and have it measured again?
Yes, 3-4 months is the recommended time for things to balance. You may still have a slight LLD at that time. But in many cases the difference is so slight that no lift is needed.

We can't predict if the LLD will stress your spine. It's a "wait and see" scenario now.
 
Do you suggest I shouldn’t wear insole now and wait for 4 months and have it measured again?
Yes, 3-4 months is the recommended time for things to balance. You may still have a slight LLD at that time. But in many cases the difference is so slight that no lift is needed.

We can't predict if the LLD will stress your spine. It's a "wait and see" scenario now.
Thanks.

Even though it is totally opposite of what my surgeon said as he said my femur is 7mm shorter and bone won’t grow anymore.
I think you are right and I am hopeful I can become walk barefoot normal again. Will have x-ray check again in 4 months time.
 
:wave: and :welome: to the forum @Age28March2022

I'm sorry you had that traumatic accident and that the pinning attempt failed.

Hopefully now you are on the path to recovery.

One month out is still early days and though you are young, that poor hip has had a rough year.:sad:
It is going to take some time - once you are further along with healing and more mobile - to determine if many of these adjustments your body is going through are temporary (like the back aches) or requires some physical therapy or other intervention.

As Jaycey advised, let things settle before projecting too much.
Just walking, and not to excess, and resting, eating well, and lots of ice .... and lots of patience....will be your best tools to get back to an active pain-free life.

Hope you have a lovely day.
 
Last edited:
Just to add, according to my search,
Limb lengthening used to correct leg length discrepancy has a reported frequency of peripheral nerve complications that varies from 5% to 30%, but is probably underestimated.
Damage may be direct or be caused by overstretching of the nerves.


Your surgeon got a close up of your anatomy, so it sounds like he did as much as he felt he could do without risking nerve damage.
 
:wave: and :welome: to the forum @Age28March2022

I'm sorry you had that traumatic accident and that the pinning attempt failed.

Hopefully now you are on the path to recovery.

One month out is still early days and though you are young, that poor hip has had a rough year.:sad:
It is going to take some time one you are further along with healing and more mobile to determine if many of these adjustments your body is going through are temporary (like the back aches) or requires some physical therapy or other intervention.

As Jaycey advised, let things settle before projecting too much.
Just walking, and not too excess, and resting, eating well, and lots of ice .... and lots of patience....will be your best tools to get back to an active pain-free life.

Hope you have a lovely day.
Thank you Mojo33!

Yes it is still early days and I would let things settle and see how it goes in few months time .
 
Just to add, according to my search,
Limb lengthening used to correct leg length discrepancy has a reported frequency of peripheral nerve complications that varies from 5% to 30%, but is probably underestimated.
Damage may be direct or be caused by overstretching of the nerves.


Your surgeon got a close up of your anatomy, so it sounds like he did as much as he felt he could do without risking nerve damage.
I am just looking for second opinion here to confirm and it looks like my surgeon was right!
 
I am sorry you have had these problems, and wound up on this forum at such a young age. I hope you will enjoy a full recovery and be back to an active normal life soon.

I saw my physiotherapist three days ago and asked him to measure my legs, because I am planning to get new orthotic insoles made. By his measurement ( may not be totally accurate anyway), my right leg, which had THR three months ago, is 5 to 10 mm shorter than the left. Despite it feeling longer. It is understandable that it feels longer than the left, because it is longer than it was with the arthritis, and my body is still adjusting. The physiotherapist said that my right leg might still match the left, because it still has some swelling and stiffness at the moment, so as it loosens up with further recovery it may lengthen a bit.

That is why I am posting this here, because, if true, that would give you hope for some improvement still.

For me, taking this opinion, plus my surgeon’s assurance looking at the post-op X-ray that he had succeeded in matching lengths, plus what I read on the forum here somewhere that up to a centimetre isn’t noticeable, I am confident that LLD isn’t going to be a problem for me

I am still going to get orthotic insoles because my general alignment through the knees is out. I will wait another month in view of the comments above about 3 to 4 months.

In case you are dreading the possibility of orthotics, maybe I can offer some reassurance there. I have used them since my early thirties. Although walking without orthotics gives me sore toes, and may possibly contribute to other aches, I don’t have to wear orthotics all the time. I wear them for walking any serious distances, and for sport (back in my younger more active days). I go barefoot or in socks all the time in the house, and wear sandals and dressy shoes on occasion, without problems. Walking barefoot on the sand, ah, one of life’s joys, no problem. Maybe if that is something you do for major distances for fitness, you might find you want to wear the orthotics and therefore shoes, which would be annoying, but at 7 mm difference, I imagine you probably could get by barefoot. And since you are a bloke, I think at least the dressy shoe thing may not be an issue for you anyway!
 
@Klassy Thanks for your input.

The physiotherapist said that my right leg might still match the left, because it still has some swelling and stiffness at the moment, so as it loosens up with further recovery it may lengthen a bit.

Regarding lengthen a bit, was it the bone itself? Or will your pelvic tilt one side so your legs will be equal in length?

I don’t have to wear orthotics all the time. I wear them for walking any serious distances, and for sport (back in my younger more active days). I go barefoot or in socks all the time in the house, and wear sandals and dressy shoes on occasion, without problems.

Did you find it weird that since you didn’t wear the orthotics all the time and you could felt the difference in your gaits.

Yeah since I am at 7mm discrepancy, I hope I can stick to one, either insole all the time, or no insole at all. I am leaning towards the latter. I also hope it would lengthen like your physiotherapist mentioned since I still can feel the swelling and stiffness right now.
 
No, sorry, I it wasn’t that the bone would grow, but the connecting soft tissue being less tight so total length from hip to foot might increase. Having read back over your posts, I see that it is actually your femur length that is 7mm short. So what I said isn’t helpful, sorry. I hope things will still be Ok for you from under the 7mm not being noticeable.

I never notice an instant difference between orthotics in or out, and my orthotics have quite a pronounced slope to them. The difference comes from the accumulated strain of many hours walking out of alignment. I think it is one of those things that our minds ignore when we get used to it.
 
Just to add, according to my search,
Limb lengthening used to correct leg length discrepancy has a reported frequency of peripheral nerve complications that varies from 5% to 30%, but is probably underestimated.
Damage may be direct or be caused by overstretching of the nerves.


Your surgeon got a close up of your anatomy, so it sounds like he did as much as he felt he could do without risking nerve damage.
I am just looking for second opinion here to confirm and it looks like my surgeon was right!
I am 9 almost 10 weeks out now, and I am also a confirmed LLD case post THR. My surgeon also suggested to wait until the 3 month mark to re-measure and see how it measures then.
 
No, sorry, I it wasn’t that the bone would grow, but the connecting soft tissue being less tight so total length from hip to foot might increase. Having read back over your posts, I see that it is actually your femur length that is 7mm short. So what I said isn’t helpful, sorry. I hope things will still be Ok for you from under the 7mm not being noticeable.

I never notice an instant difference between orthotics in or out, and my orthotics have quite a pronounced slope to them. The difference comes from the accumulated strain of many hours walking out of alignment. I think it is one of those things that our minds ignore when we get used to it.

Yes when I am sitting I can see that my knees aren’t aligned and my OP leg is slightly shorter. Still hopeful that LLD will correct itself like what Jaycey said
 
I am 9 almost 10 weeks out now, and I am also a confirmed LLD case post THR. My surgeon also suggested to wait until the 3 month mark to re-measure and see how it measures then.

May I know how much discrepancy it is for your LLD?

If I understand correctly, you are not wearing any insole for now? You have around 3 weeks left until your next check-up. Hopefully you do not have to wear insole.
 
Mine was measured .5 of an inch or 12mm. I am in the process of setting up insoles, because I can't imagine that my body will adjust itself THAT much. I also have severe back pain at this point which is likely caused by the DDL.
 
Mine was measured .5 of an inch or 12mm. I am in the process of setting up insoles, because I can't imagine that my body will adjust itself THAT much. I also have severe back pain at this point which is likely caused by the DDL.

Hope it goes well for you once you have your next check up and the LLD corrects itself.

I actually had lower back pain the next day when I woke up if I was wearing 5mm insole. I have since removed the insole for few days and I woke up without any lower back pain anymore! Not sure if they are related but I will see how it goes.
 
That is great news! that is interesting how much this affects you physically doesnt it! I had to go back on pain medication because of the awful back pain I am having. Hoping I can the insoles soon.
 
I know your surgery is different than mine. I had an anterior hip replacement 2/7/2022. My surgeon measured a 2mm discrepancy. My In person PT measured 2.5 cm. This is not a typo. I do recognize the difference between bone and soft tissue! But the struggle is real. Doc says not to use orthotics yet. But indeed the strain on other parts back included is significant. The point I think that docs miss is the strain put on other parts of the anatomy. Tough situation
 
I know your surgery is different than mine. I had an anterior hip replacement 2/7/2022. My surgeon measured a 2mm discrepancy. My In person PT measured 2.5 cm. This is not a typo. I do recognize the difference between bone and soft tissue! But the struggle is real. Doc says not to use orthotics yet. But indeed the strain on other parts back included is significant. The point I think that docs miss is the strain put on other parts of the anatomy. Tough situation

That’s a huge discrepancy measured by 2 different persons! Both use x ray to check for LLD?
 

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