Leg discrepancy causing knee pain

[overthehill]

I wish I would have been more diligent about limping. I wish someone would have said something. If I would've used my shoe lift 100% I'd be ok, but I didn't know.

 

[Layla]

Please don't beat yourself up over any of that. You did what you felt was best at the time.

I'm really sorry you're feeling anxious and depressed. The possibility of a knee replacement hanging over you can feel overwhelming, especially when you're hoping other options will help. You don't have to figure this all out at once. You're doing the right thing by exploring options and taking it one step at a time. If it ends up that you do need a TKR you won't have to face it alone and I'm sure you'll do just fine. Personally, I felt all of the anxiety, worry and low mood that can precede joint replacement is worse than the procedure and recovery.
Be gentle with yourself, you're doing the best you can. Big hugs
@overthehill

 

[Legseleven]

I'm pretty sure it's from limping for 3 1/2 years due to left hip.

@overthehill I’m sorry you’re experiencing and struggling with all this, please don’t beat yourself up over this - cartilage also thins as we age - and we have no control over this, so it’s not necessarily from limping.
The fact that you’re not yet bone on bone is reassuring too. You’re doing really well, speaking up and getting opinions and options. It can all be incredibly daunting however if it eventually comes to pass, and it sounds like you’re not at this point yet, a good surgeon and a new knee can work wonders. Yes, it can be challenging at times but every day post op is a step nearer to a better knee, less pain and more normality and I can say this honestly as someone who is 9 weeks post revision TKR and doing well.
Please take it one step at a time as this will lessen the anxiety, and how lovely that you have a PT brother to help and advise. Wishing you well with your treatment plan, however if the anxiety and depression becomes overwhelming please see your GP about this.
We are all supporting you with this.

 

[EalingGran]

Have a look at my pilates teacher's free classes on YouTube. Google Katja pilates and they come up.
She has a short side lying glute strengthening one with no squats- for those with knee issues. I find this very helpful.
I have ongoing tendon/ ligament issues despite an overall good result from my PKR ( because my leg was very twisted/ valgus for too long before surgery). It is important to keep the leg muscles as strong as possible to support the problematic knee joint.

 

[overthehill]

Yes it is and I'm going to try.
Is the side exercise specific to your situation (knee) or do you know if regular glute exercises aren't good for thin cartiledge?
Thanks for you input and I wish you well.

 

[EalingGran]

This is a specific class for knees. Strengthening glutes would be good even if the cartilage is thin.
Strong muscles protect the knee joint.

 

[overthehill]

Thanks.

 

[spaniel]

Have a look at my pilates teacher's free classes on YouTube. Google Katja pilates and they come up.
She has a short side lying glute strengthening one with no squats- for those with knee issues. I find this very helpful.
I have ongoing tendon/ ligament issues despite an overall good result from my PKR ( because my leg was very twisted/ valgus for too long before surgery). It is important to keep the leg muscles as strong as possible to support the problematic knee joint.

I am going to look this up. I too have lld plus major recent fractures from a fall in May, I did get a specially made orthotic done by an incredibly dually licensed pt and pedorthist He studied my gait meticulously, But yes the lld did put stress on other knee. .

 

[overthehill]

Well it's been an upsetting and stressful couple weeks. Finding out that my left knee has been affected isn't good news. I thought I was good-to-go with my hip! What am I doing? I'm losing a few pounds (am overweight 15 lbs) going back to my knee PT and wearing my shoe lift all the time! I saw the prosthetics guy and he emphasized wearing the lift always and better shoes. I'm considering a "offloading" brace that I could wear at home. Has anyone done that?

 

[Layla]

Hi overthehill,
I'm sorry for the challenge you're facing and the emotional toll it's taking. Fifteen pounds certainly isn't an insurmountable goal. I wish you the best as you shed the weight you're targeting.

I'm considering a "offloading" brace that I could wear at home. Has anyone done that

I'm assuming you've discussed this with your OS or PT?

Try using the SEARCH feature at the top right of the page, typing in key words such as "offloading knee brace"
"unloader knee brace" and any threads where it's been mentioned will pop up for you thread through, if interested.

I hope you're able to put some of the stress aside for the weekend and take time for yourself, doing something you enjoy. Wishing you a peaceful, relaxing weekend...you deserve it!

 

[benne68]

I'm considering a "offloading" brace that I could wear at home

Please don't purchase something without discussing it thoroughly with your doctor and getting his specific recommendation.

There are a range of off-loader braces available and they can help some people who are awaiting surgery.

The problem with off-loader braces is that they are just a "band-aid" and cannot resolve the problems in your knee. In some cases, walking with them can impact soft tissues in your knee and leg that makes recovery more difficult.

 

[overthehill]

What about the prosthetic guy? He's trained and helped me a lot so far. Much more than the surgeons.

 

[overthehill]

Also, I think a big difference might be I have LLD and am working on re-aligning my hips, which had caused only the left knee to wear down right knee is 100% fine.

 

[benne68]

According to my research, LLD doesn't cause osteoarthritis. However, it can exacerbate existing OA, which is probably what has happened in your case. It's not at all unusual for someone to have OA in one knee, hip, shoulder or ankle and not anywhere else. We have lots of members who only needed one joint replaced.

Is your prosthetics person a physician? If so, by all means discuss this with him and see what his thoughts are.

Have you spoken with the surgeon about gel injections? Again, my research leads me to believe that it might help you since your knee still has some cartilage (which can respond to the hyaluronic acid injection). I would definitely try that before the brace.

Just remember: once OA starts in a joint, nothing will reverse it in that joint. The best you can hope for is to slow the process of deterioration.

I'm sorry you continue to struggle with this problem and hope you can find an answer soon.

 

[overthehill]

I'm trying to go after this from all angles. The surgeon didn't say I had OA, at all, before my THR so I think it came from LLD. I know I can't reverse but I'm definitely trying to slow it down. I am not up for a TKR - ever - so I will just be gutting it out. Thanks for helping me.

 

[Jamie]

I appreciate your desire to do anything possible to avoid a knee replacement. We all feel that way. But you need to look at your situation honestly. Even though no one has looked you in the eye and said, “You have osteoarthritis (OA),” the loss of cartilage indicates you do have it. It is a degenerative disease that will likely continue to get worse over time. The unknown is how much time the decline will take and whether or not there something in the meantime you can do to slow the progress or help with pain.

I know you’d like to pinpoint a specific thing that caused you to be where you are, but it was likely a series of things that led to your knee problems. When you have a bad hip, your body compensates as it worsens. That can result in a tilt to your hips and changes to your gait that puts stress on other joints - often those on the opposite side. When the hip is repaired, it immediately goes back to a normal alignment, but it takes time for your soft tissues to adjust.

For example, after my right hip was replaced I ended up with both a tilted and twisted lower spine for months. Something like that can require more therapy than most people imagine. My excellent surgeon was zero help when I saw him about my poor gait and pain a year after surgery. He also told me to get a lift. But that isn’t always the best answer. A pain management nurse practitioner finally diagnosed my twisted spine and it took about 9 months of consistent work with a great therapist to straighten my spine again, correct the tilt, and release the tight muscles in my right leg and lower back that were causing my discomfort and incorrect gait.

Please try not to look back at probably causes and focus on what to do going forward. At 70, you have many great years ahead of you. You’re lucky to have your step brother to help with therapy. Continue to get opinions from not only surgeons but also therapists and pain management specialists and try any of the non-surgical options that may give you some relief for a while. Some may help, others maybe not so much. The only bad thing with this approach is it can get expensive and it consumes a lot of physical time and mental effort. It can be exhausting to be focusing on a painful knee all the time. At some point, you likely will need to at least consider the option of either a partial (if the thinning cartilage is just in the medial compartment) or a full knee replacement. But if it comes to that, it just could be the answer that frees you enough to move forward with the active life you want to enjoy. So try not to completely rule out that option down the road.

 

[Legseleven]

I am not up for a TKR - ever - so I will just be gutting it out. Thanks for helping me.

There are so many different experiences on here which illustrate just how individual everyone’s body is: how it reacts and how it heals. Once we are becoming older and have joint pain, usually a sign of wear and tear there are no quick fixes.
Please keep an open mind as to the future in order to live as active a life as possible, which I know you want to do, as we all do.

At some point, you likely will need to at least consider the option of either a partial (if the thinning cartilage is just in the medial compartment) or a full knee replacement. But if it comes to that, it just could be the answer that frees you enough to move forward with the active life you want to enjoy. So try not to completely rule out that option down the road.

I had a partial left knee last year combined with arthroscopy, because we knew the cartilage was damaged and I wish I’d been offered a full knee replacement then as it was nothing but trouble, and got worse and worse so this year that’s what I had. Last year there was some cartilage, and when the different surgeon operated 11 months later there was zero!
I’m almost ten weeks post op and it’s already feels a lot better. That horrible bone on bone - with no cartilage - pain has gone. Yes it’s challenging in the immediate post op period but it’s temporary, whereas the bone on bone pain was getting worse and worse and would have been permanent.
I’m immensely positive about the future.
The good thing is you do appear to have options and family support. If it’s all becoming too much and making you too anxious, please talk it through with your GP.

 

[Layla]

Hello and Happy Sunday I hope you slept well and wish you a good day!

I had a hip replacement almost 4 years ago and ended up with a leg length discrepancy of 8mm. Now my opposite knee is hurting and I had it x-rayed yesterday and there is loss of joint space. I totally think it's because I walked with the LLD for a year before I got the right lifts - which I now have.

I'm sure you've done your share of research. I am wondering if you've read, or heard, that a 8mm is a small leg length discrepancy and it's actually quite common. A large part of the population have differences in the 5-9 mm range. Crazy, isn't it? 10mm and under, is considered mild, many have no symptoms and compensate naturally. You're not alone in this, but I know that's cold comfort. Your case matters because you're dealing with knee pain. Medial (inner) knee arthritis is extremely common even without a leg length discrepancy. Factors that can contribute are age, weight, genetics, and activity, to name a few.

A few questions, if your comfortable answering...
Wondering by who's recommendation you ended up seeing the prosthetic specialist? Has either your OS, or the second opinion OS suggested using a lift? I'd ask the OS if correcting the discrepancy with a lift will would help take some pressure off of your left knee, reducing stress and protecting it. Has either OS mentioned surgery?

I am curious about something, and please know I'm asking as a fellow member / forum mod because I truly want to understand and hopefully we can help? You seem very determined to avoid another surgery even if you find that the options you've mentioned, injections, shoe lift, unloader brace, etc. don't provide lasting relief. Is there something specific about having another surgery that makes it such a strong "NO" for you? Is it concerns about recovery, possible complications, pain, your previous recovery...or something else? There is nothing wrong with the desire to avoid surgery and I'm certainly not suggesting you should rush into a second joint replacement. Only trying to understand why surgery feels like such a hard line for you with the hopes others here can help find ways to address your concerns and possibly even alleviate some of the anxiety and depression this is causing you.
Please understand that we do care and we're here to help.

 

[EalingGran]

try any of the non-surgical options that may give you some relief for a while. Some may help, others maybe not so much. The only bad thing with this approach is it can get expensive and it consumes a lot of physical time and mental effort. It can be exhausting to be focusing on a painful knee

I would strongly agree with this. I spent a lot of money and time on orthotics/MBT sandals/ physiotherapy/osteopathy.
None of it worked and when I saw the extent of the damage to my knee, on the MRI it was not surprising.
I regret not having surgery sooner because although I have had an excellent outcome with my PKR -my MCL ( which is not replaced in either PKR or TKR) is overstretched beyond it's elastic limit. This means I still have some residual pain due to soft tissue issues. If I had had surgery sooner and straightened my leg earlier then my MCL would not have been permanently damaged.