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Leg length discrepancy w/ TKR

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KneedItReplaced

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TKR on 5-5-09. Less than 24 hrs after discharge in ER w/ infection. I still have severe pain in that one area (right side of knee) during exercises (extension) and w/ extending knee as I put full weight on leg as I walk.
Today my physical therapist said I was still not walking well enough. I was so disappointed, as I thought it was so much better than it had been. As P.T. closely attempted to help me correct it, she became concerned and took another look at my leg lengths. (Even though I mentioned it before, it was now highly visible.) My left leg (TKR leg) is much longer than right! Never was before! I can not find any info anywhere on internet about this!
Does anyone know what might be going on?!
 
Actually I have but only in the hip. Not saying there are none. I just havent seen them. How is your other leg? Well if you had an infection, I would think it might take a bit longer to recover. That is awful. Glad they caught it and its being treated. I will ck online and here if I come up with anything I will post it...Hope you feel better soon........It will work out for the better and this will just make you stronger.......hang in there. Post any other questions you might have. Take care...
 
Welcome to BoneSmart, Kneed. We're glad you found us. Our forum nurse, Josephine, will check in soon and should have some comments from a medical perspective.

You have certainly been through a LOT in such a short period of time. You mention things said by your PT, but have you talked with your surgeon about your pain and your feeling that one leg is longer than the other? If not, you need to! It is a very tricky thing to measure leg length. Not knocking your therapist, but you need confirmation of that fact from your doctor.

I am more interested in hearing what happened after your ER visit for an infection. Did you see your surgeon then? What was done to ensure this is cleared up?

Please try and be calm. We'll be here to support you as you work through your issues. Jo has over 50 years of orthopedic nursing experience and she will be able to offer excellent advice about what you should do. She is in Great Britain, so with the time difference, she's asleep right now. But she will be online soon.

In the meantime, take your pain medication, ice and elevate your knee and I hope things will improve for you soon. You are early in the recovery process and it is quite normal to experience some pain during this time while your knee heals itself.
 
I'm a hip and when the Os measured my leg lengths it was clear that i was even....however when I bend my legs up (eg when I'm lying on my back) my right knee is significantly higher than the left.....I'm not sure why this is the case, but for me its the total leg length that makes the difference....

Is it your whole leg length thats the problem, or just one section (eg femur length or tibia length?)
Rachel
 
Quite a few issues you've touched on there, Kneedit. And too little information to be able to comment upon any of them!

As for the LLD, were your legs bowed inwards or outwards before the op? This can make a big difference when they are straightened. And there is another factor in measuring leg length that you get the actual length and the apparent length. The apparent length gives a false reading when the person measuring doesn't check if the pelvis is level or tilted. I'd be surprised, though, if your PT didn't consider this as it's a pretty basic point when measuring leg length.

I'm also surprised that you could find no information on LLD in TKR as there have been quite a few discussions about it in here, though has to be said, some of them occurred within other topics.

I would ask that you maybe restate your original post, expanding a little on the following

~ less than 24 hrs after discharge in ER w/ infection
~ severe pain in that one area (right side of knee) during exercises and walking
~ what was the condition of your leg/knee pre-op, meaning deformity
~ have you discussed this with your surgeon yet?
 
I know that I have seen some posts where someone mentioned having a lift in the non operated leg---maybe that was Hollie? I think the leg length is a minor problem that can be fixed with an orthodic. The infection is a major league problem---even i would call my OS for that!! Don't worry about the length, that can be taken care of. I was worried since I had a 10 degree bow in my left leg, but apparently no problem yet.
 
I think Gringo has that issue right now. The leg with his new knee is now straight and the other leg is bowed as he needs a TKR on that leg as well. Gringo! Front and center!
 
That doesn't mean you grew, Max! You probably weren't able to stand up straight! I "grew" too!
 
Oh! Thank you all for such quick and caring replies! My eyes are filled with tears. I feel like I just received a huge hug! (May sound a bit silly, but it is amazing how alone one can feel after a surgery. The emotions go haywire!) I am truely appreciative that someone cares! (My poor husband has had to listen to all the whing and I feel so sorry for him!
I just got off the phone w/ my OS office and am going in @ 2:30 today to address the pain and leg length issue. Next appointment wasn't until July 2nd. Although I realize there can still be significant pain @ 6 weeks for some people, this just doesn't feel right.
Let's see if I can be a bit more specific:
I am 52, have psoriatic arthritis in both knees and hands. Legs were straight. Not much pain with walking. But could not get up my stairs. (Live in a tri-level!) Knees would give out when bending or trying to get up from kneeling down. Been getting worse over the last 5 years and GP kept telling me no big deal, just exercise more! Grrr! I finally went to OS and the xray confirmed I was now bone-on-bone w/ both. Did maximum cortisone injections into joints until I was told there are no other options. Did all my research, waited til I could get the nerve up and finally scheduled after 6 months.
TKR 5-5-09 in hospital 4 days. Pain became unbearable, relentless on 3rd day. I just laid and cried all day. The nurses seem to be rather "casual" about it, but did get meds changed several times. I was on so many different meds I couldn't keep up. I like to be on top of things and know what exactly I am taking and how often, but I was just too miserable to care. I just wanted relief. On the 4th day I was discharged. I remember them telling me my hemoglobin was off and they may have to give me some blood, but the next thing I knew they were sending me home that evening. I don't really recall the docs or nurses examing my surgery site much at all. I recall one nurse just lifting a tiny corner of the bandage and peeking.
Less than 24 hrs. after being discharged we were meeting my OS in the ER. The pain had become the absolute worst ever (Couldn't even stand if someone breathed on it! That much movement made me cry!) my husband and I examed the site., I lifted the bandage ! Low and behold it was angry red! The red was almost all to the right of the incision -about the size of the palm of a hand. (Very tiny amount of pus on bandage thankfully) The leg appeared to be now swollen 3x's the size of the first day! How they didn't notice this before I was discharged is beyond me! My tears and pain level should have been a clue. OS took one look and just said "Yup looks like an infection and put me on oral antibiotics and sent me home. SO it appeared the infection set me back. I had in home PT and that went slow. She was not very good. WOuld often leave after 10 min. . I called to be schedule for out-of-home therapy and am now much happier w/ therapist. SHe is attenetive, aggressive w/out letting me suffer, but is determmned to see me improve. (The other one was just collecting a paycheck!) For the most part I have done all my exercises since surgery. Sometimes due to pain I slack off. I know that is a no-no! I also am so afraid to take too much pain meds and be left with not enough. (Vicodin ES 7.5-750mg) I'm not sure just how long they will keep refilling meds. My bottle says to take 1-2 ev 6-8 hrs prn. I usually average 4-6 in a 24 hr period. I also take Ambien CR at bedtime. (Prior to surgery I took 2-3 Vicodin a day and the Ambien CR.)
As I stated PT is ok except the flexion part and when relaxing the muscle after holding w/ tightening exercises. Then I want to go through the roof! And as the PT was teaching me to walk correctly I cried with each step on bad leg. Same pain. IT's all in that same spot where the infection was. I could walk "my way" and avoid the pain, but I know it would cause future probs. So I am back to using the cane and trying my best to do as instructed. But the real problem may lie in the fact that my leg length appears to be off almost 1/4 to half inch. SHe said my pevis is definitley tilted. I could feel it a few weeks ago when I tried standing w/ even weight on both legs. But my husnband thought I was being silly. I had mentioned to PT before but she didn't seem to address it as a problem at the time. Yesterday she addressed because it was extremely noticeable. She had me put one shoe back on and the I was even and it seem to help the pain a slight bit. She suggested a heel insert. But wait! WHat the heck is going on here? WHat caused this and isn't this going to cause major issues with my other knee? Which by the way is now getting to be miserable to the point of having to schedule that surgery. (BUt I DO NOT want to do this AGAIN! It was too much pain!) ANd mind you, I have had ver 13 various operations over the last 20 years (mostly abdominal, but this knee pain was THE WORST!)
OK I have rambled :rant: on and on, but that's what happens when your coffee kicks in, your in pain, and your nervous. ANd I wanted to make sure I explained everything. (Which I prob left out SOMETHING!)I guess I will find out today where exactly the leg difference has been created. Ad do you think if the doc made a mistake :skp: somehow, will he be truthful about what is going on? I guess I am worried he put in too long of an appliance for my leg ... and that is what is causing the opain. I know, I know! Calm down and wait and see what the exam shows ... then PANIC!:pnc:
 
Well, you've had a rough time, for sure, my dear.

First about the pain meds. There is no value at all in rationing yourself. If you do that, you may as well not take any at all! You need to be aggressive in your pain management rather than your PT right now, taking a dose when your pain is due to surface rather than when it's got to the point that you can barely stand it.

This chart describes clearly what I mean
(1 = no pain at all, 10 = the worst pain you can imagine)

[Bonesmart.org] Leg length discrepancy w/ TKR


So here you can see how waiting too long to take the meds can mean that they're actually unlikely to have any effect until the next dose is due. Should you find that your surgeon is stingy on how much or how long he will keep you supplied, then go to your PCP or GP as it seems from what others have said in here, that they are usually a lot more accommodating and sympathetic.

You can use other pain relief methods such as ice and elevation. You may not be aware that pain causes swelling causes pain and so on. The ice and the elevation will deal with both these and help everything settle down really well. You can use those blue gel ice packs, get several and keep them in the freezer so you always have some ready. Wrap 2 or 3 around your knee and keep them there with a bandage or scarf or something. But when they are fresh out, be sure to protect your skin with a thin towel or something until they warm a little or you could get a freezer burn! Use them as often and for as long as you want to. I used mine all the time, they were so effective and just pure bliss! Elevation is also very effectve, just make sure you have your whole leg lifted up on cushions so your foot as as near the level of your heart as you can get. That helps get the swelling down. Swelling and pain will also actively prevent your being able to do your PT effectively.

As for the PT, there are two issues I can see that need adjusting ..

1. you have an infection in your wound and that means that you need MORE rest in order to let your body heal both that and the wound itself. You absolutely must be sure to have lots and lots of rest if you want that infection to clear up completely. It's not a thing to play footsie with, this is serious. So I suggest you cut back on the aggressive PT until you have a clean wound again and then you can get going.

2. make sure you arrange your medication times so you can have a full dose about an hour before you go to PT. That way you'll have maximum pain relief and so get the maximum out of your exercises.

The moral of all this is .... be kind to your body and your body will be kind to you!
 
Josephine
I will post what happened today @ OS in a bit, but NOW I have a new question. I am 6wks. out, as explained, and I now have developed new bruising on the side of my foot. I had a ton of bruising throughout leg/foot, most of which was undertside of thigh/leg, and sides of foot, but it all went away. Is this unusual to get new?
Thanks, Terry ("KneedItReplaced")
 
Oh my, yes! The drainage of bruising take some weeks to ooze down the leg, encouraged by the massaging of muscle activity, and seep down from the thigh to the foot. During its passage it's in the deeper layers and doesn't show until it gets where it is superficial. So I would suggest it's not new, just old stuff doing the rounds!
 
Was too whooped rom OS visit to stay awake any longer! My OS office is in the hospital and is quite a walking from parking lot.
I want to thank you again for the response. It is all helpful and comforting!
I saw my OS for a total of 3 minutes yesterday. I explained my problems. He looked at my leg w/out touching it and said, "I'm not worried." Then he was to send in the P.T. that works w/ him and get an x-ray. I sat, and sat, and sat in the room until I could hear it getting quieter and new it was almost time for all to go home. I know they are very busy and I stupidly didn't pop my head out the door to ask if they had forgotten me. Sure enough just as I was about to, the nurse stuck her head in and was horrified to see me sitting there. At that point the PT was summoned and you could feel the awkwardness. As far as getting the x-ray at that point nobody was there! I explained I was concerned about the severe leg pain w/ walking correctly and during flexion PT, and wanted to know why the "new leg length". He had no answer. Said they need to just get me through this painful period and continue to do therapy and to get an insert for my shoe. As I sat in the chair he said he could see the apparent difference in my leg length, as my surgery knee was almost a half inch higher than my other leg. I asked why. I just am baffled as I never had this problem before. It is throwing off my gait.
1. Have they put in too big of an appliance?
2. Did they not cut enough bone away?
3. I don't wear shoes in the house, so isn't this going to mess up my hip and other knee even more?
So many questions!!
Has anyone dealt w/ this in a TKR?
I would have felt so much better if they had gotten to the x-ray. Now I have to wait until my next appt. July 2!
 
How frustrating for you! I'm so sorry you had to go through such a disappointment. And you were treated rather cavalierly. I know what my response would be to the "I'm not worried" remark. I would have told him that I WAS worried and asked him to explain to me the whys if his lack of worry. Surgeons can be so curt!
 
1. Have they put in too big an appliance?
2. Did they not cut enough bone away?
3. I don't wear shoes in the house, so isn't this going to mess up my hip and other knee even more?

1. Had they put in too big a femoral or tibial prostheses it would be mostly too wide and too much around the bone. They're not that much different in thickness. If the tibial insert, the plastic spacer, had been too big, you would be having a lot of trouble making your knee work as it would be too tight.

2. They can only cut the correct amount of bone because they use jigs for every step.

3. I would think it would give you back ache before it is a problem for your other leg. I really do think it's an 'apparent' difference because your pelvis is titled and the remedy for that is good PT more than anything else.
 
Kneed, in my opinion it is time for you to search out another excellent surgeon in your area and get a second opinion. Make a written list of your questions to be sure that they all get answered. Are you even sure the infection is gone? I can't tell from your posts whether anyone has done the appropriate blood tests to determine whether that is still a problem or not.

Do make sure you keep your pain under control as Jo suggested. At this stage in your recovery, it's quite normal to have some pain and to need medications for it. As said before, if your surgeon won't prescribe adequate pain medication, get to your primary physician.

What does your knee wound look like now? Are you running any fever?

You need to be a whole lot more assertive with all these folks. You are the "customer" here and they need to be more responsive to your concerns. Put your (good) foot down and don't settle for any less from them....including the 3-minute surgeon.
 
That's so deplorable! Listen to the smart advice Jo' Jamie and others have given you! Oh...Btw, NO way should you be put off THAT long! This is YOUR knee, NOT theirs and they should at least have the courtesy to answer your important questions!
 
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