Revision THR Leg Length Discrepancy

[Josephine]

Josephine, my problem was not due to deformities or any disorders.

I don't dispute it but I was generalising.

Some dr's call my OS, sometimes during surgery to say why can this artificial hip doesn't correctly fit the patient...and when he looks at the xrays, tells them the reason and then they have to implant it anyways, because they don't have the correct ones on hand and then have to have second surgeries, once the correct apparatus is ordered.

My goodness, I must have been really lucky with the surgeons I've worked with because in all my 50 years in theatre, I never came across a situation like that. That's just terrible.

Correction: I did once scrub for a case where we were doing a hemi-arthroplasty (stem, no cup) for a fractured neck of femur on a pretty large gentleman. When we got the head out and measured it, we found it was a staggering 2½" in diameter. Normal average being 1¾-2". Happily we had a major orthopaedic hospital a short drive away and when I phoned them, they had one in stock. So we sent our anaesthetic tech over to get it. It took him about 30 minutes so we kept the patient on the table until he got back. He was none the worse for the experience! But ever after that, where ever I worked, I always kept a 2¼" and a 2½" prosthesis in stock!

 

[CanukTriMom]

I am with Josephine on this one, I have never heard of an ethical doctor putting in a prosthetic that is close enough because the didn't have the correct one on hand. Maybe I am interpreting what you wrote in the wrong light.

I would go to another doctor ASAP!

 

[lynnsfave]

I wish my doctor had someone close by with a wider neck/stem. But then, he should have know mine was 'abnormally' wide when the X-rays were initially taken. Since my surgeon didn't have a source close by, he just put in one that was too narrow. It caused my leg to be an inch shorter and my spine to curve which is causing pain in my tailbone such that I can't sit or lay for long, and bending over is almost impossible. Unfortunately, attorneys don't think it unethical enough to pursue.

 

[CanukTriMom]

@lynnsfave

I am really sorry to hear this, so you will need custom prosthetic correct. Have you reported this OS to the AMA? I would then contact the Orthapedic Surgeons Association and report him there and get their help to find another OS to rectify the situation.....at least a try I would think.

Good luck

Chery

 

[Josephine]

Since my surgeon didn't have a source close by, he just put in one that was too narrow.

Lynn, may I rephrase this a bit to 'put in the best he could'. Because if he hadn't sussed that beforehand, then he was kind of hamstrung and could only do the best he could under difficult circumstances.

As a matter of interest, has he ever apologised or shown any regret for this?

is causing pain in my tailbone such that I can't sit or lay for long, and bending over is almost impossible

Would you allow me to try and help you here? I don't know if I can but I'd really like to try.

I'm going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what is the date of your surgery?

3. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

4. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[lynnsfave]

1. Antero
2. August 4, 2014
3. The hip itself? 0. Sciatica? 8. Tailbone? 6-8, depending on position. Lower back, shoulders? 4.
4. Dilaudid 2 mg. 1 in morning, 1 a night. Initially it was 1 every 4 hours. I try to keep it to a minimum.
5. I have a cleaning lady, so no housework. I live alone, so very little cooking. I grocery shop and went to the mall, but it wears me out quickly.
6. Last Friday was my last day of PT which was 3x/wk. I right a recumbent bike for 8-10 minutes, stretch my calves 3 x 30 sec; do 20 reps of: kick butts, rising up on my toes, squats, toe taps (on a step about a foot high), swing my legs forward, out and back, sit down and stand up, march, and side steps; balance with feet in front of each other for 20 seconds each 3 times. Laying down exercises: leg raises, bridges (30 x 5 sec), hang leg off bed; sitting exercise: raise leg 30 times, holding each 5 seconds. I think there's more but can't remember them.

 

[lynnsfave]

I don't know how you put in the quotes! But He didn't do the best he could. They're in bed with Stryker, and Stryker doesn't make wider neck/stems. Other manufacturers do, and as I've read, a surgeon can also get one custom made if needed. My doctor never mentioned the issue. I wouldn't go back to see him for the post-op; I was afraid I'd punch him because I was so upset with him. I saw a different surgeon who told me about why my leg was short. I've since seen the CEO of this group, the go-to guy for fixing problems. And of course he put all the onus back on me; came up with every excuse ... My femur head is rarely but abnormally wide, my leg was already 1.5 cm short before the surgery (the op report said I was 2mm short) and I had scoliosis (which I didn't have as of January 2013). It's a CYA all the way. He's not going to admit his surgeon made a mistake.

 

[Josephine]

Thank you for the date - I have added it to your signature. So that's 10 weeks out, yes?

The hip itself? 0. Sciatica? 8. Tailbone? 6-8, depending on position. Lower back, shoulders? 4.

Yikes! That's something!

Dilaudid 2 mg. 1 in morning, 1 a night. Initially it was 1 every 4 hours. I try to keep it to a minimum.

Considering your pain levels, that's really not enough. At the very least you should consider taking Tylenol 1,000mg 4times a day.

I have a cleaning lady, so no housework. I live alone, so very little cooking. I grocery shop and went to the mall, but it wears me out quickly.

I'll bet it does.

Your exercises -
PT which was 3x/wk.
recumbent bike for 8-10 minutes
stretch my calves 3 x 30 sec -
kick butts x20
rising up on my toes x20
squats x20
toe taps (on a step about a foot high) x20
swing my legs forward, out and back x20
sit down and stand up x20
march x20
side steps x20
balance with feet in front of each other for 20 seconds each 3 times x20
Laying down exercises:
leg raises
bridges (30 x 5 sec)
hang leg off bed
Sitting exercise
raise leg 30 times, holding each 5 seconds

I'm not surprise you have so much pain - were they training you for the Olympics or something? My dear girl, that's far too much to impose on a newly implanted hip. I'm only surprised you don't have more pain than you have. I do hope you're not doing any of this at home? If you are, you should stop it all.

The fact is that hips actually don't need much exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

I would now like to ask you to identify where this coccyx pain is - I know you think it's obvious but please bear with me and thank you for your patience

Can you tell me the exact site of your pain using this chart?
Please note the instructions in the smaller image

 

[Josephine]

I don't know how you put in the quotes!

Look here to see how: How to quote a post I just realised I have to update it a bit!

He's not going to admit his surgeon made a mistake.

Oh I know and I do feel for you. Butting heads with the medical establishment is a no-win situation for sure. As you have just seen from my well intentioned reply, it's all too easy to put caveats into these things. I can't speak for them in the US but I do know that in the UK, no surgeon can be 'in bed' with any company because they don't have any buying power. That's all in the hands of the Clinical Commissioning Groups who are our purchasers and 'powers that be'. But it's all just as impenetrable if you have a grievance.

 

[lynnsfave]

I was never good at doing the exercises at home. I had outpatient PT 3x/week for 8 weeks. I'm not doing anymore at home.

My coccyx pain starts out at right at CL3B/R4B, right where that line meets, and goes out to BL3B AND BR4B. The absolute worst time is sitting on the toilet!

 

[Josephine]

I'm not doing anymore at home.

Jolly good!

My coccyx pain starts out at right at CL3B/R4B, right where that line meets, and goes out to BL3B AND BR4B. The absolute worst time is sitting on the toilet!

Oh well, that's coccydinia all right. No doubt about it.

A member once posted a remedy she'd used - you might like to check it out 'fixed my own tailbone'
Here's what she posted

Here is a link to manual manipulation of coccyx that I tried.
https://www.coccyx.org/personal/2003/brenda.htm Look for Brenda 'manual manipulation of tailbone'. Plus there are others who have tried her directions and it worked.

 

[lynnsfave]

Thanks for the link. I printed it off. I explored, but I'm not sure if I'm in the right area. There's the end of a bone and then another knob below it. But will it help if the spine is still hitting it wrong? Or maybe the surgery itself somehow did it?

 

[Josephine]

You know I doubt it. I've never heard of coccydinia being caused by hip replacement surgery. I tend to think you've just been unlucky here. I think the 'knob below it' is hte end of the coccyx. It does tend to curl inwards a bit. In fact, when we've manipulated a coccyx under anaesthetic, the surgeon usually puts a finger in the rectum to get to it!

 

[lynnsfave]

The CEO surgeon showed me where my spine is now curved (scoliosis), when it was straight as of 1/13. I really think something happened during surgery ... the narrow head or offset acetabulum ... that was enough to put pressure on my coccyx. I'm wondering if he does the hip replacement on the left, if that will even out everything and the coccydynia will be relieved?

 

[CanukTriMom]

I had an anterior as well and one of my restrictions is absolutely no bridging. I also do leg raises but not that many, sounds excessive most definitely!

 

[Josephine]

I'm wondering if he does the hip replacement on the left, if that will even out everything and the coccydynia will be relieved?

Who can tell? You're asking an unanswerable question, I'm afraid.

 

[lynnsfave]

Josephine, I must have missed the article you linked about LLD. Now I'm really concerned. Since I have real LLD and I know I have a curved spine as a result of the surgery, what will happen if he replaces the left hip and it ultimately straightens my spine or curves it the other way?? Will my right leg go back to being the correct length and my left short because my spine curved the opposite way? But I'm going to bring a copy of the article to my surgeon.

Also, I wrote to Dr. Padgett and he requested copies of my X-rays. He should have them by now, so it's a matter to waiting to see what he thinks.

I have a couple attorneys who are very interested (so far) and have asked for copies of my records and X-rays.

 

[Josephine]

If you have a spinal curvature then I would suggest that your LLD is not 'real' it's an apparent difference since the invariable consequence of a curvature is a tilted pelvis.

 

[lynnsfave]

OK. The surgeon who wants replace my left hip to "match" right shorter leg didn't mention anything about a tilted pelvis. But I'm concerned if it's a tilted pelvis that's shortening my leg, what will happen when the left hip is replaced with the wrong size replacement and it either straightens or curves my spine the other way. I'm really confused as to what to do. I'm seeing a surgeon tomorrow for another opinion, but I also have several attorneys very interested in my case.

 

[toohip]

Hi @lynnsfave - Did you hear from Dr. Padgett?