THR leg length discrepancy

[GenomeGenie]

Hi all -
First time on here...looking for some advice and reassurance. 48 yo, THA for severe arthritis, 2 weeks post-op, and although I did not have a limp pre-op, I have one post-op. Surgeon said I did have a measurable leg length discrepancy pre-op, but when he tried to even it out intraoperatively, he was able to dislocate the joint, so he had to put in a longer length. The limp has improved, but it is still noticeable. I do have hip obliquity post op (none before), but my concern is that whenever I try to correct the obliquity, the leg discrepancy increases. What is other's experience with post-op leg length?
Thanks so much.

 

[Jaycey]

@GenomeGenie Welcome to BoneSmart! The first thing to mention is that at 2 weeks out of THR nearly every new hippie feels LLD. There can be many reasons for this but the good news is in most cases this feeling just fades away. Give it 3-4 months before seeing anyone to do a measurement. Don't use any lift until that time. Here's an article from our Library Leg length differential - LLD

And here are your recovery guidelines:
Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any 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.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Celle]

Hello @GenomeGenie - and

Please will you tell us the full date of your hip replacement and which hip it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately in the future.
Thank you.

 

[GenomeGenie]

I had my surgery July 1, 2020. Total Hip Arthroplasty, posterior approach.

I am also noticing some quadriceps muscle wasting, especially above the knee... How common is this?

Thanks so much.

 

[Celle]

Thank you for your surgery date. I've done your signature and I will add your name to the July Sparklers surgery thread.

Yes, some muscle weakness and wasting is normal. It will recover.

 

[zauberflöte]

Hi @GenomeGenie I had a weird LLD before my first hip, wherein if I tried to bring my feet together below me standing, I couldn't because of the pain. One (and I can't for the life of me remember if it was the good leg or the bad one!) dangled off the floor by an inch or more. I figured (correctly) that a new hip would fix it. Post op, I did feel an LLD, but was reassured by reading on there about perceived LLD. The sensation faded, and eventually was gone without me noticing it was gone. The second hip didn't really present the same way.

I have never been properly evaluated, but it feels like the second THR "balanced" my pelvis better. I also learned after the second that I have a slight scoliosis, and putting 2 and 2 together, that it's exactly what a PT was trying to help me correct when I was about 40. It's just above the bra line, and definitely affects my shoulders, neck, and thus jaw, but I don't know if the effects cascade downwards as well.

I had to look up hip obliquity! In the process I found a recliner that's made somewhat like a waterbed for your derriere.... now I want one!

 

[GenomeGenie]

Hi @zauberflote - thank you for your reply. It sounds like I am in the same place you were after your first THR... except my hips were level and I didn't have a limp prior to surgery. My hip issue presented with back pain for about 5 years prior, before a good PT realized it was my hip that was the issue, so I went from a 'bad back' to a 'bad hip' in about 6 months. Apparently the joint was bone on bone, and so the THR was necessary, but I'm having a hard time with the limp, and am very concerned about the long term consequences on my spine of LLD. Do you have back xrays from before your surgeries? Did you have the scoliosis then? Or could it have been caused by the LLD, and the spine needing to adjust to that?

 

[leejaa]

I see you are concerned about your leg length discrepancy and pelvic obliquity. Was this diagnosed by your surgeon or is it a feeling you have when you walk or move? It is quite common for many people to have a feeling of leg length difference. Some of this can go away as you recover. Below I posted an explanation from our library. You are quite early in your recovery journey and our bodies take time to adjust and heal.


Why Does One Leg Feel Longer After THR?
It is not uncommon to feel as though there is a difference in leg lengths after hip replacement. Your leg can feel shorter before surgery due to a loss in cartilage. During your procedure, the surgeon makes every effort to ensure your legs as equal as possible.

Wait at least three months post op before making a final judgement on leg length. During this time, don't use any lifts in your shoes, as that will just keep your body from readjusting itself normally. Often the discrepancy is not a true difference, but is a perceived discrepancy. It can be attributed to tight muscles, a pelvic tilt, and at times even arthritis in the spine. Most cases resolve with stretches, exercise and time. In the rare situation of a true difference a shoe lift may be prescribed after 6 months or more, but in most cases no treatment is necessary and your legs will eventually feel normal again.

 

[GenomeGenie]

Thank you @leejaa! Not formally diagnosed with hip obliquity by the surgeon, but the PT is concerned about it. Prior to surgery the affected leg apparently measured slightly longer, and the surgeon said when he tried to put in an implant that would make legs same length, he was able to dislocate the joint on the OR table, so he had to put it in an implant that was longer to prevent dislocation. Because I did not expect this and it wasn't discussed pre-op, it has been a source of a lot of anxiety post-op, and although the LLD has improved somewhat, it is still there. I am trying to take it one day at a time and not panic, and the reassurance and input I have received so far from reading the information on here helps a great deal, and I am very grateful for it. Thank you!

 

[Jaycey]

although the LLD has improved somewhat

Please don't stress about LLD yet. It is very early days for you. It can take 3-4 months for any discrepancies to settle.

 

[Hipster-2]

+1 don’t worry too much about the LLD this early, as long as it’s not currently hurting your back. My mother and several friends and colleagues were all really freaked out about this after surgery, and within a couple of months had forgotten all about it as their bodies adjusted. In fact, my mother now denies that she was ever concerned about this, though she was in real distress about it in the first few weeks after surgery and cried daily about it when I was staying with her to lend a hand around the apartment. I wish I’d known about this site at the time, as I could have maybe eased her mind about it. So be patient and do your best to adopt good posture and walking mechanics while working around it for now - the body has amazing powers for dealing with this sort of thing!

I wasn’t as lucky as my friends and family - mine persisted and was the source of real problems because of an already-janky lower back and SI joint, but if that hadn’t been the case I would have just ridden it out and let my body adapt.

 

[zauberflöte]

@GenomeGenie I don't have any back xrays but one from after both hips. But-- I had my hips at 61 and 65, and PT for my neck and upper back in my late 30's/early 40's, and the area my PT was talking about then: "there's this little 'z' in your spine that I just can't seem to fix", is exactly where the scoliosis is on the xray from a year or so ago, after a spectacular fall into the bathtub tailbone-down. I still do the exercises that PT gave me, and they are what keep my back moving!
The pre-op LLD was extremely short lived, maybe 6 weeks. If I could have stood the pain I could have set the foot down.

Now you've seen the article about post-op LLD, so you can relax and, er, enjoy your recovery!

 

[Akblueloon]

I had my THR-left side done on May 27. I had a LLD and a limp, and at my 2 week follow up the doctor acknowledged the LLD, said it often adjusts as our muscles, tendons etc heal and adjust. I am now almost 9 weeks post op and I feel like it is much better. I go in this week for a follow up and hope he will say it's taken care of itself. I feel like on a good day I can walk without a limp and I generally walk about 2 miles, have done up to 4 one time. On a day when I'm feeling the hip more, general aching in the glutes/periformis and around the incision (I had superior approach surgery) I feel like I have a limp but I think it's more compensating for the discomfort rather and LLD. I think 3 weeks out is probably too early to be too concerned about it. Your body is adjusting! Good luck with the continued recovery!