THR Length discrepancy post THR

[Bhippie]

I’m now 7.5 weeks out from THR anterior approach on right hip. So far, it’s a miracle. However as I descended into hip replacement, I developed bilateral knee and other hip pain. Post-op I’m walking up to two miles, with knee pain mostly gone but lingering discomfort in other (non-op) hip. Surgeon (one of top in LA/OC area) says I have bursitis and sent me to PT. PT looked at my gait then measured leg length. Somewhat to my surprise, my operative leg seems to be about 2cm shorter than my non-op leg.

I will contact surgeon but conventional wisdom is that op leg is typically longer, not the opposite which I seem to have. I remain convinced that my op was top notch, but wondering if others ended up with a shorter op leg and how they resolved or mitigated that.

 

[Mojo333]

@Bhippy
to the forum and congrats on being on the recovery side of THR.

Could you please share the date of your THR and which hip was replaced?
We add this info to your signature and this helps others keep up with your recovery and helps with advice.

We have had members express concern about apparent leg length discrepancy, LLD, and Here is a link to the article in our library regarding the issue.
I had both hips replaced at once and PT identified a slight LLD that was basically a functional LLD due to ongoing inflammation in healing tissues and tight hit flexors.

Tightness in the muscles of your pelvis, hip and torso (usually the psoas, gluts and obliques)- this muscle tension can rotate the bones of your pelvis and give the impression that one leg is longer and my PT said it was fairly common.

Post-op I’m walking up to two miles

This is phenomenal and I don't know how long you have been doing this, and if the 2 miles is done all at once, but this may be a bit too much, too soon.
I overdid things as I was so excited to walk well and pain free and realized that Just Because I Could, Didn't Mean I Should.
Lots of healing still happening at 7 1/2 weeks and the bursitis in the good hip may be a signal you should try easing off of extended activity.. break up the walks into shorter walks several times per day.

Although you sound as if you over the tough first bits of recovery...
I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines may help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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 these​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this ​

Activity progression for THRs​

6. Access to 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.

 

[Eman85]

I don't think I'd get excited about a PT measuring and finding a difference, 2 cm is over 3/4" that would be noticeable and you would be waddling. Think about walking pre-op with a shoe on one foot and none on the other, that's probably less than 3/4". Last member that got a diagnosis like that it all cleared up a short time afterward. https://bonesmart.org/forum/threads/new-thr-and-quite-upsetting.71952/page-3#post-1574753 At 7.5 weeks it's all still early on. You say your pain is in the non-op hip? I'm sure it's not happy with the 2 mi. walks especially if you weren't walking like that pre-op.
One suggestion that always comes up is did you buy new shoes or wearing pre-op shoes? Old shoes have old wear patterns from walking with a bad hip. PT's and OS don't sell shoes so it doesn't seem to come up in recovery discussions with them.

 

[Bhippie]

Thanks for the replies, links, and info. To bring things up to date, my surgery was anterior approach THR on Nov 22 2022.

I’ve interviewed two PTs and have decided to lock in with one.

As for the potential hip length discrepancy, one of the PTs I considered is a DPT. During initial visit she measured length from ASIS to medial malleolus 3x which is supposed to be the best method. She did so after scrutiny of my gait, said it seemed I was dropping with my right foot. Also that I likely had bursitis and ITBS in “good” hip. Of course those could explain a hobble in my gait too. Otherwise op hip is fantastic with better range of motion than non-op hip.

I appreciate the advice about walking for two miles every other day or so may be more than my left (good) leg and hip can tolerate. I begin with my chosen PT next week.

 

[Eman85]

One thing about walking, it's not distance or speed that counts. If you want to get rid of a limp you have to walk without one even if it's 50 ft. If you walk distance you'll limp a lot of it and it didn't do a bit of good doing that for me. Walking like you're in finishing class is what helps most. Slow steady heel toe steps.

 

[Layla]

Hey there Bhippie
Happy Two Month Anniversary!
How are you doing and how is PT going for you? I hope all is well.
Best Wishes for a great week!
@Bhippie

 

[Bhippie]

I’m past my 3 month milestone now. Op hip is super, no restrictions and everything looks great on x-rays and I don’t think about it at all. My leg length discrepancy seems to be sorting itself out, full lower body x-rays showed a decided pelvic tilt. Originally measured at nearly 3/4”, I’m now just about even in length according to PT. Nurse evaluated to show about 1/4” difference now. I have a small insert I use in my shoe on the shorter side - my op hip.

My limiting factor is my non-op hip and knee which I punished for about 8 months compensating for the bad hip. I went in to surgeon expecting to need that hip done too, but was told I only have mild to moderate OA and it’s way too soon to consider replacement.

Both doc and PT agree I have IT Band syndrome (Classic symptoms) with possibly trochanteric bursitis. I’ve been doing PT and HEP for that and things are improving, however slowly. I can do about 2.5 miles hiking, and bike 10 to 15 miles every other day or so.

I find that if I push too hard (my tendency) then things do not improve. But if I push just right, I feel improvement. My left leg/thigh are very weak compared my right (op) side which is far stronger, so focusing on glute meds/min/max which helps.

 

[Epicterv]

Im 10 months post op on a right hip replacement. My rt leg seemed to get longer and longer as i was to heal in this time. Now i limp that other people notice and comment on. I do use a lift in left shoe. For me it got worse as time went on. Still very painful at 10 months out. The metal hits the pelvic bone which causes my back to go out. My leg (not the metal part) is painful. I cannot sleep on the metal leg. My foot gets very cold which does concern me a lot. Knee pain and thigh pain is normal for about 6 months of healing. At the 6 month mark there is a noticeable improvement there. Another improvement at 9 months. Be careful on trying to walk too much too fast, stay with your restrictions. When they x-ray on your checkups, its to see if there are fractures. Its a main concern after a hip replacement, fractures can happen easily. I'm very happy your surgery sounds like it went well. A lot do not. My roommate refused to leave the hospital until she had answers instead of being brushed off. Hers was so badly uneven her knees did not line up. My replacement i consider was a failure in many ways. but especially how long the surgical one is and the problems it causes. My left leg is worse in terms of being corroded. number4 level. Worst level. But i had a pinched nerve in my right so they did that one first, Now I'm too afraid to get the left one done. Take very good care of a hip replacement that turned out as well as yours. There are so many things that could go wrong they don't tell you about. 9 months go by quickly, no hurry. Good luck keeping the leg from getting longer. Take care of you.

 

[Jamie]

@Bhippie .... you are very wisely listening to your body and paying attention to what it needs at each step of your recovery. Good for you. I'm finding now that I've had a hip replaced, that the leg differential can be a real problem that needs attention. I had to be 50% weight bearing for 6 weeks after surgery and I didn't realize what a job that did on my muscles. I spent 2 months in PT getting pressure point treatments for muscle spasms that were causing pain. Then once those got resolved, I was fine for a week or so and then started having trouble walking and groin pain again. After a trip to the surgeon....it was a tilted pelvis...no doubt the result of spending 6 months transferring weight to the unoperated leg. Like you, I got a lift and the pain immediately stopped. Also, like you I can feel my muscles finally strengthening properly and I believe it will all work its way out.

Sometimes we just have to hang in there and keep pursuing answers for what we are feeling and experiencing. Your IT band problems may take a while to resolve, so I hope you're still seeing a therapist about that. Congratulations on getting your pelvic tilt down by a half inch! You are definitely on the right path and I believe you'll get there. Keep searching for the right balance between activity and rest. Your ability to hike for a couple of miles and bike 10-15 miles is a very good sign.

 

[Bhippie]

Update: I'm now two weeks out from my 6-month checkup. My op hip (rt side) is perfect. No complaints, no issues, no pain at all. My non-op hip and knee-ish are what is still giving me grief, and limiting my functionality. Doc thought bursitis, PT checked things out and said definitely ITBS with potentially trochanteric bursitis. I've been doing PT since mid-Feb or so, and things are definitely improving, but not quite there.

I eBike to work regularly (only 4-miles RT) but eBike 10 to 15 miles every couple of days. When I hike, I can do a mile, maybe 2 on a good day, but it's always a bit uncomfortable on my "good hip" side. Again, absolutely no issues at all with the op hip. It's gold... Oh wait, it's actually titanium! (pun intended)

While I have just begun to be able to lead up stairs with my non-op leg, it's still an issue with pain laterally and below knee, perhaps where the IT Band attaches. I still have continual hip pain, normally about a 1 on a 1 to 10 scale, but it ranges depending on what I am doing and can go to 3, maybe 4, at times. Twisting motions, especially on uneven terrain, are troublesome. But I have soldiered on, and faithfully do PT and experiment to see what helps and what doesn't.

PT says I have very tight and weak glutes and hams in my non-op leg. Doing some of the PT I can actually have my non-op leg shaking. Op leg is very strong..

This upcoming visit is supposed to be the decision point as to whether I need to get the other hip replaced as well. While PT has improved things, I'm still a long ways away from "back to normal." I know I have OA in the "good hip" and we'll see what that looks like now and whether THR is on the horizon.

As for all of us, it's a journey. For some it's short, some it's longer, and some it's a twisting road.

 

[Bhippie]

Update: I just finished 6-month check with surgeon. Op hip is perfect. We evaluated my other hip, which has been troubling me.

I’ve been able to walk/hike maybe 1.5 to 2 miles on flat ground, with mild pain. Anything that is uneven terrain, especially loose, bouldery stuff will shoot that pain level up. While I seem to have resolved some of my leg and knee pain via PT, the hip pain is relatively constant, though normally a 1 or 2 out of 10. An eBike ride will push that to a 3, a hike on uneven terrain will move that to a 4 or 5. This is very similar to what I experienced with my other hip prior to surgery.

While I was hopeful that I wouldn’t need THR on my other side just yet, the new x-rays show marked advancement of OA even over the last three months. We discussed alternatives, but I postponed for way too long on the other hip and don’t want to go through that pain and misery again.

So… I’m now scheduled to get the other hip replaced in a couple of months, and I’m actually quite happy and relieved. I could barely walk 50 feet when I had my right hip replaced and recovered nicely. I’m in much better condition now and have been doing steady PT for 3 months, so feel confident my left hip THR will be an even easier procedure for me.

I had always assumed based on my x-rays and OA that I would eventually need both done. So it seems that 8 months after my first THR this will come true. I checked a medical diary I keep, and my first hip pain symptoms on my right hip were back in June 2021. So nearly two years later, I’m so very eager to bring this to closure.

The journey continues!

 

[Jaycey]

We discussed alternatives, but I postponed for way too long on the other hip and don’t want to go through that pain and misery again.

Agree - putting off the inevitable will only result in a more complex and possibly longer recovery. At least that was the case with me. Having the second THR when symptoms began meant less limping around. My recovery then was weeks versus many months post LTHR.

Please let us know when you have a surgery date. We will be here for you again!

 

[Bhippie]

Surgery date for other hip is now July 18th. I know the process and what to expect, so this makes it easier. However, with any major surgery there are always things to consider, especially for me. I have a genetic clot factor disorder which is always something to think about, but yet not fear. I hope I can put to rest some fears for others in similar situations.

My complicating factor is that I learned some years ago, after a life-threatening PE episode after decades of a history of DVTs, that I have the second most common genetic clot factor mutation - Prothrombin Type II G20210a.

Prothrombin G20210A (Factor II Mutation) Resources

A Genetic Clotting Condition or Thrombophilia Prothrombin 20210 Mutation, also called Factor II …

www.stoptheclot.org

After my life-threatening PEs, technology had finally reached a place where I could be genetically evaluated. Because of my genetic mutation, I was placed on a regiment of Eliquis for life. In the past I had been on coumadin, which is troublesome to manage. I've found that Eliquis is easy-peasy, and very effective. I no longer have any fears about developing DVT or PE. In Eliquis we trust! Though I do wear support hosiery and take precautions as part of normal activities.

While it's been a positive life-changer for me, I also understand that major surgery is always something to think about. My surgeon for THR told me when I first visited him that he had lost two patients to post-op PEs. I did not take this as a negative, rather a grateful "full-transparency" acknowledgement of my genetic condition, and that bad things that can happen if precautions aren't exercised.

He insisted I work with a hematologist and we developed a protocol where I came off Eliquis 4 days prior to surgery, and used a "bridge therapy" of Lovenox to cover the gap. While Eliquis leaves your system quickly, Lovenox is even more predictable and transient. So I self-injected over the weekend before my surgery, and had a final Lovenox injection 24 hours before the procedure.

One day after surgery I went back onto Eliquis. Appropriate precautions were taken pre- and immediately post-op, and I never had any issues though was cautious (elevating leg, monitoring swelling, wearing support hosiery, etc.).

For those, like me, that have mitigating factors above and beyond the usual cautions that one must consider, I can tell you that Eliquis, consultation with a knowledgeable hematologist, plus "bridge therapy" prior to surgery, are all very effective ways to minimize risk for DVT and PE.

 

[spaniel]

What a fabulous post indicating excellent physician transparency as well as superb comanagement with hematology!

 

[Bhippie]

A quick update, I think I will start a new thread after I get my other hip done... I've been staying on top of exercise and biking as much as I can heading into surgery. I know this will help in the recovery. It really is a lot easier the second time around, and knowing what to expect. Plus, I'm not as advanced with OA as I was with my first hip replacement, last November.

Surgery is July 18 and I expect it will go smoothly, with a good recovery. I'll post on the other side of surgery in a different thread.

 

[Eman85]

I'm not a moderator or anything but it will all end up back on this thread, recovery you get one thread for life. Kind of like your permanent record in school. You do get to change the title.

 

[Bhippie]

I am now 2 weeks out from THR on my other hip. It’s a busy time with lots of pre-op testing and evaluation, plus I’ve been at a family reunion and have a work conference the week prior to surgery. All this is good, being busy keeps my mind off things…

I can still walk a mile or so, though not without pain especially when on uneven terrain. I also have fairly intense pain below my knee and on the side of my hip, sometimes groin, when I hike too far or sit for too long (e.g. on a plane).

These are very similar to what I experienced pre-op on my first THR on the opposite hip and I expect these symptoms to also resolve quickly post-op.

One thing I leveraged the first THR was a power recliner rental which I will do again. That recliner helped me get up/down and keep my legs elevated in the early weeks post-op. Plus, heck… it was great for watching football at the time.

I did spend the first two nights sleeping in the recliner, simply because my bed is a bit high and was an initial challenge. But quickly transitioned to bed.

 

[myglasshalffull]

Best of luck on your upcoming surgery. I found your earlier post about your blood clotting issue very informative. My grand daughter recently had a pulmonary embolism, she's 18 and now on Eliquis.
Next month she has to stop Eliquis two days before her next hematology appt and then they run blood work. Her hematologist seems to feel it will only need to be on Eliquis 3 months, in August she will have sonogram to be sure no clots present.
Scary stuff these blood clots.