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THR My story so far. I should be happy..

LimpyStimpy

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(I didn't realize this was so long until after I submitted it, sorry. If you would like to get to the meat of my reason for coming here, skip ahead to the "Fast Forward to home" paragraph)

Hi all! I'll just jump in. This was my second hip surgery. Both were due to cases of AVN at differing levels of progression. The first was my right hip where they tried a relatively experimental 10+ hour procedure called Vascularized Fibular Graft to actually remove my fibula from the same leg and insert it as a strut into the head of my right femur. They would then redirect blood flow to it so that my actual femur head may fill back in with new bone on it's own. The recovery was VERY long. I mean months in a wheelchair, then crutches, then a cane for about a year. In the end it was fairly successful. Almost no pain. Great!

A couple years later, my left hip has the same problem and I go back to the doc to see if he would want to do it all over with the new one and he remains hesitant for a couple months before finally telling me he was retiring and wouldn't be able to take it on. He referred me to a new doc that he recommended highly. By now, the left hip was too far gone to do anything fancy like they did with the right one. In fact, this new doc suggested that maybe the graft they had done was a bunch of extra and unnecessary stuff when a simple core decompression would have had the same results with a lot less pain and much shorter operation and recovery time. I thought, oh well. It is what it is. It worked. I'm over it.

So now this new guy says a THA is necessary and I am completely okay with it. The pain in my left hip by now was way greater than my right ever was prior to the surgery. So we do it a couple months later. My wife schedules time off from work to take care of me for the first week and we line up my mother-in-law to babysit our 2 year old daughter for the remaining couple weeks until I am well enough to take care of her myself during the day (I work evenings.)

Everything went really smooth. We got checked in very quickly and I was under anesthesia within a couple hours of arriving. I woke up in recovery with no feeling in my legs as expected. They promptly moved me to my own private room where the feeling returned and the pain began, which was quickly taken care of using fentanyl and oxycodone. Everything was great and I was even up to use the bathroom and walk up and down the hall with the help of a walker, all within hours of the surgery. I was on track to go home in the morning. Or so we thought.

The pain started getting a bit harder to manage after the fentanyl wore off and I was afraid to ask for more but they did eventually up my oxy by adding an extended release version to the instant release they were still giving me. The pain had started to move to my knee and along my shin and down to my ankle in waves. Nobody could really explain what was going on with that and it kinda got ignored, more on that later. But, now when I would stand up, I would get very dizzy and feel faint and lightheaded and couldn't even make it three steps anymore. My BP was as low as 83/40 at one point. Always only triggered by standing. This happened for the next two days. I didn't get to go home quite yet. They pumped me full of fluids and albumin and kept me monitored. Almost magically, on the last night in that room, the dizziness cleared up and I was able to go home the next morning. Nobody ever really told me what caused that issue and everyone seemed pretty surprised by it yet confident that it was over. I am wondering if it was some kind of reaction to the anesthesia wearing off or something? The only variable from the first night when I walked very well down the hallway was the fentanyl. So maybe it was caused by the pain spikes that I could actually feel when that drug wore off? Who knows, maybe you have an idea?

Fast Forward to home. Overall the THA for the AVN in my left hip goes well and now it could only get better from here on out, right? My wife and I manage the pain, I get exercise, good sleep on our new recliner couch, and even take my first poop in a week. But, the pain wave in my shin and knee and ankle keeps coming and going. After experimenting a bit, I figured out that it may happen mostly when I am reclined or lying on my back and I go from straight leg to bending my knee, or vice versa. And it lasts for a few minutes. Sometimes it is associated with a slight pins and needles sensation in my foot. I had planned to bring all this up to my doc when I meet with him at our follow-up on Thursday the 6th. That was until late Friday night, after my wife and daughter went to bed, I was still wide awake and feeling spry. I reduced my pain meds that day to the point of only 1 tramadol and I was still able to tolerate the pain for the most part. So, with the walker as backup, I got up and stretched out tall for the first time since the surgery and walked with total weight bearing on both legs. I slid the walker along with me, just in case, but didn't rely on it for balance or anything. It was tolerable even without the pain killers! I was excited. I pushed the walker aside and walked through the kitchen and back again, by myself, and tried my best not to limp just to check out the new hardware. And I noticed something odd.. With every step with my right (non-operative) foot, it felt as if I was stepping down off of a platform or something. I didn't really feel like my left leg was stepping up on anything, but definitely the right felt like it had to drop a little farther to hit the ground than I was expecting each time. I stood as tall and I could and looked down and realized that I really couldn't stretch my legs properly.. My heart started racing and I grabbed my walker again, just in case. I could lock my right knee, but only if my left knee remained bent quite a bit. Oh great! I thought.. My left knee is messed up! That would explain the pain in my knee, shin, and ankle from earlier.. But, no.. That wasn't it. I actually could lock my left knee, but it raises my right heel about an inch off the ground! That's when I remembered reading that the operated leg could be lengthened or shortened by a few millimeters and there wasn't much that could be done to avoid such a minor discrepancy. But, this. This is way more that a few millimeters. An inch at least, judging by the distance my right foot has to raise in order to lock my left knee.

It was too late on a Friday night to try to call the doctor and I wouldn't have a chance to speak to anyone about it until Monday morning so I did what anyone with the internet would do in my situation. I googled it. I intentionally avoided forums and news articles and blogs about it and focused directly on medical journals and peer reviewed scientific studies. It turns out that while it is true that about 5 mm is the average of a leg lengthening from a THA, a lot of the time, patients perceive a "feeling" of a much longer leg than what it really is due to having been used to the gait from the limp before surgery, among other things. So, I tried some other ways to perceive it. Sitting straight up in my rental hip chair with my feet matched up side by side, and with my back flat against the back of the seat, I could very clearly see that my left knee sticks out WAY farther than 5 mm from the right knee. Now I can actually perceive it with my eyes and it's not just a "feeling". I also stood back against the wall with a pencil held firmly atop my head and heels and butt against the wall, I made a mark while standing as tall as I could on only my left leg with locked knee. Without moving my body or changing anything else, made another mark while standing as tall as I could on only my right leg with locked knee. With a ruler, I measured 31 mm between the marks. My right leg mark was 31 millimeters higher than the left one. Not 5 mm. Not even 10 mm. 31! That's about an inch and a quarter... Will I forever have to walk with one platform shoe? Can nerves stretch that far for long before becoming damaged? Is THAT where the waves of pain in my lower leg and the short bouts of pins and needles is coming from?

And here we are, the next day.. Depressed as hell when I planned for this day to be one to celebrate. Completely abstaining from any of my pain meds and able to walk without support. I should be happy... I showed my wife and redid the wall measuring experiment in front of her for the same results. With secret tears in her eyes she tries to reassure me that it's probably normal and it could settle or something. I hope she's right. I'm not convinced that she is. I hope it's just pelvic tilt or something like that, but I feel like the way I measured it against the wall eliminated most of those kinds of variables. I know the only real way to be sure is to have an xray done on both legs and measure those. But I still have to go at least another whole day feeling like this before I can even call the doctors office.

What can I do? What can they do? Assuming it really is 31 mm, will they be willing to go back in before the bone starts to fuse and make the adjustment? Will they just say, oh well, wear a special shoe? Will I try to sue them? I read that experts say anything over 15 mm is considered substantial enough to win a lawsuit, but I don't want to do that, I just want them to fix it. Will insurance even cover a revision so soon? Should it be done on their dime anyway because they are the ones that messed it up? Am I freaking out for no reason? Is my freaking out and getting depressed a side effect of quitting my opiates so quickly? *sigh* I don't know what to do, but I know I will not be satisfied if there really is such a large discrepancy.
 
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Jaycey

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Welcome to BoneSmart! First let me reassure you that nearly every new hippie feels this leg length difference. In most cases this feeling eases with time. Muscles atrophy pre-op when you are limping around try to stay off a sore hip. And yes, most people develop pelvic tilt.

Give this time to settle - at least 3-4 months before doing anything. At that time if you still have this feeling see a good PT or podiatrist for an accurate measurement. Here's an article from our Library Leg length differential - LLD .

I'll also leave you with our recovery guidelines. The articles may answer questions you have about this journey.
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
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

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.
 

Mojo333

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Hi @LimpyStimpy and welcome to the forum.
I'm sorry this situation is stressing you out...especially after the long recovery you describe after your fibular graft on right hip.

Could you please supply the dates for your surgeries...so we can add these to your signature.

Wondering ...Have you noticed any muscle issues / atrophy with your leg that had fibula removed?
I'm not very familiar with this procedure although there have been a few members over the years that have had this procedure.

I'm glad it is one day Only until you can try to schedule an appointment as I can imagine some xrays would definitely be helpful.
 
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LimpyStimpy

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Could you please supply the dates for your surgeries...so we can add these to your signature.
Sure, my right hip graft was July 20 2015 and my left hip arthroplasty was Jan 21 2020

Also, no I don't really detect any atrophy or muscle issues in place of the removed fibula besides occasional soreness at the sites of the remaining end pieces (if that makes sense). Other than that, the only discomfort at this point is if I try to cross my legs such that my right calf is resting on my left shin. The missing bone makes it feel really weird and I try to avoid it.
 
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Mojo333

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Thanks.:ok:
I hate that this LLD issue is causing you so much anxiety with you being less than 2 weeks out from THR.:unsure:

You sound like you have done exceptionally well with this recovery and already off the pain killers!...although these are still early days with lots of healing happening.

I agree the difference does sound concerning but I do think you will do yourself a favor by not driving you (and poor wife) crazy all day today by trying to measure it and we all know the stressors of Over Googling.:umm:

I think your concerns are valid but try to concentrate on relaxing and icing to keep the internal swelling at bay.:ice:

Sending healing vibes your way and hoping you can manage to have a peaceful Sunday.
 

MsJunebug

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I had my THR January 15th. The first night I had the pain/spasms running down to my knee and beyond. When I mentioned it to my OS the next morning, he said it is not uncommon and usually only last a few days. It was gone by the second night.

The feeling of LLD drove me crazy from the first step but in the last week it has subsided to the point I rarely notice it. Hang in there and don’t panic. Three different PTs told me this is totally normal.
 

Sheffield1966

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I had my first hip replacement in 2003, the second on 20/1/20. Back in 2003 I was borderline suicidal because I was absolutely certain my leg was a good few inches too long. I completely threw my toys out of the pram. Guess what? It sorted itself out in the following weeks. I'm 12 days in on the second hip and I've made a vow not to fret until the end of March. I'm sore, my hip looks like a battleship on the right but heigh ho let's hope it settles down, am confident it will
 
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LimpyStimpy

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So I just had my first follow-up after surgery and had my staples removed. My issues with potential "real" LLD have not been solved. My actual doctor wasn't even at this appointment, either. It was his APN who led the meeting in his place. I brought up my worry about LLD and he took one look and confirmed it, almost excitedly, as if I would think it's funny. Though the odd thing is that he determined this by lying me down on my back and comparing my heels. I read in so many places that you cannot check it that way because of pelvic tilt, but he seemed so immediately confident that there is at least a good inch of discrepancy. I mentioned pelvic tilt and he said that's not really a thing and it's just something chiropractors say to get business and warned me not to let any chiropractor touch my hip. So he gave me a shoe insert for my other leg and sent me on my way even more confused than I was going in. The only attempt at consolation he gave me was mention of the fact that eventually my right hip will need replaced and they can match them up at that time. what?
 

Jaycey

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Well I really don't think that APN handled this very well. He might not be concerned but should have shown a bit of empathy!

If I were you I would not use the lift in your shoe yet. You need to give this 3-4 months from your surgery date. In many cases this feeling eases. Then find a good podiatrist or physio who can measure you correctly. The article I left you earlier shows how this should be done.

And no - I don't agree with his comment about pelvic tilt. It is real and he shouldn't just brush this off.

Please keep us updated!
 

leejaa

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My OS and his PA both said to wait at least 3m before checking for LLD since your body has to settle into its new walking pattern and position especially if you have been limping for a while and also the hip has to settle in. This was really early to do such a quick check and give you a shoe lift. This was my second hip and at first I did feel off balance and I know they did measurements to equal me out with my other replaced hip which did have a 1/8" discrepancy. This resolved without me noticing once I was up and about and not limping. I had been using a cane and not walking properly for about 8m and it plays havoc on the rest of your body.

I hope some of your LLD resolves with time.
 

Layla

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Happy One Month Anniversary! :wave:
I hope you've been doing well since you last posted and you're willing to wait on worrying about the LLD just yet. It's still early days and things may settle into place over the next couple months. Wishing you a wonderful weekend!
@LimpyStimpy
 

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