THR New THR and quite upsetting

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steveeasy

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Being rational. I know my leg is longer than the other. I can see it. my knee sticks out 2 inches further than the other one. I am not a medical expert so it may get shorter. Why did no one talk to me.? Did they even know.? After telling the PT my leg was longer and showing her she said I would see the surgeon in 2 weeks. I was then told 6 weeks and only a video conference.

So being rational or not, changes little what happened. I feel guilty for showing some frustration but I actually think I had little choice. Ive done too much and now need to rest. my body will heel itself. I have a meeting with my surgeon next week. My discharge papers show no problems so is it normal to actually come out with a longer leg. its not a sensation, I can understand why people get this with such trauma from major surgery. But does a surgeon actually keep an account it a patient has a problem. do they check leg lengths. Does he have a plan?. ive so many questions. going to see a GP today to show them. im like the leaning Tower of Pisa.

Steveeasy
 

Ocean

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My knee stuck out too, but that did resolve with time.
 

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I am all ears here! I am slightly more than eight months post anterior THR. Everyone told me to "wait" and the discrepancy "would likely" resolve. While mine is nowhere near two inches, it is about 12 mm. My neurologist acknowledges the limp and the difference (He's a man I trust and with whom I've had a good rapport over years).My PT is also exceptional. Any significant walking gives me what I'm told is gluteus medius, IT band issues and other strains. I also have some back pain. With this said, I got my own records and an absolute novice can see how much the pelvis is tilted. This was not the case before surgery. Similarly I have had cavalier care- but in my mind, perhaps the surgeon DiD think this would level out. Now, I do not even get a call back but the secretary gives me advice! So for you- it might level out to some extent as sometimes (and generally) this is an issue of muscles and soft tissues. But dont let yourself get gaslit either! So onto what has helped: 1) getting a lift after a few months of injuries to the other areas 2) maintaining a level of safe exercise (swim daily and do some mild PT) 3)getting a more "official "lift from another pracitioner in a few days. I will never go to another surgeon that has not been in practice in the local community for such a very very brief time having recently joined the practice. It has been quite an emotional learning experience for me. But I will firmly tell you that I am walking better though I do injure myself easily with the discrepancy. Also my other foot experienced ongoing paresthesias which persist yet are not quite as bad- but not at ALL taken lightly by my neuro. Most complaints totally dismissed by the ortho as well. If the ortho does not have a plan, see if you can find a rehab doctor who is willing to work with you. You are still very early with all of this and much may level out but seek out advocacy as others have suggested.
 

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Hi @steveeasy . I am sorry to hear that you have had such a worrying start to your recovery. It is tough to have your valid concerns brushed aside by the people who should be caring for you. How are you feeling now?

Sending hugs.
 
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steveeasy

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Good Morning,
9 days g6ne and I am finding it far more difficult to progress at all. I still have a leg that is nearly 50mm longer than the other one. visually I can see this as when seated the knee sticks out further. when I stand on left leg my right foot wont touch the ground unless I tip toe.

The only pain is in my thigh that will not reduce no matter if I ice or rest. Infact it just gets worse at present. I cant lift the leg as the thigh muscle is clearly not right. I woke this morning and suddenly it dawned on me no wonder why it is so tight and not recovering. its been stretched. if my leg is two inches longer then so must the muscle now be.

I wish I knew the answers to the many questions rolling around in my head. Ive spoken with PAL and all they told me was if there has been a mistake then the hospital that has done this must correct it. no other surgeons would. now that made no sense either. Infact quite frankly nothing has made any sense at all.

Ill might know a bit more in a week but i am starting to have less trust in anything i am told now. not that ive been told anything. still chin up at least im not in pain and mentally feeling ok.

Best Wishes
Steveeasy
 

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I cant lift the leg as the thigh muscle is clearly not right.
We call this log leg. Nearly everyone feels this when first out of surgery. The muscles just don't engage. Just give it time. This will ease fairly quickly.

Have you spoken to your surgeon yet? You might want to request a meeting - or at least a phone call.
 
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steveeasy

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I cant lift the leg as the thigh muscle is clearly not right.
We call this log leg. Nearly everyone feels this when first out of surgery. The muscles just don't engage. Just give it time. This will ease fairly quickly.

Have you spoken to your surgeon yet? You might want to request a meeting - or at least a phone call.
Meeting on wednesday. looking forward to that. Its difficult dealing in life with trivial matters. I can just imagine how this is going to go. I cant think of any possible reason for my leg to be extended that long and not tell me why. not mention it in the notes.

Log leg. yes thanks for this. ive just researched it and how to manage it. I use my sticks to move the leg about. I thought it was the Trauma of the operation. it dissapeared slightly yesterday afternoon and I could walk better with my sticks. returned quickly though.

You have to experiance things to understand the guidance offered. time and rest and it will heal itself. then try and build on that with gradual excercise.



Many thanks

Steveeasy
 
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Klassy

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time and rest and it will heal itself. then try and build on that with gradual excercise.
I do think that is right. I would add, frequent ice, and maybe, later in your recovery, if still stiff and sore after 2 months say, an occasional heat pack and gentle massage.

I had my two hips done privately because of the wait for NHS. Two different surgeons and private hospital companies because I moved 200 miles in between. I got a bit more handholding than you have from the private system, for my £25,000 odd, but not much. Saw my first OS before, immediately after when I was too dopy to interact, and at 6 weeks. Saw my second OS before, a few days after, 10 weeks after and 6 months after. The 6 month follow up was a mere formality because I was so good by then.

First surgeon said my leg would feel longer but it wouldn’t actually be longer. First (left) leg did indeed feel about an inch longer post-op but the sensation gradually passed. Not much thigh pain as I recall. No log leg.

Second surgeon said my second (right) leg had been much shorter, and he had lengthened it. He showed me my pre and post hip X-rays and laid a ruler across the key points to demonstrate that there was a downward slope that he had corrected. I don’t think it had been shorter for much time, ie I don’t believe that the first OS had left me with a discrepancy. I suspect it happened in the the last few months, during which time that hip became too painful to walk on. If the discrepancy was there at my pre op consultation, which was several months before the op (my choice to wait, I had things I needed to do), he didn’t mention it, or any plans to lengthen the leg.

After the second hip, I had log leg for weeks and considerable pain in the front of my thigh. It was so bad in the hospital that I was literally chewing the bedclothes one night because the night nurse wouldn’t give me ice or more pain relief. Once I got home to a constant supply of ice and my own drug schedule, it was much better. I told the OS that I had much more pain than after the first hip, and he just shrugged and mumbled something along the lines of, it was to be expected. I don’t think bedside manner is a big part of the surgical training!

So I think that the difference between my two operations is that the second one involved lengthening, and that caused more thigh pain and swelling. The recovery was slower to start with. This seems to fit your description. The good news for you is that, after a tougher start, my second recovery was quicker than my first. In fact, my only major setback, caused by overdoing it, was strain to the left ( first) leg. Even better news is that both my hips are wonderful now.

I think you said that your other hip needs doing, and I hope you can get that done soon. In the meantime, please don’t overdo the walking or other exercises even when your post op leg feels great, or you may have a painful wait.

I think that you also said that the medics didn’t seem to care which hip you had done. I am sure that they could have explained this better, but it may be that both hips showed similar arthritic damage. And only you can say how much they are hurting, and therefore which one needs the most urgent attention.

My journey has been expensive and involved frustration and discomfort and lots of worry ( much relieved by finding this forum) and a short period of pain. But worth it a million* times over, to be pain free and mobile. I hope your story has a similar happy ending.

*well, maybe not a million times £25,000. That could be tricky to find down the back of the sofa. Though I believe Bill Gates is currently single …
 
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steveeasy

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Klassy,
Can I just say thank you for your post. very interesting read. I went private with no hand holding. Not a word spoken to me. from that to such a big discrepancy in leg lengths equals quite a poor performance bordering on something worse. im sure a graph could be made with leg length discrepancy and handholding performance. not that I wanted my hand being held. I wanted reasonable behaviour.

My left hip was always the worst but 3 months before surgery my other hip became more painful and I lost the strength in the leg. discussed with GP and told to discuss with post op. did they said probably xray prior to surgery. then had call saying they would do either one just remind surgeon on day. sorry its a bit to casual for my liking but I get the idea.

Anyway ive good news id like to share , its a miracle Ive just removed the insoles of 3 shoes and added them all to my short leg. Hey presto. I can walk no pain. no limp. So for the interim ill get some shoes suitable for the discrepancy, the insoles are collapsing with not quite enough support . I can feel when I have the other hip done which might be in 6 weeks e can just extend the other leg. easy.

planned or unplanned!!

Steveeasy.
 
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Ocean

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@steveeasy, I’m glad that you have found a temporary solution to your pain.

I didn’t have log leg with my first hip replacement but with this one I am experiencing this, plus more pain than before. I think maybe this is due to my surgeon evening up the leg length.

I also paid privately for my hips because I’d waited so long with the NHS. I chose the same Consultant whose list I was on for the NHS, so the surgery was the same, just a little more time spent with the surgeon post op really.

Take care.
 
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steveeasy

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Correct one thing and get another. im sat with my insoles in my shoes able to walk, but now my Laptop wont sit level on my lap. its 10-15 degrees of horizontal. Thats crazy but totally expected if my hip bone is longer. not sure what will happen if I try and eat spaghetti bolonaise on my lap with my shoes on.
Steveeasy
 

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subie2021

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@steveeasy Looks like you need to stick some insoles into your pants' back pocket until the swelling in that opposite butt cheek goes down. :heehee:

But for real, I hope all your problems soon resolve. Best wishes for easier days ahead.
 

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Hi @steveeasy,
I am in the US so not the same healthcare system. I had my robot assisted surgery on 9/12 to fix osteoarthritis due to hip dysplasia

Here is my timeline in case it helps.

December 2021 had steroid shot in hip. Relief lasted 2 weeks. The local Pain Managent doc suggested a surgeon in their practice (20 min from me) who did robot assisted hip replacements. But this doc did posterior incisions.

I wanted an anterior incision if possible. No movement restrictions, no muscle cut, faster recovery. He gave me the name of another doc who was in the same healthcare network (40 min from me) but did either approach with the robot. That was all I needed!

Here is the general guidine of the what my doc did.

I met w his PA and had an xray Feb 2022.
Confirmed bone on bone. Only fix is a new hip.

I had my initial appt w the surgeon in March 2022. He had a model of a hip and showed me where the problems were with mine on the xray. Then showed the bionic parts and how they fit together. Also mentioned how the new hips look good on xray at 20+ yrs so I might never need another one! Described the advantages of the robot and how it was guided by CT scan data. I am an engineer so all of this was right in my wheelhouse. There is nothing cooler than robots!

I scheduled the surgery for 9/12 because that was when my boyfriend had a block of his vacation to stay w me for 3 weeks to recover.

A checklist was mailed to me by the scheduling nurse of what other appointments I would need before surgery. Fitness for surgery signoff by my primary care, etc

CT Scan was 8/8. Had to be repeated on 9/9 because there was an issue w the original data (this is not typical)

At my pre-op appt on 8/30 he had me stand on blocks to level out my hip. The height was a little larger number than the original xray indicated. 2 nurses went over the discharge instructions w me. They gave me the antibacterial cleansing cloths.

I cringed when I read your description! There is nothing that my doc farmed out to PAs or nurses or med students. He even called my boyfriend from the OR to let him know things had gone smoothly.
 
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steveeasy

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So do I.

my initial meeting with the surgeon lasted less than 5 mins. He said he did two types, little old ladies and active. Yes thats fine. stuck a sticker on file and walked off. he never came back.

Pre op.
Some funny nurse. people kept coming in. she was laughing and joking. told me it was posh but I could not have (Cant publish this bit) as it is offensice. . I could not believe it but it was what was said.. could not even discuss my anesthetic. the really crazy thing is I then told the NHS, my Dr. another surgeon and PALs which monitors and supports patients of my concerns. They all reassured me.

I make no misrepresentations here. thePT at the hospital thought it funny. when I eventually went a little crazy being told id not meet the surgeon in 6 weeks but get a zoom call. I broke out furious a hospital could be so utterly poor. Even then the PT was talking to admin staff saying. dont they Jill all come out with long legs.

3 months ago I was active. doing arial rescue training on poles. tree climber and worked every day until the day before surgery. Im not sure if ill work again. It was a private posh hospital and I was an NHS patient and the hospital were paid by the NHS. my very worst fers came true. I got a very third class service.
Still there might be a good reason for it. im sure he will come up with an excuse. even if there is why not tell me.

Steveeasy
 

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Hi Steve,
I was nowhere near as active as you were prior to surgery. I am 52 but had to walk with a cane.

Little old ladies I guess means a glued or cemented implant. Active likely means normal implant in strong bone.

But I did aerobics classes for many years when I was younger 3x a week for 15 yrs.

I got the bionic hip of a young active person. Not the woman needing a cane to walk. With the robot there was more precise position of the components. My leg length was checked w a HANA table.

Post surgery I had no pain. The hospital nurses were awesome. Always helpful and kind. I could finally straighten my right leg and they were even. Some bruising and swelling which flared up and faded over the first 3 weeks.

I felt so strong that I quit the pain pills, icing and elevating. Dumb move! I was not superwoman after all. A cape did not appear in my closet

When I get pain it is on the OP side only. It is very localized pain between the knee and the hip. Or groin pain as a signal I did too much.

No pain in the hip itself which has felt very strong from Day 1.

I expect ALL of this is my body getting used to the bionic parts.

You definitely want to let any swelling taper off before trying to measure for an LLD. Hips take time unfortunately.

Mine was corrected by 7mm. There is still about 5mm difference but nothing that isn't fixable w a shoe insert or heel lift.

I hope yours settles down asap.
 

Klassy

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Hi @steveeasy , I am glad that you have a temporary fix with the insoles.

That was an interesting summary of your conversations with the staff, very poor communications. I’m not excusing them at all, but the really important thing for you is the work that was done inside your leg, and will be soon for leg 2. There is no reason for you to think that work wasn’t done well. It feels dismissive when hip replacements etc are described as “routine surgery”, nothing routine to us patients about the experience! But to the staff it IS routine, we are just one of umpteen standard procedures, and they have loads of experience, which we benefit from.

Once you are through this recovery there will be years of pain free active life ahead. Have a look for the recovery thread by @Giddsy1 for someone a bit more like you than little old lady me ;-) . He is back to work at a physical job with his new hip.
 

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Re: "my knee sticks out nearly 2 inches more than the other one" -

I had much the same experience with my 2nd , ( left)THR on 16 May 2022, as some on here will remember! I too am in uk and had it done on the NHS. I only saw this surgeon once, never to be seen again! whereas first hip I saw surgeon several times and he seemed genuinely interested. To start with one knee was much forward and leg felt much longer, I kept ringing orthopaedic team physio in person who assured me legs were now the same length, and this forum explained it is a common perception. It has largely gone now and I am able to walk fairly normally but I do have a sacroiliac joint problem for which NHS has offered physio plus I am seeing a McTimoney Chiropractor later this week to see if he can help with pelvic adjustment. I had to really push with NHS physio to accept there was an S I problem, but I believe that unfortunately it is quite common after THR. I do keep asking why I didn't have this problem with the first hip and I think maybe some surgeons are just better than others, and in the NHS we can't always choose (well, I would have had to wait longer for my first surgeon!). But who knows, maybe just the luck of the draw? Anyway @steveeasy it does get better and the leg length differential sensation does subside. But if not, maybe consider some private adjustment like a chiropractor to help rebalance the pelvis. I will report on my own post how the chiropractor treatment goes! (On the plus side I restart teaching my yoga classes this week so can't be that bad!!!!) Good luck and stay positive.
 
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steveeasy

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Hi,
moving forward slowly. Log Leg. from a seated position I cant lift my leg of the ground at all. very tight in the morning and painful after any walking. Can anyone identify which is the Muscle traumatised by the surgery. Post op I could not move my foot at all forward. i used my toes to walk the foot on the floor. 12 days in its not a lot better if at all. less swelling and less fluid in the foot. I wonder if stretching the muscle by 2 inches has made it hard. Just trying to understand what and why. I appreciate exercise might well not be the way forward at present.

Thanks
steveeasy
 
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lanstan

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Dont know where to put this but it sure explains a lot about the muscles involved.https://youtu.be/qlCvKEOZtpo
 

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