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Author Topic: Leg Length Difference  (Read 25273 times)

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Luann

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Leg Length Difference
« on: June 28, 2010, 07:05:42 PM »
Hello all, Thanks for all the info. I was very distraut when, after having my hip resurfacing (45 yr female, right hip, C+, Dr Sparling WA) 3 weeks ago, I found that my resurfaced leg was about 3/4 of an inch longer! The Dr said I will learn to compensate and I must practice straightening my operated leg out when walking. I am still on crutches so this is not so hard. However, once I can walk without them (still 3 weeks away) I feel I will limp badly and feel very off balance with the discrepency. You have all taught me a lot and given me hope and the means to try and correct it.  Luann
F age 45 right hip C+ Dr.Sparling 6/02/10

Pat Walter

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Re: Leg Length Difference
« Reply #1 on: June 28, 2010, 07:15:43 PM »
Hi Luann

I am sorry to read your post.  I was always thought they could not lengthen your leg that much with a resurfacing.  Did your doctor tell you why that happened?  Did the acetabular cup not get set properly into your hip?  Since they take a little off your femur head, there is no way to lengthen the leg from there than I am aware of. Of course, I am not a doctor.

Are you sure it is that much longer or just feels longer?  Many people feel their operated leg is longer since there is a lot of swelling and your joint has been dislocated.

If you continue to have problems, I would eventually send a copy of your x-rays to several of the most expeirnced hip resurfacing surgeons to get some extra input.  

Please keep in touch and let us know how you are doing?

Pat
« Last Edit: June 28, 2010, 07:16:31 PM by Pat Walter »
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stevel

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Re: Leg Length Difference
« Reply #2 on: June 28, 2010, 08:11:08 PM »
Hi Luann,

My operated left leg was about 1.1 cm (7/16 inch) shorter according to the physical therapist.  Since I favored my right leg so much before surgery, my left leg was underdeveloped and was shorter with a tilt in the pelvis.  The Dr. advised continuing physical therapy and everything evened out after six months of physical therapy.
Steve
LBHR 60mm/54mm Dr Su 9/29/08 age 55
RBHR 60mm/54mm Dr Su 11/1/19 age 66

resurface

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Re: Leg Length Difference
« Reply #3 on: June 29, 2010, 01:13:39 PM »
Hi Luann

I had a similar discussion with my PT after week 3.  I originally put a small flat insert into my shoe.  I saw my doctor and told him I thought I had a descrepancy based upon my impressions and the PT.  He looked at the x-rays and measured.  No difference.  A few words to consider:

(1) it does take time for both sides to even out and it requires a great deal of stretching and muscle development.
(2) leg length cannot be determined precisely from a PT while you are lying on your back.  This per my surgeon.  It needs to be done based while evaluating your post-op -xrays.  In my case [if I recall] he measured from the lesser trochanter across.  It was near perfect.

At 8 weeks I see, nor do I feel any leg length difference and no insert.  Your case may be different but at least have your surgeon based it on the radiographs if this has not been done.

If it is 7/16, what is your surgeons recommendation?  Seems like that is a sinificant insert - IMHO.

Good luck to you...


Luann

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Re: Leg Length Difference
« Reply #4 on: June 30, 2010, 07:00:40 PM »
Hello again, Thank you for the replies!
 I have seen the Dr. only since surgery, at day 7 post op. I had noticed the length difference (longer on the resurf leg) since about day 3 post op. The PT's at the hospital just kept telling me that I needed to stretch it, and it would eventually get better. I was released from the hospital on day 4 with no PT help once at home, just a list of exercises I needed to do on my own.
 Once home, I was frustrated with the fact that if I stood straight up (with the help of my crutches) I could not completely straighten my operated leg without standing on my toes on the other. I finally put a small insert/lift into my non-op leg so I could pratice my walking exercises without the "standing on my toes" problem.
 The very next day I had that 7th day post op appt with the surgeon, Dr Sparling of WA. He has done abut 400 + resurf's and is reported to be one of the best in the OR/WA area. He, however, is not the most "chatty" Dr. out there, and I often have touble getting him to comment much on my conerns (at least to my satisfaction). I mentioned my leg length discovery, and he more or less souned like it was not going to be a problem, and that perhaps I was imagining it (due to some of the reasons you have all already mentioned). He absolutely did not want me to have the lift in my shoe, and made me take it out. He said I should practice standing up straight and "tilt" my pelvis to the right (right is my "longer" resurfaced side) and teach my body to compenste. I then showed him again how much I had to stand on my toes to straighten my operated leg and he then said  "well, maybe it is longer, we will just have to wait and see and then decide later if you need a lift".
 He never looked at the radiographs to check leg length. He didn't measure anything! Now, I do realize that I still have a lot of healing and PT to do (today I'm at exactly 4 weeks) but I try to do what the Dr said with tipping and straightening my pelvis to the right and it is so far near impossible. I have 2 more weeks on cruthes. I feel the real test will be when I get to walk without them. If I still have problems after I've had a week or two off of them, I am going to request from the Dr. more professionally delivered PT. I think if he Rx'd it then it will be paid for by my insurance.
 By the way, I had what I believe to be, a unique hip situation. Rather than the oseoarthritis "bone on bone" cariliage damage that many people have when having a hip prothesis, my cartilage was almost completely intact. My pain and imobility were due to profuse oseophytes or "bone spurs" that surrouned my joint and caught the liguments and tendons as the moved around it. It caused me moderate chronic pain, limp (leaning forward with my foot and leg turned outward) etc. Perhaps this had something to due with the outcome. Maybe there wasn't as much to "resurface away"?? Hard to ask the Dr., he gets impatient with me.
Anyway, to sum it up, after reading this discussion group, sounds like most hippes learn to walk in spite of it all. My Dr. sure didn't seem too worried. Hope this gives you more info. on my situation. Thank you again for all your help and concern, Luann
F age 45 right hip C+ Dr.Sparling 6/02/10

resurface

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Re: Leg Length Difference
« Reply #5 on: June 30, 2010, 07:34:30 PM »
Luann

Hi.  Sounds a bit odd to my ears.  Reminder - you are the patient.  Ask your questions regardless of his demeanor.  I too had more osteophytes than OA.  I would ask him to look at a post op radiograph and measure.  I also am a huge believer of PT.  I have placed almost all my exercises on this site under Hip Stories "New Hip on May 6th..."  These have all been prescribed by a PT who works with THR and resurfacing people.  I am 8 weeks out and expect to keep with the PT for 6 months, 2x a week plus my at home exercises. 

Anyway... good luck.  Ask your questions as you made a big committment to yourself with this surgery [implicitly so did your surgeon].

Luann

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Re: Leg Length Difference
« Reply #6 on: July 01, 2010, 07:15:39 PM »
Hi Hahn/resurface, Thank you agian for your help. I just read your "hip story" and some of your other entries to get a better picture of your experience.
 Yes, my Dr., Sparling WA, has been rated one of the top 10 in the country for HR (not sure, however, what critical group gets the credit for this... too long since I read it). I know for sure, in my area of Oregon and Washington, (I could not afford to travel) he is one of only two who have preformed 400+ or more. That is the reason I chose him. He is not, however, my first choice for "bedside manner". I have some "medical" training (just enough to be dangerous!) as I am a dental hygienist (RDH) and also went to massage therapy school. I do ask a lot of questions when I have an appt. (I keep notes) and even call them back if I forget anything. Last appt. I was personally offended when, after discussion about the lift I had put in my shoe and how I should learn to handle the length discrepency without it, he said in a rather mean way "Boy, you seem to have an answer for everything!" I must admit after that I backed off a bit with my questions and concerns. I refuse to let him intimidate me, though, and next appt. he'll get just as many questions (one being to please measure leg length by radiograph).Perhaps I'm just the "type A" typical refurace hippy you talked about before and want to fix and solve all my problems too soon. I actually feel that I am doing extremley well. I really feel very similar to your report of recovery.
 Sounds like you, too, are pretty used to being fit and athletic. I was a race horse jockey for many years in my younger day. I still train horses and cut and work cattle, as well as reining- a sport on horseback in which you spin, run hard and slide to a stop, etc. I am just dying to get back into the saddle, care for my horses, and feel fit again. I have very expensive horseflesh just vegetating out in the pasture right now, too!
 Your PT therapy sounds so much more intense and advanced than mine. Right now I still do not have permission (at 4 weeks) to lose my cruches for another 2 weeks (only 50% weight allowed). They said this is because they are waiting for the bone to strengthen around the implant (intergrate). I am doing (only on my own, no PT Rx'd ) what I consider to be quite "wimpy"  therapy: leg lifts, stretching, bending, riding my recumbant sat. bike, and walking about a mile a day (very tiring on the arms with crutches!). I liked your comment on sitting on both "butt bones". As I read it I realized I, too, was favoring my operated side and immediately evened out the weight.
 As I mentioned before, when Ifinaaly get released from the cruches, I will try to walk for awhile on my own. If I do not feel like the leg length issue is resolving, I am going to ask the Dr. to Rx some more professional PT. Hopefully he will not feel pressured by the insurance company and will recommend it for me.
 Please keep all us Newbies posted on your progress, it has helped me immensely.   Many thanks, Luann
F age 45 right hip C+ Dr.Sparling 6/02/10

Luann

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Re: Leg Length Difference
« Reply #7 on: August 12, 2010, 10:36:51 PM »
Hi all,
 I wanted to update, since I made the original post. I am now 10 weeks + out, and walking without assistance. This last week I have had major improvements. No limp, and appart from a little muscle tightness, no pain (however, when first standing from a sitting position, I do have some pain and limping for about 5 or 8 steps before I "warm-up" out of it ). Even though my leg still feels longer, I DO feel that I am walking quite normally.  So my fears that the length difference would effect my walking have thankfully not been realized. Anyone kind enough to evaluate my walking tell me this is, indeed true. So far I simply LOVE my HR!!! I haven't been able to walk normally for 4 or more years. Does this sound familiar?
 When I am simply standing in place, I do still feel that the operated leg is about 1/2" ??? longer. If I straighten that leg out completely, I must stand on tip-toe on my good leg. Not sure if someday I will feel better wearing a slight lift in my shoe or not. For now the Dr. says he would prefer I just get used to the difference.
 Love to all Hippies, Lu
F age 45 right hip C+ Dr.Sparling 6/02/10

gary2010

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Re: Leg Length Difference
« Reply #8 on: October 14, 2010, 09:45:53 AM »
Hi Luann,
the best person to sort out leg length problems, pelvic tilts and scoliosis is an experienced sports chiropractor, most of these problems can be corrected with adjustments and postural exercises which will improve your walking gait and running action. Left untreated, these imbalances tend to cause chronic low back or neck pain. Headaches, indigestion, lung congestion can all result from postural imbalance.
G

Luann

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Re: Leg Length Difference
« Reply #9 on: October 14, 2010, 08:28:29 PM »
Hi Gary,
 Thanks for the advice. However, this is not the kind of length difference that can be corrected with chiro. adjustments. The exercises could be of some help, but the length difference is due to actual length difference. It could only be corrected with more surgery (ie- a revision, a HR or THR on my other leg, etc.) The Dr's measured the actual bones and prothesis, and agreed that the operated leg is actually longer. I am about 5 months out now, and there is no difference in the "longer" than the day I came out of sx.
 I have learned to walk well, with no limp or indication of the length difference in my gait. It only bothers me when I stand for any length of time, as I cannot stand with both legs under me comfortably (it is almost 1/2 " longer). I am getting a lift (something the Dr said I could do if I wanted to) in a pair of shoes tomorrow, to see if I am more- or less- comfortable with it. By the way, I have some minor stiff and slightly sore days, but overall still can do anything I want at this point, with no real problems or ROM issues. Just not fun to stand (I find I must either spread my legs/feet wide apart to accomodate for the length difference, or simply "kick" my longer leg out in front of me, or bend my knee... doesn't hurt, just gets tiring to the leg I put all my weight on!) 
  Thank again, Gary, for caring!  Lu
F age 45 right hip C+ Dr.Sparling 6/02/10

gary2010

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Re: Leg Length Difference
« Reply #10 on: October 16, 2010, 07:55:58 PM »
I seem to have got off lightly then; I've battled my assymetry most of my life and it's all greatly improved since the op - I wonder what will happen when I have to get the other one done?

Luann

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Re: Leg Length Difference
« Reply #11 on: October 17, 2010, 04:47:57 PM »
Good question, I would discuss it with your Dr. Maybe my Dr was not as skilled? Or perhaps I just had some bad luck. Keep us informed. Lu
F age 45 right hip C+ Dr.Sparling 6/02/10

Tommy

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Re: Leg Length Difference
« Reply #12 on: October 17, 2010, 11:17:36 PM »
Luann
    This story sounds so familiar. I have a 1/4 inch length difference in my leg It makes me drag the leg when I run. Didn't notice this until I had my hip done, but apparently this was this way before surgery. My wife reminded me that during one pre op x-ray they said my pelvis looked tilted. After surgery I complained about having to stand with my legs spread, then got to looking at video and pictures as far back as 10 years and you can see my stance was not right. So far a lift has help a lot but can't find one that fills comfortable.
                       Tommy
Dr Tupper  LBHR  6/02/09
Oklahoma

John C

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Re: Leg Length Difference
« Reply #13 on: October 18, 2010, 03:36:41 AM »
Hi Luann,
A couple of thoughts from my experience:
My operated leg came out just under 4mm, or 1/8", longer, which I thought was very reasonable considering all of the grinding and hammering that goes on during the operation. I convinced myself that I felt this at first, but after a few months, it was no longer an issue in any way.
However, my mother had a THR, and her leg came out longer by closer to 1/2". This did cause her back trouble, and her orthopedist told her to get lifts put on all of her shoes (by having a shoe shop add thickness to the soles), which solved the problem.
Regarding your doctors comment about PTs not being able to measure leg length; my PT measured the distance from the iliac crest down to the ankle bone, and came out exact to the mm with what my surgeon had measured  by metal pins that he inserts at surgery to get exact measurements, and the PT did this with no hints from me.
So, my thought for you would to get your shoes raised on one side if you start having low back issues, and maybe consider doing so anyway to prevent them.
When all is said and done, getting a few shoes modified to match your great new hip is really not so bad.
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

Luann

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Re: Leg Length Difference
« Reply #14 on: October 19, 2010, 03:46:56 AM »
Hi John and Tommy,
 Thanks for all the advice and support. I have had lower back pain since I can remember (30 years or more), so this is already an issue. Now that my HR'd leg is longer, I'm afraid it will become even more of a problem!
 I appreciate the tips. I actuall will get the "lift" from the sole of the shoe, not from inserts. Went today to get them added to my Z-coils (anyone here ever try them? They are awesome, and no, I am not a rep or sales person) but wouldn't you know it, they were closed on vacation. After I get them added to the Z-coils, I will also look into one of those shops that can "bulk up" the heel of regular shoes.
 Thanks again guys, Lu
F age 45 right hip C+ Dr.Sparling 6/02/10

Lopsided

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Re: Leg Length Difference
« Reply #15 on: October 19, 2010, 11:37:22 AM »
Lu,

I do not understand why your hip has come out so much longer, and I am sorry to read this. I also have back problems, and know that a balanced pelvis helps a lot. Hopefully your horse riding helps a lot, as the length of your legs is less important. Do you forget the imbalance when you are riding?

Before my operation my leg was about a quarter to half an inch shorter, and even this I did not like. I asked the surgeon before the operation if he could fix this and he replied, "will be OK, you have a hip problem not a leglength problem." It turned out that after my operation, my pelvis is well balanced and my legs are the same length. Of course I am pleased about this, but I am wondering, does resurfacing often lengthen the leg, or did my surgeon allow for this, and what will happen when I eventually have to have the other hip done.

Keep well Lu.

D.


Proud To Be Dr. De Smet's First Uncemented Conserve Plus, Left, August 2010

Luann

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Re: Leg Length Difference
« Reply #16 on: October 19, 2010, 11:24:20 PM »
Hey Dan,
 Good questions. I have no idea how the Dr's can "fix" some leg lenght differences, make others worse, and then entirely create a problem, as in my case. I found this addressed on a couple other places on this website, too. Seems most people have a shorter HR'd leg, not longer as I do.
 Common sense tells me it just HAS to affect a person's overall balance and well being (esp. back issues). But then again my back has hurt for years (old racetrack injuries) and my legs were of equal length before HR. Hopefully your next surgery will not change your new found symetry. I would definitely discuss your concern with the the Dr who performs your next HR.
 You are right to guess that I do not notice it when I ride. I thought at first I might, as was prepared to have to lengthen a stirrup if needed. Must not be enough difference to notice in the saddle. I left my stirrups right where I always have.
 I will try again to get the shoe "lift" next week. I am anxious to be more comfortable when standing in lines, conversing with people while standing, etc.
 Hope your doing better still. For a while you were stuck on the plateau. Any change in altitude since?  Lu
F age 45 right hip C+ Dr.Sparling 6/02/10

Luann

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Re: Leg Length Difference
« Reply #17 on: October 23, 2010, 02:11:38 AM »
Hey hippies,
 Got the "lift" today. It is the kind that is part of the sole of the shoe (actually, as I mentioned before, I wear Z-coils, and the lift is a small circle of plastic that goes between the coil and the shoe) and not an insert. Anyway, WHAT A DIFFERENCE!! I have not been able to stand and stretch both legs out under me in 5 1/2 months! Walking is easier, too, even though I had learned to compensate while walking with the length difference.
 My Dr had left it up to me, whether or not to "fix" this difference. I gave it a gallant effort, but now I'm thinking I should have done this as soon as I learned to walk unaided after my HR.
 Can't wait to see if the little discomfort I still have left is helped by this newfound stance!

 Thanks to everyone on this site!! Luann
F age 45 right hip C+ Dr.Sparling 6/02/10

John C

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Re: Leg Length Difference
« Reply #18 on: October 23, 2010, 06:20:36 AM »
Luann,
Delighted to hear that the lifts have fixed the problem. As I mentioned earlier, it made all the difference for my mother when she put lifts on the sole of her shoes.
For the benefit of any future patients who encounter this issue, be sure to tell your doctor about your experience with the lifts Since he was not very supportive of the idea at first, I think that it is important for him to hear about how much it helped you, so that he can be more supportive next time.
Very happy to hear how well it worked out for you!
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

Luann

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Re: Leg Length Difference
« Reply #19 on: October 24, 2010, 06:02:28 PM »
Thanks John,  I will tell the Dr. how much it has helped. I see him again sometime after Thanksgiving. Thanks again for your advice. Lu
F age 45 right hip C+ Dr.Sparling 6/02/10

 

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