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Old 09-16-2012, 06:34 PM
Stan Shmenge is offline
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After total hip replacement, operated leg is easily 1/2" shorter. We are not happy!


It is making her walk with a bad gait. If she sits in a chair, you can see that one knee is shorter than the other. If she takes her flat sandal off her good leg, she walks almost normally. Surgeon says stuff like "she was like that before" and " maybe in a few months when everything stabilizes, it will be even." But when asked what to do now, he said, "get some lifts at CVS."

Is this within the normal range considered acceptable? Is there any alternative at this point? We are especially concerned that the spine will be a future source of trouble if she is always off kilter. She doesn't wear shoes at home, so lifts don't do her much good there.

I would appreciate anyone with personal experience with this.
  #2  
Old 09-16-2012, 07:46 PM
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The Mayo Clinic lists it as a possible risk.
Quote:
Change in leg length. Your surgeon takes steps to avoid the problem, but occasionally a new hip may make one leg longer or shorter than the other. Sometimes this is caused by weakness in the muscles surrounding the hip. In this case, progressively strengthening and stretching those muscles can make the hip more stable.
ETA: It's not uncommon to have a leg length difference naturally, she may have had a shorter leg on that side to begin with and the surgery made it even shorter.

Last edited by running coach; 09-16-2012 at 07:48 PM.
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Old 09-16-2012, 07:47 PM
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the few people I know that have had hip replacement usually complain of the opposite problem - that the operated leg feels longer - but is usually passes. if lifts don't help or are not a viable option, you can always opt to have another surgery to correct the issue.
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Old 09-16-2012, 09:02 PM
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User complaints are a critical part of medical product and service quality assurance.

Complain, in writing, to the hospital, the surgeon, the hip manufacturer, and the FDA. You can probably file a report on line with the FDA.

This may be a normal variation in the product or surgery, or it may be a nonconformance. No-one will know unless users provide the information for trending.
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Old 09-16-2012, 09:10 PM
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Probably unhelpful and insufficiently relevant anecdote ahead:

My brother broke his femur near the growth plate twenty years ago--when he was a teen. Surgeon anticipated that the broken bone would grow extra long, and compensated for it.

Bone didn't. Leg is half an inch shorter.

Brother has a lift--one made by a real shoe repairman type--which he uses most of the time he wears shoes. And when he's been measured for a tux, he's been told he should tell them he's got different length legs.

Otherwise, no big.

Of course, he was probably a lot younger, and therefore more adaptable.
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Old 09-16-2012, 09:29 PM
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If she sits in a chair with feet in the floor, her knees are at different heights? That means her lower legs are of different lengths. It says nothing about her upper legs or hips.

Did I understand you right?
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Old 09-16-2012, 09:51 PM
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One of the steps that should be performed during hip surgery is a leg-length check. The surgeons do this after the hip implant is in place but before closing the tissues so they can make adjustments to the components if necessary. It's possible that a half-inch discrepancy would not be apparent in the OR, or her surgeon could have skipped that step or misjudged the lengths. I think it would be wise for your mother to see another orthopedic surgeon (not from the same office) for a second opinion. It is much easier to correct or compensate for the discrepancy early in the postop course, so I don't think a wait-and-see approach is a good idea, and the CVS lifts suggestion is, IMHO, crazy talk.

Of course, keep in mind that IANAD.
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Old 09-17-2012, 12:50 AM
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Talk with a good physical therapist about your concerns.

Did she work with a therapist at least a few times after her surgery? Start there, or if you've got some sort of sport & spine rehab facility nearby, see if you can get an evaulation there. I recently had several visits with a physical therapist for a hip alignment issue (unrelated to a hip replacement), and came away from each visit with specific exercises to improve my gait and joint stability. Good luck.

Last edited by justpassingthrough; 09-17-2012 at 12:53 AM.
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Old 09-17-2012, 10:47 AM
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I have one leg 5/8" short due to a farm accident when I was twenty. Now, thirty-five years later, I wear a built-up shoe on my short leg. This is a bit of a pain when replacing shoes, but not a major one. I would suspect that it could be more of a problem for women, given the much greater diversity in shoe styles.

However, I went thirty years with one short leg, and all I can say to anyone with a similar problem is, do NOT ignore it! In the short term, the body compensates for the discrepancy. In the long term, the compensation itself causes all sorts of joint and back problems. Best to avoid them by wearing the appropriate adaptive equipment.
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Old 09-17-2012, 12:27 PM
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Quote:
Originally Posted by Napier View Post
If she sits in a chair with feet in the floor, her knees are at different heights? That means her lower legs are of different lengths. It says nothing about her upper legs or hips.

Did I understand you right?
Possibly the OP meant that one knee was closer to the body (ie, the upper leg was shorter, or in closer). I'd go with your interpretation without context, but assuming that the OP is making any sense, it must be the other way, right?
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Old 09-17-2012, 03:41 PM
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Possibly relevant anecdote: My mother-in-law had hip replacement surgery about 15 years ago. After the surgery, she was walking with severe limp. Surgeon said, "Oh, that's just a side effect of the surgery - it will go away." A while later, it had not gone away and she went to a different doctor. New doctor says, "Your surgeon didn't attach one of the tendons [or ligaments or whatever] properly and knew he screwed up. Now it's too late to correct it." Plus, the old surgeon had kept telling her that everything was fine, so the statue of limitations for a malpractice suit had expired. She still has a limp, severe enough that she walks with a cane and has a handicapped placard for her car.

So my advice would be, if something seems off, get a second opinion. That way either your worries are assuaged or you find out that something is indeed wrong and hopefully get it corrected before it's too late.
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Old 09-17-2012, 08:57 PM
Stan Shmenge is offline
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Quote:
Originally Posted by Sudden Kestrel View Post
I think it would be wise for your mother
She's my girlfriend. Good thing she doesn't read these!

Quote:
Originally Posted by iamthewalrus(:3= View Post
Possibly the OP meant that one knee was closer to the body (ie, the upper leg was shorter, or in closer). I'd go with your interpretation without context, but assuming that the OP is making any sense, it must be the other way, right?
Yes, exactly. One knee sticks out farther.
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Old 09-17-2012, 09:09 PM
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Quote:
Originally Posted by Stan Shmenge View Post
She's my girlfriend. Good thing she doesn't read these!
Waha! I could've sworn I read "mother" in your post. My unexpressed but still heartfelt apologies to your GF . (My advice for a second opinion still stands, though.)
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Old 09-18-2012, 07:52 AM
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My company sees this a lot - leg length discrepancy after hip surgery. I've done lifts as small as 1/4 inch and as large as 3 inches (the latter for post-traumatic industrial accident, not hip replacement)

The surgeon's suggestion to just get something at CVS I find rather disturbing. While some people can do well with off-the-shelf stuff many benefit from actual shoe lifts. If the leg length issue doesn't resolve in post-surgical rehab she should be evaluated by someone who actually knows about this issue rather than a hip surgeon who, however good he may be as a hip surgeon, apparently is a bit clueless on the long-term care and management of mismatched legs and gait problems.

Quote:
Originally Posted by BrotherCadfael View Post
I have one leg 5/8" short due to a farm accident when I was twenty. Now, thirty-five years later, I wear a built-up shoe on my short leg. This is a bit of a pain when replacing shoes, but not a major one. I would suspect that it could be more of a problem for women, given the much greater diversity in shoe styles.
Also drives those of us who do the shoe modifications nuts, too. Worst was the post-surgery woman who claimed a collection of high heels about 3-4 inches each numbering in the hundreds who just could not deal with the notion that no, she was never going to be wearing any of them again, and no, none of them could be modified sufficiently for them to be compatible with her now-impaired ability to walk.

MOST shoes we can add a lift to, even many with heels, but yes, the diversity of women's styles is a complication. We'll still try to find a way to make it happen.

The other bad news is that either adding a lift to a shoe or making a custom insert for your shoes is NOT cheap. I'm sorry about that, but there is significant labor involved in such customization. However, a well made lift will make walking easier and prevent all sorts of joint and back pain so although the price tag is a pain in the ass many if not most find there are some real benefits there.
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Old 09-19-2012, 03:16 PM
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I talked to an orthopedist friend of mine who's done hundreds of these surgeries, and he says that up to an inch of leg length discrepancy is common after even the most carefully planned surgery, and generally is not a problem in the long run. He makes sure to warn patients ahead of time about it.

A big part of the problem is that when the hip is worn out, a lot of the connecting structures that hold it in place are likewise fibrotic and retracted. So even before surgery there's often a discrepancy due to that (assuming the other hip isn't as retracted). That retraction and fibrosis may or may not get altered significantly during the surgery, and the surrounding connective tissue may or may not further contract (or even relax) during healing.

So it's not like trying to make one wooden plank match up with another one; it's a very dynamic, changing, plastic system that is being forcibly restructured by Mr. Surgeon, and leg length variations are more the norm than the exception.

That's not to say that the discrepancy couldn't be a sign of a bad complication such as infection or hip failure. But generally that's not the case.

Best take your questions to the operative surgeon first. If dissatisfied with the answers, then seek other opinions if you wish. But know that leg length discrepancy is an expected outcome, usually compensated for without exceptional interventions after standard therapy and healing times are completed.
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Old 09-19-2012, 03:41 PM
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Due to an accident when I was 17 where some of my femur was pulverized my left leg is an inch and a half shorter. I've been told by 2 orthopedic surgeons a 1/2 inch is within the range the body can compensate for. The prescription for my lift is 1 inch. It requires I buy shoes then have them modified adding 60-100 dollars to every pair of shoes I buy.
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