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Don't Despair
Tue Jun 29, 2004 9:34am

Don’t despair about your early post-op leg length discrepancy. Permanent leg length discrepancy after hip replacement cannot properly be assessed before 6-8 weeks post-op and sometimes longer. Trauma and twisting of the pelvis during hip replacement surgery can often result in swelling and muscle spasms in the pelvic area and a pelvic tilt that appears to be a leg length discrepancy. The pelvis articulates with the sacrum and that SI joint being out of alignment can wreak havoc on the leveling of your pelvis. Usually the whole area, lower back and SI joints are in need of adjustment.

You can begin working on pelvic realignment doing a simple exercise while lying in bed with knees bent and feet flat on the bed.
1) Lift the hips off the bed about 6-10 inches. Then slowly lower the back by rolling down through the spine and lowering one vertebra at a time, then raise the hips by rolling up through the spine lifting one vertebra at a time.
2)With hips lifted off the bed alternate pressing each hip toward the ceiling.

Once I received my release from post-op precautions I did additional pelvic work on the floor while lying on my back, feet up on the wall or sofa with a 90 degree bend at the hips and knees and doing several exercises:
1) Lift the hips off the floor and gently rock the pelvis by pressing the pubic bone toward the ceiling and then pressing the pubic bone toward floor.
2) Lift pelvis off floor with weight on your feet (feet can be flat on floor as well as elevated on sofa or wall), press hips toward ceiling, alternate pressing one hip toward ceiling and then the other.
3) While standing make a figure eight with your hips. This was very difficult at first but definitely helped to get flexibility back in my pelvis.

There is a technique called SOT or "Sacro-Occipital-Technique". This is a very large school of thought and this technique is widely known. This technique is a very comprehensive full body alignment technique and employs the use of wedge shaped blocks on which the person comfortably lies. As the person relaxes, gravity helps realign the sacrum, pelvis and lower back. This can be an excellent technique for people with a pelvic tilt. When you're looking for a chiropractor, ask his secretary what technique he uses, and see if you can find one who does SOT.

There is also an incredible do-it yourself program available in the book "The Egoscue Method of Health Through Motion”. You can buy the book and do two simple exercises: The "Static Back" and "Supine Groin Progressive". These exercises are specifically designed to straighten out the lower back, to balance the pelvis on the sacrum and to realign the femurs in the hip sockets.

Acupuncture when artfully used can cause muscles spasms to relax and nerves to balance out, resulting in a more aligned spine. Massage can locate "trigger" points from which whole groups of muscles can be released from spasm.

Elisabeth reported on a successful technique utilized by her physical therapist to correct leg length discrepancy. “My physical therapist identified a forward rotation of my right ilium (about five months after right THR) and had me work with her to correct it, in one fell swoop. I lay on my back, right knee raised; she wove her arms under that knee and over the other; then I bore down with the right leg while working to raise the left leg off the table. We both felt a pop. (Luckily, the sound came from my pelvis--not her arms!) She measured my leg length again and found a half-inch reduction of the one-inch discrepancy. She called this technique a muscle energy technique. She said good, licensed osteopaths also know these techniques. I felt much more limber afterward.”

I’m not an advocate of using heel lifts in your shoes in the early stage after hip replacement. The use of a heel lift may actually encourage a pelvic tilt that could be corrected over time.

Best wishes with your recovery, realignment and rediscovery of high heel shoes.

Pauline




  • ME TOO leg length!!!Emily, Tue Jun 29 7:10am
    I had the same thing happen to me just a few weeks ago. But my difference is the operated leg is 3/4 INCH longer...The doc (Dr. Klapper, LA) told me 'yuo might want to put a half in ch lifet..." I... more
    • metric conversionElisabeth, Fri Jul 2 11:28pm
      "Three cm is tiny.Really nothing to woory about." FYI, 3 centimeters equals 1.1811 inches.
    • Don't Despair — Pauline, Tue Jun 29 9:34am
      • Leg Length DiscrepancyDr Swanson, Wed Jun 30 5:45am
        Post-op leg length discrepancy usually occurs due to post-op swelling, and sometimes tensioning of the abductor muscles if the prosthesis has more offset than the patient's pre-op offset; or if the... more
        • Leg length Dis. Pain getting worseMargaret Smith, Thu Nov 2 9:37am
          It has now been 8 mnths since my RTH replacement I have a metal on metal hip done through the 2 incision mini hip aproach. I am 3/4" long on operative side. I am having increasing pain on standing... more
          • Leg Length DiscrepancyDr. Swanson, Mon Nov 6 5:20am
            Ms. Smith, From your radiographs, it appears that your right hip is approximately 1cm longer than the left. However, clinically, you feel like you have a much larger discrepancy. We call this a... more
        • 1.7 cm LLD following a THRerin, Fri Feb 24 10:13am
          I have an actual leg length discrepancy of 3/4 inch following a THR two years ago. I understand that there is an inherent risk of a LLD following a THR. I need to know what is an acceptable amount?... more
          • Re: 1.7 cm LLD following a THRPauline, Fri Feb 24 4:28pm
            Dr. Swanson addressed this issue in this post http://disc.server.com/discussion.cgi?disc=216603;article=187;title=Mini%20Total%20Hip%20Replacement%20by%20Todd%20V.%20Swanson%20M.D . Best Wishes,... more
        • Dr. Swanson, Thank you for your reply. If the discrepancy is still significant after a three month period, what is the next step to having it repaired? Should my orthopedic surgeon agree to do a... more
          • Dr Swanson's ReplyPauline, Tue Jul 13 11:02pm
            Susan, Dr Swanson has been teaching in Europe, however, I sent a SOS that we need his expertise here in the good old US of A and he provided this information. Most patients can accommodate a leg... more
            • leg length discrepancyDr. Swanson, Fri Jul 16 5:14pm
              I'm back in town. Pauline did a good job paraphrasing my response to leg length discrepancies. However, there is 1 error: only approximately 10-20% of my patients with leg length discrepancies... more
          • Answer the question please doctorKarl, Mon Jul 12 9:49pm
            My father has also experienced the discrepancy in leg length (2 cm) after THR in Atlanta, GA. He has been met with resistance from the doctor that performed the surgery and others with the only... more
            • Dr Swanson's RepllyPauline, Tue Jul 13 11:11pm
              Karl, Please see Dr Swanson's reply regarding revision to correct leg length discrepancy above. He also mentioned that in your father's case, age would be a definite factor in weighing the benefits... more
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