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Elisabeth
see Total Joints
Sat Jul 3, 2004 12:03am

Susan, please see the detailed explanation about leg-length discrepancy at Total Joints, which comes to us from Sweden in quirky English translation:
http://www.totaljoints.info/Long_leg_TH.htm

I can't imagine why an experienced PT or nurse would be at all surprised by such a discrepancy seen during the early post-op period.

My PT measured a 1" discrepancy on me at about four months post-op. I really hadn't noticed it. I was catching my toe and tripping often, but most of that was due to extreme weakness in my previously scarred hip flexors. As Pauline mentions, my PT was able to help me use my own strength to realign my pelvis--which made half the discrepancy vanish on the spot, according to her measurements. My lower back felt a lot better, but I still didn't notice anything in particular about leg length.

So an "acceptable" discrepancy relates partly to the patient's own perceptions. But hip replacement is complex reconstructive surgery, and even the best surgeon is limited by the geometry of the patient's skeleton (a high-riding dysplastic hip, for instance) and the need to create optimal tension on the soft tissues. Muscles are levers, and they can't work if they aren't taut. If the hip stem or offset is too short, important muscles will lie slack. The patient will experience a chronically weak hip with persistent limp, and the artificial hip may easily and repeatedly dislocate.

Revision surgery is undertaken only for catastrophic complications, since each surgery creates more muscle scarring and a higher risk of infection, besides the usual surgical risks (thromboembolism, respiratory problems, etc.).

Do read the information at Total Joints. I'm sure your hip will settle down with good PT and regular walking, and you'll do fine. Be sure your PT is licensed or certified; don't settle for an aide. I'm very lucky to have found a PT with a master's degree and a great deal of experience and dedication.

  • I am a very active 48 year old. I had a total hip replacement, due to CHD 11 days ago. Soon after I got home from what seemed like a successful surgery, I noticed that when I sat down, the knee on my ... more
    • leg length discrepancyDonna K., R.N., Tue Aug 25 9:32pm
      Susan- Although I didn't have a significant difference like yours early post-op, please be aware that this is very, very early to get worried about it being a permanent amount of discrepancy. Right... more
    • leg length discrepancyamyjane, Mon Mar 9 6:30am
      I have the exact same issue and have never been so miserable in my life. I'm two months out and they reassure me that it takes time. Additional x-rays have shown a trule 1/2 inch difference in the... more
      • leg length discrepancyAnonymous, Tue Aug 25 7:34pm
        hello.. I had a total hip and came out about 4 cm long on the operated side, that is about one and a half inches. I can not wear any of my shoes. I had to have the un-operated side built up in a huge ... more
        • leg length discrepency after thrAnonymous, Fri Apr 20 8:26am
          I am almost 3 months out after left thr. I was supposed to have both hips done at the same time, but due to complications, I have to go back in the future to have the right hip done. I could have... more
          • Please respondBrenda, Wed Sep 13 10:48pm
            I am not sure when this was posted, but please let me know of the outcome. i am 4 months past THR and my operated leg is 1/2 inches too long in actuality...but 2 inches in functional due to tilted... more
            • respondingkathy, Fri Sep 15 11:00am
              Hi, this site isn't really active anymore that I know of. I'm sorry to hear of issues. Leg length discrepancy is not uncommon. I have a slight one and use a lift in operated leg. I have had lots of... more
          • Re: leg length discrepency after thrPauline, Sun Apr 22 6:38am
            Thank you for sharing your story. This information will be of great assistance to others. Best Wishes, Pauline
    • leg length discrepancyBridget, Thu Jun 5 7:16pm
      I am going through the same thing. I had my THR on May 19 and I noticed my operated leg is much longer. Everyone keeps talking about shoe lifts or having my shoes rebuilt. It's not that easy for me.... more
      • question for Bridgetamyjane, Tue Apr 14 7:11am
        Bridget, Now that it's been awhile, have your legs evened out?
      • Re: leg length discrepancyPauline, Fri Jun 6 4:19am
        Bridget, You are still in the eary stages of recovery from hip replacement. Your body will be healing and realigning for some time. I have a small leg length discrepancy which at first seemed... more
        • HR rehabjh, Fri Apr 17 7:18pm
          Thank you so much for a very helpful message. I have ordered the book and will follow your pelvic exercises.
          • Re: HR rehabPauline, Sat Apr 18 7:34am
            Best wishes with your rehab. It has been 8 years since I had my hip replaced by Dr. Swanson. I have never had hip pain and my hip is incredibly stable. There is life after hip replacement - a... more
            • Re: HR rehabamyjane, Sun Apr 19 5:40am
              Pauline, How long did your recovery really take? At first I heard 3 months, now I hear 6-12 months? Just not sure what to expect? Thanks! Amy
              • RecoverySue, Mon Apr 20 8:01am
                Your recovery is in stages, you will not wake up and suddenly feel healed. You will start to see small changes even in the first couple of weeks and it will keep getting better. I am ten months out... more
              • Re: HR rehabPauline, Mon Apr 20 8:00am
                Amy, Recovery from hip replacement has different stages. At one week post-op I no longer took pain pills. At three weeks post-op I was able to return to work full time. I don't remember having any... more
    • 3/4 " discrepancyMargaret Smith, Mon Jun 26 8:20am
      I had this procedure done using the 2 insision approch, I am now longer on the operative leg the cut was performed a good bit above the lesser trocater was this done correctly,, this has been... more
      • Re: 3/4 " discrepancyPauline, Mon Jun 26 8:31am
        Margaret, I wouldn't rush into revision surgery just 4 months after surgery. Particularly, if your surgeon believes the leg length discrepancy is a muscular situation. Often times a pelvic tilt can... more
        • Re: 3/4 " discrepancyMargaret Smith, Mon Jun 26 1:31pm
          Thank You for your Promp response, I understand the risks involved with revision surgery as I am a n OR nurse and have seen it done many times.. I have gone for a second opinion becasuse my... more
          • Re: 3/4 " discrepancyPauline, Wed Jun 28 7:33am
            Margaret, A leg length discrepancy of 3/4" is significant enough to consider revision surgery. The unfortunate thing about the two incision approach is that it is a new surgical technique and most... more
    • see Total Joints — Elisabeth, Sat Jul 3 12:03am
    • 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 DespairPauline, Tue Jun 29 9:34am
        Donít 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 ... more
        • 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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