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Re: leg length discrepancy after total hip replacement
Thu Aug 27, 2009 5:41am

Susan,

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 1/8" leg length discrepancy which at first seemed immense. It has been over 7 years since my hip replacement and this small leg length discrepancy does not affect me in anyway. I do not have any type of a limp and I have a large collection of high heel shoes which I wear regularly. I've pasted some techniques for accelerating the realignment of your pelvis below.

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. See if you can find a chiropractor who is experienced in 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. You can also look on line for an Egoscue clinic in your area or take part in their on-line therapy program.

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 and realignment.

Pauline


  • 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
    • Re: leg length discrepancy after total hip replacement — Pauline, Thu Aug 27 5:41am
    • 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 JointsElisabeth, Sat Jul 3 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... more
    • 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
        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 ... 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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