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Leg Lengths
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wayne.jpg (14363 bytes)Leg Length Differences
after THR surgery

by Wayne B,  New Orleans, LA
Member of Totally Hip since Spring of 1997
Bi-Lateral THR patient

Hi Linda and all you Hippies and friends,

Two different people have recently been digging and found a note I wrote in the Newsletter on July 15, 1998.

One was Lizz, who was one of the first members of Totally Hip when Linda founded it. I was so impressed. Neither one of us frequently write to post in the Newsletter....but here we are still being of help to each other!  Thank you Linda....the lights shine and just never go out. God still blesses.

To answer the questions some of you have put to me about that posting so far away:

  • Exercise is vital, whether you are getting ready for THR, trying to postpone THR, or recovery from THR. 
  • My surgeon says it takes about a year for all the tissues to fully heal in the area and get adequate strength back in the muscles affected by hip pain.

Unhappy that I am back to work at the office 60 or so hours a week with barely time to speed read the newsletter and hardly have time to write once in a while.....but happy that I am basically pain free in both hips now that I had my other side done this past summer.

  • I do credit my faster recovery on the last one with the fact that I got in some pool exercises before and everyday for 2 months after surgery. I still do what I can, but there are now so few free hours!!
  • I used 2 of those "noodles" they sell at Wal-Mart, etc. and moved my legs in all directions I could, with avoiding certain moves with my side that already had a THR from the previous year. (They also have belts like Aqua-Joggers for flotation exercises. Santa are you hearing this?)
  • The major muscles to try to build are the ABDUCTORS, that move your leg from a standing position out to the sides as far as you can. You can do that while standing along the side of the pool, holding on to the side, and do this exercise.
  • Also I did both of them together like a frog, while floating with my armpits hanging over the noodles.
  • Also you need to build your butt muscles, the GLUTEALS ---all these help keep the artificial hips in their sockets and prevents dislocation!!!
  • You can find all kinds of positions with the noodles, including while using some of the pool steps as props. Doing what you can with every joint, including knees....while not bearing your full weight in the pool setting,  is just wonderful for pain relief. Plus you can build the muscles without full weight bearing.
  • This is all that I did, but your case is likely different than mine and needs to be given to you by your doctor or by a physical therapist under the doctors orders.
  • There are tons of books on pool exercises, but some are dangerous for people after THR,  especially when one side is THR and the other side is not. You have to choose something that is safe for your type of THR.
  • Mine was a lateral approach, but sometimes...especially in revisions...they may need to use a posterior approach and you therefore may have additional or different precautions for your exercises after surgery than I did.
  • If bone grafting or other things specific to your case, they may not want you to do any weight bearing for a certain number of weeks. That may mean using something other than the pool for a while, unless they have a lift and a therapist to supervise.

This makes my point of using the pool as much as possible BEFORE surgery. You don't weigh as much when in the water so you can actually do more and hurt less.....plus you do not even have to wipe the perspiration away!

Each case is different. If your doctor does not go in big for rehab and PT, I would find another surgeon. EVERYBODY can benefit from rehab and PT in some way!!!!

My plan would be to:

  • Directly ask the new doctor for a paper showing pool exercises allowable for you, if you can get or have pool access. If they do not have one ask if you can get one from one of the physical therapists associated with their office. If no pool, ask for a paper showing exercises you can be doing at home.
  • Finally discuss what your plan will be for physical therapy after surgery (including pool therapy you can do on your own or under supervision of PT) and ask to go meet these people before surgery. This way you know where the facility is located and meet these fine people. They are the ones that will really help you make the surgery a great success.
  • Let the surgeon know you want to work hard physically on making the surgery an outstanding success.
  • Ask if the hospital your surgeon uses has a Hip Class that you could attend prior to surgery.  If so, you could also address pre-op exercises and see what you can expect when in the hospital. There is nothing like meeting and talking to real hippies. Chances are that someone at those classes will have had surgery done by your surgeon, as well as someone will at least be a hippy already, or knows someone who had THR in that hospital at least. No matter how tough we are.....always helps to know the hospital a little before you go for your surgery there.

Hope this all helps a bit and answers some of your questions. I am now happy I spent the time writing what I did back on July 15, 1998!   Soon this will be added to the archives on Hippy Newsletter Library, but since I have requests to see it ....I will post it at the end of this note. It was in response to someone who was having trouble understanding the issues.

Good exercise can often help the surgeon prevent you from having such leg length problems.

See links on Linda's www.totallyhip.org home page for Exercise, and Other HIP sites on the web.

Here is the pertinent part of that July 15, 1998 newsletter post:

Seems I am lucky and have little or no problem with leg length discrepancy, but it may take a few more months before I know, as I am still somewhat tilted with my pelvis (some of which I hope can be fixed by PT and exercises). My doc says it takes about a year to see the full potential of the rehabilitated muscles after a THR. He recommends working with PT a long time on any leg length problem before putting an insert in a shoe, as often the cause is related to several other factors.

My surgeon wrote a THR handout for his patients, and here is what it warns us about leg length problems:

"It may be necessary to lengthen the leg in order to maintain stability at the hip site. If the soft tissues are lax, it increases the potential of dislocation. Therefore, it may be necessary to actually lengthen the leg in order to get enough tension on the soft tissues surrounding the hip replacement that it decreases the potential of dislocation. If a leg length discrepancy is encountered, in most cases we can compensate for this by a correcting lift or insert" (in the shoe). .......this tells why I wrote the paragraph below:

Thanks, Doc for doing another wonderful surgical job. I tried to do my part and work on my abductors and quads a lot more before this left THR so as to make the muscles and tissues as tight as possible. Last time I was not able to do the kind of exercises that would have helped tighten them very much. I had waited, and waited, until really both hips rather than one needed THR. Now I understand more about why one should not wait SO long for a THR when the pain is already significantly altering one's lifestyle and happiness. It is that we get lax with our muscles and tissues because the pain limits our activities more than we think sometimes. This increases the chance that the surgeon will leave you with one leg longer than the other, just to make the THR tight enough so it will not easily dislocate.

I have seen a lot of complaints and concerns in Linda's Hippy Newsletter since I joined in 1997 about one leg being too short or long after THR. These are likely not surgical errors or else it would either be so tight one could not move their leg without tearing muscles or tendons, or it would be so loose it would dislocate easily. Also because of the pain, we can have some flexion contractures that may limit how much freedom the surgeon has to lengthen a particular leg while doing a THR.

This also makes some of us have "pelvic obliquity" which is a tilted pelvis, often more on one side than the other. This may make it appear that the THR made the leg length problem worse, and thus more noticeable AFTER the surgery. If the spine is tilted or twisted to one side (sometimes congenital and sometimes due to arthritis of the spine) this also may cause a pelvic tilt. (Fortunately I was able to increase my "apparent" right leg length by almost 3/4 inch SLOWLY OVER 6 MONTHS with pelvic tilt exercises concentrating on one side after my first THR)

The first THR helped me have much less back problems once I got the pelvis to partially correct. My doc said it will NOT do its full correction until after this other side was fixed and I got some PT under my belt. (This suggests that waiting too long for THR can lead to leg length and back problems????) This is why good PT is essential after most THR's, as some of these fixable/adjustable problems might be solved for the most part, in the right hands. Otherwise some of us would be going around with a large lift in one of our shoes, complaining about the lousy job our surgeon did, and looking for a lawyer to sue the surgeon. The most common cause is likely the body that the surgeon had to work with, quite possibly because we postponed the THR too long and we got too debilitated in the old bod. (OR... some of us might have a twisted body for other reasons...just need to remember those things can affect leg lengths too).

My surgeon believes PT is essential for giving a patient the best shot at overcoming all those problems mentioned above. I am standing up straight now for the first time in years, and pain free in the hips! Don't you think I am going to have pain from PT and exercises to get my twisted body back in some kind of normal posture? YES, and full results will only be seen after I can stop using a cane and get to normal weight bearing and walking. But this pain is good...it will go away with exercise and the healing process...helped greatly by going in the pool hanging on to a couple of foam "noodles" and getting that soreness worked out with some exercises.

MAKE your doc order PT as much as you can get or afford after THR!!

Well, for me, after 6 weeks of out-patient PT 3 times a week, he ordered me to continue PT twice a week for the next 2 months.

 

Well that is the article I wrote on July 15, 1998, 6 weeks after my THR for the other side.  It is still what I would say today.

Hippy Hugs,
Wayne

 

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