I am a 51 year old female who had my right hip replaced on Sep 3, 2003. I am now 7 weeks into recovery and have been advised by my Physical Therapist to start walking without a cane. I am having some difficulty with this and was wondering if the problem is being caused by the fact that my right leg is now 1/4 inch longer than my left leg. I had my left hip replaced in Jan 2003. Is limping a normal part of recuperation after hip replacement? I have used a cane for support for 2 years and am looking forward to walking without assistance soon. I have been discharged from physical therapy but continue to do the exercises 3x a day. Thank you for your help. Joanne

-- Joanne Long (joannelong@comcast.net), October 23, 2003

Answers

Hi Joanne,

Having just had 2 hip replacements 5 months apart (November 2002 and April 2003) and spending my whole period of recovery on the internet researching hip replacement etc. there is not much I don't know medically about the procedure and its effect on the human body. I do know from a personal stand-point that a length discrepancy of 1/4 inch is not abnormal. I had a leg length discrepancy between the two surgeries of over 1 inch due to my condition (coxa vara). I am appalled that your physiotherapist is pushing you to get rid of your cane- I would suggest you ditch your PT and keep the cane until you no longer have a limp ( the cane is not causing your limp). You need to see a qualified kinesiologist who can diagnose which of your muscles are weak, which are tight and analyze your gait. I still have a major gait problem, which is only now being corrected since I started seeing a qualified physiotherapist. Like you, I was told to get rid of my walking devices and "walk straight". Unless you know what is wrong, you can't fix it. As you have been walking abnormally for some time, it will take a lot of mental work to reprogramme your brain to learn to walk properly with your new hips. It is very difficult and requires tons of patience. Also 7 weeks is not long post-operatively for you to be doing any strenuous activity since your hip is probably uncemented, with weak surrounding muscles and you need to let the bone grow onto the prosthesis over the next 6-12 months. If you have the time to surf the internet, a good website is "totaljoints/info.com" for everything you ever wanted to know about hips but were afraid to ask! Good luck with your new job- as that is what rehab is! Do yourself a favour and find yourself a qualified physiotherapist who can help with your gait retraining (I had no luck with publicly funded physio and the cost of private care is well worth it!)

The two modalities used in my new physio rehab programme are Pilates to strengthen the core abdominal muscles and IMS (intra-muscular stimulation) to release too-tight leg muscles and ilio-tibial bands. Both of these subjects are covered extensively on the web- Happy Surfing...

-- christina delottinville (seamoregirl@hotmail.com), October 27, 2003.

Wow! some of these stories are incredible,,,I had my left hip done six months ago and because of a bad placement I was 1 and 1/2 inches taller, It caused alot of back pain and of course a severe limp. I had my second hip done 6 weeks ago by the same surgeon as he said it would correct the leg lenght diff, Well maybe it did but now I have severe nerve damage and am in more pain than ever,,,,constant pain I have a foot drop and no control over foot, cant turn to left,right or up,I cannot walk without a walker and am at my wits end, Dr says it will get better but hasnt even taken an exray or really told me what happened, I am going to see a specialist next week,His specialty is physical medicine and rehabilitaion, I am losing faith, I really wish all of you good luck with your recovery but I think we are on our own

Diane

-- diane pennamen (aladin806@peoplepc.com), December 09, 2003.

I've been advised that the website I indicated was incorrect regarding hip replacement info. Try "totaljoints.info/hip". Sorry for the inconvenience.

-- christina delottinville (seamoregirl@hotmail.com), December 19, 2003.

You should visit this website: http://www.niams.nih.gov/hi/topics/hip/hiprepqa.htm

-- Robert Toussie (Robert Toussie @aol.com), March 15, 2004.

On Jan 27'2003 I had a right THR and came out 1 and a 1/2 inches longer than when I went in. Of course when I kept telling them this in the hosp they kept telling me that it was just a sense and it would go away. Well it didn't go away , it did get a little better after my physical therapist did whats called mobs.The overlengthening caused severe pelvic obliquity(crooked pelvis). My muscles were so tight they actually moved my pelvis out of place. Mobs is when the physical therapist trys to from the outside slowly move the pelvis back where it belongs. It went back a little ways and then the insurance said i couldn't go to physical therapy anymore so that was the end of that. Now 6 months later my discrepency is starting to get worse again. I can tell because the shoes i had altered so that i could stand and walk straight don't fit as well anymore. The doctor who did the surgery has never been any help. I think their afraid if they help you their admitting they did something wrong.Theyv'e been complete asses! Please excuse the language ,I think sometimes it's harder to deal with the anger part of it than the physical. Especially if you have a doctor that runs the other way.The surgery also caused severe nerve and muscle damage which i deal with through pain meds. The nerve damage got better after7 months,thank god. I'm seeing some awesome doctors in Boston to have a ilius tibiul band release surgery,were hoping that it will give me some pain relief so that I can start walking the malls with my daughter again without feeling like i have lead in my leg and pain in my hip,leg and back. I also need to start building up the muscles in my leg. My other choice was a group of docs in philadelphia for a total revision which is way to risky. I'd love to hear from someone, it will be nice to be able to talk to someone whos going through the same thing. Did any of you have your THR because you had protrusio acetabuler? Well thank you for listening,I hope your all doing better. Take care, Evelyn

-- Evelyn Eaton (atsmarshall@aol.com), March 20, 2004.

I am 54 years old and have had minimally invasive hip surgery approximately 8 weeks ago by a world famous MIS surgeon in Pittsburgh. When I went to pt for the first time the therapist was appalled that my operated leg was over an inch longer than the other leg. It has also been angled to the left below the knee. My knees are not even, I had to have an injection of cortisone in my knee because the way I tried to walk caused bursitis and I have excrutiating lower back pain. My surgeon has been of no help. I have been to 3 other doctors to try to get some help. This procedure is so new that there doesn't seem to be any help out there. I am extremely unstable. After seeing my surgery 4 weeks after the surgery he demanded that I not even move from the crutches to the cane, but walk unaided. I told him to try walking with one leg over an inch longer than the other without aid. He ignored more. I am very frustrated. If you find any help please pass it on. Thanks.

-- enid porter (mystery@pulsenet.com), March 24, 2004.

Disclosure: I am the inventor and manufacturer of a heel lift product.

That said, I have a short leg myself, and have done a lot of research on the topic. I offer a couple of documents on choosing and using heel lifts as compensation for moderate leg length differences, which are very common after hip or knee replacement, and can cause all sorts of related problems.

Check out http://www.clearlyadjustable.com/leg-length-discrepancy.html and http://www.clearlyadjustable.com/selecting.html for information on selecting appropriate products for your needs.

-- Rick Zehr (rzehr@clearlyadjustable.com), April 16, 2004.

Hi Joanne,

I'm a physical therapist and find that a 1/4" leg length inequality can have a significant impact on function and comfort. If the right leg was shorter than the left leg before the surgery (and I have no way to know whether this is the case), the relative difference will be magnified since your spine, pelvis, ankle and really every other joint in the body is used to the other leg being longer. Either way, I think it makes sense to try a heel lift, if only to make it easier to swing the right leg forward while walking, ideally with the consultation of a physical therapist who understands leg-length- inequality. I like the clearly adjustable heel lift (clearlyadjustable.com).

IF the physical therapist is recomending you progress to walking without the cane, it is not unreasonable to have a therapist help you achieve that goal, rather than just stating the goal.

Regards, Bill Gallagher PT, CMT,CYT Director, East West Rehabilitation Institute 202 west 88th street (212) 781-2626

Instructor in Clinical Physical Therapy Columbia University New York City

-- Bill Gallagher PT, CMT, CYT (bill@eastwestrehab.com), September 19, 2004.