Short Leg after Hip Replacement: Email Advice

This AP Pelvic Standing Xray is not that of the patient in question

Recently had THR (total hip replacement) surgery and experiencing severe Short Leg Syndrome - Should I go to my surgeon and suggest correcting this asap?


Regards,

Dr Blake's comment: 

     Thanks so very much for your email and I am sorry for your predicament. We experience a feeling of one leg being longer for many reasons which include tight muscles, weak muscles, pelvic tilts, limping from pain, and true short legs. A slight short leg structurally can be magnified in feeling by one or two of the other problems produced by the surgical treatment. I relie on the Standing AP Pelvic xray in normal stance to give me as much information on the structural difference in hip heights that your body must deal with when you walk, and the pelvic tilts, including any sacral base unevenness at the base of the spine. You take this information and combine it with the data collected from a physical therapist on muscle tightness and weakness patterns to further get a strong picture on what is going on. Then you ascertain if gait is influenced by pain, weakness, tightness, or spinal sway above. Spinal Sway places severe stress on the operated hip and documented as limb dominance to one side. In summary, most of my patients I see following hip replacement have a combination of structural shortness and functional shortness (related to muscles, scar, pain, scoliosis, etc). It can take a good year post hip replacement to gradually work out the problems. As a podiatrist, I can measure things, and make observations, but relie on PTs and physiatrists, chiropractors, and osteopaths to help me in treatment. Surgeons are smart, but you really need a non surgeon spine specialist to help you work through the functional part before imparting on perhaps hasty and unnecessary surgery. That being said, you must start at the beginning with a standing AP Pelvic xray and get that interpreted. Hope this helps you. Rich

Hip Replacements: The Search for the Even Leg Lengths

Hip Replacement Surgery and Short Leg Syndrome

     Once you have had hip replacement surgery, there are incredible muscle and soft tissue weaknesses and tightnesses to overcome. Physical Therapists are key in correcting the soft tissue/muscular problems which develop due to surgery. Remember, all joints are weaker after surgery and need to be restrengthened.

     Yet, hip replacement surgery, in my estimation, leaves most patients with a short leg. Unfortunately, the xray shown above is not commonly done preop, so the surgery itself may be lessening the difference. But, in treating patients post hip replacement surgery, treatment of their short leg with lifts can be an extremely helpful part of their progress. I do try to save radiation as much as possible, but these Standing AP Pelvic Xrays can be vital at establishing the exact amount of leg length difference to start Lift Therapy.

Hip Replacement Complication: Short Leg Syndrome

A common problem after hip replacement surgery that I have to deal with is short leg syndrome. I am asked by the doctors involved, or the patients, to give a lift to the short leg. I will discuss the treatment of short legs in many posts, and there are several links below. I will use this patient I saw yesterday to drive home the point. Due to right hip pain, Shirley had a right hip replacement 4 years ago, and 6 years ago she had had a low back fusion at L4/L5. Following the right hip replacement, her back began to be painful again. Presently, she would describe her pain as level 8 on a scale of 0 to 10. She was sent by her pain management specialist, a physiatrist who felt she had one leg longer. After hip replacement surgery, it is tough to get accurate landmarks with palpation, so I routinely order a Standing AP Pelvic xray to get the hip joint heights, the slant of the base of the spine (sacral base unleveling), the lowering of multiple pelvic landmarks, and the lean of the spine to the right or left. In this case, the spine leans to the left, the sacral base drops to the left, and the left hip joint is approximately 7/8 inches shorter than the right. Lift therapy has just been initiated and we have a long haul in front of us after 4 years post surgery.

http://www.drblakeshealingsole.com/2010/10/short-leg-syndrome-advice-for-treatment.html

http://www.drblakeshealingsole.com/2010/11/top-100-biomechanical-guideline-10-know.html

http://www.drblakeshealingsole.com/2010/09/short-leg-heel-lifts-vs-full-length.html

http://www.drblakeshealingsole.com/2010/04/toenail-clippings4-dominance-seen-in.html

http://www.drblakeshealingsole.com/2010/04/toenail-clippings3-shoe-lift-for-short.html