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Leg length difference results in weakness, tendonitis
I had a right hip replacement 2 years ago, and followed PT direction for all this time. The natural leg, right was 1cm shorter which may have added to the problem over time. I also have mild scoliosis leaning towards that direction. After the surgery, the right leg was 1 cm longer. I am 5ft and it was an immediate feeling of too high. The bigger problem was the inability to strengthen the right leg, and it is painful. I also have pain down my thigh. Resulted in ITBand tendonitis and bursitis, leg cramps when walking. Added a 1cm foot lift which aided the leg cramps but still a problem of strengthening the leg/groin area. The Dr is suggesting an injection in the groin and/or removing some tissue in that area. I have not been able to find anything about this type of treatment. It is my feeling the change in skeletal structure affected my overall muscle structure and no PT is able to address the problem. Is this a surgical solution only?
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@redbeets Welcome to Mayo Connect, where people meet to share their health journeys and support one another.
I feel your pain! After hip replacements (bilateral) I had a similar issue, and struggled for 4 years to understand it. My ortho at that time did not believe PT was necessary. 5 years later, the hip implants were recalled, and I had revision surgery - before I chose my surgeon, I asked "Do you prescribe PT" and he replied "Of course".
The new surgeon tried to adjust the leg length difference during revision surgery, but couldn't because all the muscles and tendons had stretched over time, creating a high risk of dislocation. SO he sent me to a specific PT Clinic, where individualized PT was done (it is part of a specialized orthopedic hospital that deals with both trauma and congenital issues.)
The PT's did a complete analysis of my spine, gait, tendency to "toe in", and overall strength. They prescribed a series of exercises, including pool therapy, to get me walking straight and strengthen the muscles on both sides. They explained that what was going on was a combination of the leg length difference, spinal compression, irritation (Tendonitis & bursitis) and all of the muscles (both legs and back) needing to relearn how to work together. It took 4 months of twice weekly sessions to get "back on my feet" without pain, then I had to continue the exercises for another six months. During PT I had some bouts of tendonitis & bursitis, which the surgeon managed with steroid injections so I could continue. Even now, 14 years later, I often get twinges of the former pain, and do the exercises for a few weeks. Or my husband sees me turning my toes in and reminds me.
Can you find such a PT in your area, and ask the surgeon to refer you?
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1 Reactionredbeets,
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-uneven-leg-length-after-hip-replacement-surgery/
The 1cm difference would change the dynamics of the spine over two years.
Uneven leg length often a result of scoliosis because of changes in the SI joint (maybe partially cause of the groin pain), can also advance scoliosis. I think you are right that the changes in skeletal structure limit the amount of help physical therapy can provide.
https://www.youtube.com/watch This is a video explanation of the changes to the left hip that could make your legs even.
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1 Reaction@sueinmn Thanks it does sound very similar to my situation. I have been to most of the local PT and have not found anyone that views this in the indepth way it needs to be. Are you able to give me the name of your PT location and perhaps I can get the methodology to share here.
Thanks for taking the time to respond
@gently
Thanks for your comments. I appreciate your willing ness to share similar situations. I do not need surgery on the other side--although it was mentioned that it could be resolved that way. I have also seen and had this explanation about measurement. It becomed an exercise in the surgeon explaining his approach. This is not meant as criticism just wanting to admit differences and how to resolve them 1 size does not ever fit all! It appears the orthopedic PT world does not realize that muscle memory formed over 75 years does not change that easily. Also mentioned to me was that there may be "too much" in the groin area creating part of the problem.
Have you heard of removing or "rearranging" tissue from that area?
@redbeets My PT was through the Courage Center in Minneapolis. There is not a methodology to share here - this is highly individualized and requires a Doctor of Physical Therapy to do it. You need to ask the local PT where such an option exists in your area - it may be some distance away, but they could design a program that could be executed locally using their treatment plan.
Muscle memory can be changed - it just takes time and determination. I'm not sure what "too much in the groin area means" - perhaps there is some sort of scar tissue?
@sueinmn
Thank you kindly for your input. I seem to be hitting a brick wall just trying to get an appointment with a revisionist surgeon.
I hope you still are able to enjoy life.
@redbeets, sorry. Nothing worse than getting on a patient site and hearing the same old thing the doctors recite.
I haven't heard of soft tissue revision on the replacement hip. There was a brief discussion here where a commenter finally found a doctor willing to do scar tissue removal on the replaced joint. But when she came out of surgery she found out that it became necessary to do a revision after all. She was very unhappy with the results, as you might imagine.
There is a procedure where they take lessen the tendon tension, but it doesn't seem helpful in your situation.
If you haven't already, you might send your images out to other surgeons for independent evaluation.
@geThanks intend to get a second opinion before I would have any surgery. I don't always take the physician's comments as gospel. I think this procedure would not be readily discussed with the patient/physician. They would have to state the cause which usually leads back to the replacement. Not every replacement is without problem--we are all built differently. What I can't agree with is an inability to recognize problems and look for a solution.