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Leg length difference after TKR! What can be done?

Posted by Mamie @mamie, May 12, 2018

My sister, who also has chronic venous insufficiency, had a total knee replacement at the end of February. Has been doing exercises, going to PT, but after more pains, her PT suggest she start using a cane. Pain in legs and lower back. Finally PT measured her and said her "new knee" leg is 1.6 inches!!! longer than the other one. She is devastated that she is now in worse pain than she was before TKR. She was told to build up the shoe of her shorter leg and find someone to add to the bottom of the shoe as well. Now she can't walk around barefoot anymore but has to put on shoes to ease the pain even a little. What can she do? Any suggestions?

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ellerbracke | @ellerbracke | Jul 4, 2019

There have been some discussions I recall about major problems with leg length differences after TKR, but I may have happen to have an insidious one, after 9 months post surgery. Seems like the actual leg length difference is only 1/4”, but after compensating for this during the span of many weeks it messed up my gait. Amazing how just this little bit of imbalance can cause problems. Currently I am following instructions on how to get both sides of my body in sinc. Orthotic inserts as an alternative. I’ll try much before that necessity. I like my (low-heel) stylish sandals.

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3 replies
Moderator
Colleen Young, Connect Director | @colleenyoung | Jul 4, 2019
In reply to @ellerbracke "There have been some discussions I recall about major problems with leg length differences after TKR,..." + (show)
@ellerbracke

There have been some discussions I recall about major problems with leg length differences after TKR, but I may have happen to have an insidious one, after 9 months post surgery. Seems like the actual leg length difference is only 1/4”, but after compensating for this during the span of many weeks it messed up my gait. Amazing how just this little bit of imbalance can cause problems. Currently I am following instructions on how to get both sides of my body in sinc. Orthotic inserts as an alternative. I’ll try much before that necessity. I like my (low-heel) stylish sandals.

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@ellerbracke, I moved your message to this existing discussion of the same name. I did this so that you can meet other members like @mamie @edithmiller @lturn9 and @merillo, who also are dealing with different leg lengths after joint replacement and ways to correct the gait.

Elle, is the difference causing referring pain elsewhere in your body? What exercises or ways are you getting the both sides of your body in sync?

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1 reply
lturn9 | @lturn9 | Jul 4, 2019
In reply to @ellerbracke "There have been some discussions I recall about major problems with leg length differences after TKR,..." + (show)
@ellerbracke

There have been some discussions I recall about major problems with leg length differences after TKR, but I may have happen to have an insidious one, after 9 months post surgery. Seems like the actual leg length difference is only 1/4”, but after compensating for this during the span of many weeks it messed up my gait. Amazing how just this little bit of imbalance can cause problems. Currently I am following instructions on how to get both sides of my body in sinc. Orthotic inserts as an alternative. I’ll try much before that necessity. I like my (low-heel) stylish sandals.

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Elle, With such a small difference (mine is about 3") PT should be able to get things working in the proper sync without inserts. Best of luck, You are in my prayers for a quick and satisfactory result. You're right about a small difference throwing you off! Good luck with your leg.

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lturn9 | @lturn9 | Jul 4, 2019
In reply to @mamie "Thanks, @gailfaith, for your comments. I am happy your bilateral TKRs went well and saddened that..." + (show)
@mamie

Thanks, @gailfaith, for your comments. I am happy your bilateral TKRs went well and saddened that you now have to use a walker after your accident.

Yes, my sister, who is in her early 60s, is having back problems because of the great difference now between the length of her legs. Is anyone aware of what leg length discrepancy (LLD) is below what could be considered the standard of care in a TKR? I've searched online for those who have had TKR and no one seems to come close to 1.6 inches. Almost all seem to have a half inch, with 1 inch seeming to be the largest LLD.

It's unfortunate that doctors don't seem to be held accountable for their mess-ups. Possible problems are never mentioned in all of the TKR marketing, nor did her doctor mention it when she made the customary one-consultation appointment to see if she needed a TKR.

Apparently you can't even build a shoe up that high with custom orthotics and why should she have to seek out and pay for custom shoes for life? She is devastated. If anyone has any information on what she could do to help herself, please post. Thanks.

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My thoughts and prayers go out for your sister, I have Peripheral Neuropathy and had 4 TKRs on my left leg. Not my L leg is approx 3" shorter than the other. I went to a orthotic shoe co and they made a shoe approx 3" greater in height. I have also had shoes modified as a local leather co so getting it done is not difficult. But for me, it is very difficult to walk with the shorter leg on a built up shoe. My ankle tries to roll over and even when it doesn't I feel like I am balancing on high heel shoes! Also, all my life I have worn 9-1/2 EE but after the problems with my legs I was told I should wear size 11 EE! I feel like I am in clown shoes. I was unstable and tripping over things but I changed to a size 10EE and it made a huge difference. Don't always believe everything doctors tell you. You know more about your body than they do. Pay attention to what is happening and make sure what they say makes sense,
Best wishes for a Happy 4th of July!

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lturn9 | @lturn9 | Jul 4, 2019
In reply to @mamie "Hi, @lturn9. I am so sorry to hear about the problems you are experiencing. It's so..." + (show)
@mamie

Hi, @lturn9. I am so sorry to hear about the problems you are experiencing. It's so baffling to think that orthopedic surgeons can do such things as shortening the bone without realizing how that would affect the patient afterwards. It's as if they are operating in a vacuum without awareness of the aftermath.
My sister was convinced that her leg length discrepancy brought on groin pains. But the ortho docs she consulted attribute those new pains to the need for another replacement -- this time her hip.
She also was told that what one doc measured as leg length discrepancy is actually just "perceived" since she has knock knees. Very confusing. But she has signed up for hip replacement next week.
For your situation, have you looked into MLS Laser Therapy for your neuropathy (that is if you meant diabetic neuropathy in your feet). Apparently the laser made by that company has shown that it improves that condition -- at least that's what its literature says:
http://www.celasers.com/medical/mls-laser-therapy/research
I have been getting MLS laser therapy from a chiropractor near me. It has helped pain in various areas because of my deteriorated hip. He also uses it to hit trigger points where my muscles are bunched.
As far as your leg length problem, have you looked into Feldenkrais? It's a way of movement that rewires your brain to allow your body to compensate and move differently.
Also, would stretching those muscles on the shorter leg - under the guidance of someone who might know specialized PT (perhaps for folks who have muscle diseases) help?
I wish you HOPE. Don't despair.
So far I am putting up with collapsed hip joint (which still does not hurt) but having more problems with all the compensating parts (ankle, back, knees, etc,)

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Thank you for the suggestions and kind thoughts. re: "Diabetic Neuropathy" Nope, I am not diabetic (Thank the Lord!) and my Neuropathy is Ideopathic (Unknown origin) and could have come from an infection in my past or some other incident. re: Your Sister's Hip, There must be a definitive test to determine if her Hip is actually bad? I hope she doesn't have it done then discover it was not necessary! But I'm sure the Doc would say, "Sorry" and refund the money! Yeah, right. Sorry, I've gotten cynical. ;-\ I just realized you posted last Fall so this caution reached you sister too late. I hope all went well?

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2 replies
ellerbracke | @ellerbracke | Jul 5, 2019
In reply to @colleenyoung "@ellerbracke, I moved your message to this existing discussion of the same name. I did this..." + (show)
@colleenyoung

@ellerbracke, I moved your message to this existing discussion of the same name. I did this so that you can meet other members like @mamie @edithmiller @lturn9 and @merillo, who also are dealing with different leg lengths after joint replacement and ways to correct the gait.

Elle, is the difference causing referring pain elsewhere in your body? What exercises or ways are you getting the both sides of your body in sync?

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Strangely enough it causes my left leg to tighten up. I don’t (can’t) take a full stride, the outside of the lower leg, the ankle, and the outside of the foot is painful, and at times the whole leg goes numb, the knee twinges... The exercises I was given aim to lengthen and loosen the muscles in the shorter leg, and tighten up the muscles in the TKR (right) leg. I am just really aggravated ..... initially it took me 4 + months to get my TKR leg fully extended, then I got hit with trochanteric bursitis on that side, and when I was finally pain free on the right, now the left acts up.
I am lucky that the length difference is so small, and probably fixable with PT, but it surprised me how much of an effect even a small discrepancy can have.

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JK | @contentandwell | Jul 8, 2019
In reply to @ellerbracke "There have been some discussions I recall about major problems with leg length differences after TKR,..." + (show)
@ellerbracke

There have been some discussions I recall about major problems with leg length differences after TKR, but I may have happen to have an insidious one, after 9 months post surgery. Seems like the actual leg length difference is only 1/4”, but after compensating for this during the span of many weeks it messed up my gait. Amazing how just this little bit of imbalance can cause problems. Currently I am following instructions on how to get both sides of my body in sinc. Orthotic inserts as an alternative. I’ll try much before that necessity. I like my (low-heel) stylish sandals.

Jump to this post

@ellerbracke Interestngly, many people do have a slight difference in leg length, naturally. I do and when I get the length of pants altered they have to take that into consideration. I guess when you have had two legs the same length all of your life and then that changes it is an adjustment though. I hope that PT will help you with that, I think that maybe part of it is simply adjusting to the difference.
JK

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1 reply
ellerbracke | @ellerbracke | Jul 9, 2019
In reply to @contentandwell "@ellerbracke Interestngly, many people do have a slight difference in leg length, naturally. I do and..." + (show)
@contentandwell

@ellerbracke Interestngly, many people do have a slight difference in leg length, naturally. I do and when I get the length of pants altered they have to take that into consideration. I guess when you have had two legs the same length all of your life and then that changes it is an adjustment though. I hope that PT will help you with that, I think that maybe part of it is simply adjusting to the difference.
JK

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@contentandwell : JK, I am not even certain that my legs were the same length before the TKR. They never gave me any problems before. Perhaps the almost 2 years of compensating for one sort of pain or another (knee, back, hip) has simply caused my muscles and tendons get out of whack, rather than that the surgery lengthened the leg. The result is the same, though - trouble walking normally. PT (5 days doing the exercises at home) does seem to help as far as relieving the tightness and pain in the left leg; unfortunately those exercises are tough on the TkR knee and the hip on that side, where I just got over the bursitis bout. There’s always something, I guess. Oh, to go back to the good young days of being 68, before this whole mess started!

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1 reply
lturn9 | @lturn9 | Jul 9, 2019
In reply to @edithmiller "I have had hip replacement, broken femur, and ending up with one leg longer than the..." + (show)
@edithmiller

I have had hip replacement, broken femur, and ending up with one leg longer than the other, I ha d surgery making them both the same length. My thinking in your case is to go some where like Mayo. They have done corrective surgery. I wouldn't mess with all the surgery that doctor wants you to go through..

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Thank you for those kind comments. Lately I have been considering amputation to be rid of this short, painful leg in the hopes an artificial leg may allow me to get back to using a cane. I am currently researching amputations and prosthesis' available. Found a Amputee Forum so maybe they will be able to help. BTW, if you go to a surgeon for a problem don't be surprised if their "solution" is to pull out a knife! It's what they do. Best wishes.

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Debbra Williams, Alumna Mentor | @debbraw | Jul 9, 2019

@lturn9 - I am so sorry for what you are going through. But, wow - amputation sounds terribly drastic. Has a doctor recommended that? I would agree with @edithmiller that there would be a great benefit in going to Mayo or or another respected health organization to seek out some other options. Is that something you would feel comfortable pursuing?

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