Leg length difference after TKR! What can be done?

@sarahleemoore62 Sarah Lee, I am sorry you are going through so much trouble with your knee replacement. I have not had that experience, but I do work with a physical therapist for issues when my pelvis goes out of alignment and for me that does cause knee or low back pain when it is out of alignment. My PT tells me keeping proper body alignment prevents the uneven wear and tear on the knee joint. I would think this is just as important after a knee replacement that the alignment is correct with the replaced knee and your body's other joints like ankle, hip, and pelvis are in proper alignment. When my pelvis is out of alignment, it sometimes functionally seems that one leg is longer that the other. In reality, that isn't true, but the pelvis may have an upslip that moves the leg upward as if it was shorter. That affects my walking and causes low back pain.

Here is a link that explains knee mechanics and movement. Of course a knee replacement changes that, but it also explains other alignment issues.
https://mskneurology.com/resolve-knee-pain-alignment/
From your X-ray image when you follow the line that is equidistant between your feet upward, you can see that it is not equidistant between the 2 sides when it gets near your pelvis, and it looks like one side of your pelvis is higher.

I do hope that you have a top notch orthopedic surgeon if you are considering revision surgery, and it doesn't hurt to get several opinions on that. Some questions you may want to ask would be if the knee replacement implant is positioned properly at the end of the bone, but did it leave a longer femur on that side because not enough bone was removed before placement in surgery, effectively, are your legs actually different lengths?

If you were going to have a re-operation, who would you trust to fix it and get it right? You need the best surgeon you can find with experience in revision surgery. I feel for you, as that will be a big surgery and long recovery. I can relate to that with my ankle that has had surgeries because of a bad fracture with long recoveries. I saw my mom going through having both knees replaced.

If you wanted to seek an opinion at any of the Mayo Clinic Campuses, you can get started with this link. I have had spine and ankle surgery at Mayo Rochester and it was a good experience. http://mayocl.in/1mtmR63

Jennifer

I'm looking to find a top notch Orthopedic that does revision surgery. I have been to a couple, but still looking.
Thank you so much ❣️

@sarahleemoore62 I just ran across this the other day. I can't say I was surprised because Mayo is excellent. Apparently, I am not the only one who thinks that. Mayo Rochester is #2 in the world for orthopedics. Wow! Here is the link.
https://www.beckersspine.com/orthopedic/item/53832-37-us-hospitals-health-systems-ranked-among-world-s-best-for-orthopedics-by-newsweek.html
I had a bad fracture of my ankle in 2020 and came to Mayo for surgery with an Orthopedic Trauma surgeon. That is a specialty beyond orthopedics. I had the surgical plates removed 6 months ago because they were bothering me, and my bones were healed enough do that. There are lots of folks on here, myself included, who can share travel recommendations and Mayo has a free Concierge service that is very helpful.

Mayo Clinic in Rochester has Concierge Services to help make your trip go smoothly. They provide information about travel, lodging, Mayo Clinic and community resources to plan your visit. And it’s free.

Now with the Live Chat service, concierge services provide preliminary trip planning for all 3 Mayo Clinic campuses in AZ, FL and MN

Five Ways to Contact Mayo Concierge Services

Phone: 507-538-8438
Live Chat: https://www.mayoclinic.org/patient-visitor-guide
Email: concierge@mayo.edu
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In-person in Rochester MN: Lobby hours are 8:00-5:00 Monday through Friday. Offices are located in the International Center in the Mayo Mathew’s Lobby, Executive Lounge on Mayo 5, Radiation Oncology Lobby – Desk R

Good luck in your quest! I hope you will come back and share your experience when you find an answer.

Jennifer

I forgot to mentioned that my leg is now over 2 cm longer

Jennifer - sorry for so many messages, but wanted to thank you for all your information. You have been a big help

@sarahleemoore62 I am here as a volunteer to help, so no worries. You are very welcome here. I am sure your situation is somewhat difficult and you are searching for help. I was in that position before I had spine surgery. I had some unusual symptoms and 5 local surgeons (not at Mayo) turned me down. They all could see the spinal cord compression in my imaging, but didn't connect it to my symptoms, so for 2 years, I got nowhere just chasing surgeons and being turned down. I wrote to a neurosurgeon at Mayo and he took me as a patient and helped me. That is why I like to help patients here because I know how hard it can be to find quality care, and because of what Mayo did for me.

It was all different when I got to Mayo, and they were very efficient in figuring things out. Within a few days, all testing was complete and I was offered surgery at the first appointment. I was very impressed at the quality of my care and the results. Mayo is a special place for me. When I broke my ankle, I sent a message to my spine surgeon asking for a good orthopedic surgeon, and he had a good one contact me within an hour, and I was on the schedule for an appointment a couple days later, and scheduled for surgery 2 days after that. I didn't know healthcare could be like that. Mayo is also a very welcoming place with art everywhere and people playing pianos in the building atrium. If your insurance covers it, it is worthwhile to travel to Mayo. There are lots of hotels with full kitchens in the rooms, so you can stay in.

Covid changed things a little bit about protocols for patients and visitors, so I haven't seen my ankle surgeon's face without a mask. I know he has treated patients and had to do some bone lengthening (or straightening) for some with a circular external cage that gets screwed into a leg bone. It makes me wonder if something like that could help you, if the knee replacement implant could just stay in place and the plasticity of the bones could be altered. The more I think about that, the more it seems like it may be an answer for you. I found some links related to my surgeon.

You might be interested in reading these stories about limb lengthening that mentions my orthopedic surgeon, Dr. Andy Sems. https://www.mayoclinic.org/biographies/sems-stephen-andy-a-m-d/bio-20054747
https://www.mayoclinic.org/biographies/sems-stephen-andy-a-m-d/bio-20054747
https://www.mayoclinic.org/medical-professionals/orthopedic-surgery/news/limb-lengthening-and-regeneration-clinic-addresses-complex-discrepancies-and-deficiencies/mac-20430352
https://www.mayoclinic.org/medical-professionals/orthopedic-surgery/news/multidisciplinary-and-coordinated-approach-to-limb-lengthening-care/mac-20508158
https://www.mayoclinic.org/departments-centers/limb-lengthening-regeneration-clinic-minnesota/overview/ovc-20472088
You of course can contact Mayo and ask about this. You could ask to send your records for review to see if the Limb Regeneration Center can help you. It doesn't cost anything to do that. You would need to contact Mayo and set up a temporary account and get instructions on how to send in records and what they need. If you do become a Mayo patient, they will convert that to a patient account that will be your account for any future appointments at Mayo. I only have experience with Dr. Sems there, but I'm sure they can steer you toward a specialist in that area. There was an e-mail listed in one of the links for the Limb Clinic and I think that is one that Dr. Sems monitors.

Does this sound promising? I hope this is the answer that you need, and for me that is kind of exciting to think about!... and just for fun... here is my patient story. https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

Do you have any more questions? Go ahead and ask! I'm here for you!

This is wonderful news.
I am scared and every Orthopedic tells me something different.
I have to look into my insurance for out of state coverage.

If your close to Rochester Dr Serria, and Dr Sanchez are amazing

@sarahleemoore62 Sarah Lee, I wanted to share to page where you can look up what insurance Mayo accepts as in network. You can also call them to ask if your insurance is in network, and how you can appeal if it is not.
https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance
You already know what you went through with the first surgery. I think I would be worried too having to do it all over again. Mayo does take cases that other facilities are not able to treat. Some of what Dr. Sems has done is to correct severely bowed legs enabling a person to walk again, and that was with the fixator cage that gets attached to the bones. (See video in story at end of post.) It gets adjusted to move the bone and stretch it, so the bone remodels itself. Right after I broke my ankle, the hospital I was taken to put a fixator cage on my ankle and closed the wound where one bone was sticking out. I had that for a couple weeks while the swelling was subsiding a bit before I came to Mayo for internal fixation to put the ankle back together. It was annoying to live with a big metal cage on my ankle and when I bumped it, it was like getting kicked in the shins, but that was also painful because of the trauma of course. The cages that go around a leg are circular. I had talked to another patient of Dr. Sems with one of these cages on his leg on one of my Mayo visits. I'm sure it is a bit painful when it gets adjusted, but that is in very small increments and done every day. I had asked Dr. Sems about this at one of my appointments.

If you are having trouble getting insurance coverage for Mayo, You should initiate an appeal with your insurance to request coverage. You have an unusual situation that a lot of places don't have experience with, and you need a place that can give you a good result. All of the various opinions you have are evidence of that. The last thing you need is someone guessing about how this should be addressed. My husband takes calls for a service investigating claims for insurance companies and has taken calls from other people after knee replacements with mismatched limbs.

Here is another story I found in Sharing Mayo Clinic about limb regeneration and Dr. Sems with a video about how they helped a patient. It really is quite remarkable.
https://sharing.mayoclinic.org/2016/05/29/limb-lengthening-and-regeneration-clinic-offers-hope-for-amarachi/
Please let me know what happens. What have the orthopedic surgeons told you as how they could treat the mismatched length of your legs?

I'm in Michigan, but may consider - thank you very much!