Leg length difference after TKR!

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?

Liked by EES1

Hi Mamie,
I can imagine that your sister is very disappointed to have one pain replaced by another post total knee replacement surgery. I'm bringing @sophee @mrfish @gailfaith and @bernese53 into this discussion as they may have some thoughts about dealing with leg and back pain due to one leg being longer than the other.

You may also connect with other members talking about TKR in this discussion"
– scar tissue after knee replacement https://connect.mayoclinic.org/discussion/scar-tissue-after-knee-replacement/

Mamie, has your sister tried building up the shoe of the shorter leg? Has it helped? Has she returned to consult with the surgeon who did the TKR?

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@mamie, gailfaith herel. Can't imagine why Colleen listed me as having one leg shorter than the other, Yes I've had bilateral TKR in 2004 and 2006l I was waling without even a cane within weeks after the surgery; But maybe Colleen is psychic, in that I can understand having back problems, You may have seen the long post I submitted after months in rehabilitation after a severe accident in November where my scooter knocked me down, fractured my femur and took a deep chunk chuck out of my leg ( I guess it was hungry!). Walking is difficult for me now and I walk leaning heavy on the walker with my hands. Now my back is starting to bother me (I do have back problems- but that has not bothered me for a while) But I realize that when I do walk , I am leaning forward and when I stand straight, that relieves it. I can't fathom why you might be leaning forward, but what about leaning to the side to compensate for the increased height. Have someone knowledgeable take a look and see if you are leaning to one side and tell you if you CAN stand straight.. If so see a Dr. or therapist who might advise you how to compensate without creating more problems. My best to you!

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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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@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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I am 83 years old. 3-1/2 years ago I had a hip replacement, followed by a broken femur 6 weeks later. That left me with my leg about 2 inches shorter than the other leg. I was told about purchasing built up shoes, etc. I wore lifts in my shoes that helped, but did not make-up the length difference. The results left me with back problems and other aches and pains. Last fall I found out that I could have my leg made longer (NO JOKE). Four months ago the surgeon went back into my hip/femur and made my leg longer. It has made a world of difference in my attitude, being able to stand level. My balance is perfect.
I suggest that your sister see an orthopedic doctor and discuss the option of having her leg made longer.

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I am sorry to hear of your sister's TKR problems! The doctors never discuss the possibility that bones are "trimmer" to fit the prosthesis and normally they only trim a 1/4" or so. I have had 4 TKR's on my left knee and now that leg it almost 3" shorter than the right! I can only walk with a walker. I am posting here in the hopes someone will have a creative solution so I can walk again. My shoe being built up almost 3" is one problem, but the bigger problem is without the femur length I had, I have lost some of the muscle's lifting advantage making it impossible to straighten my leg the last 2" or so. On top of all this I have Neuropathy which affects my balance. I fear I will spend much of my remaining life in a wheelchair. I was told the 1st 2 knee joints failed because I am allergic to the Bone Cement used. #3 was put in place using a force fit without cement – it lasted the longest – almost 3.5 years. l am now on #4 and using Percocet to manage the pain. I'm hoping someone can provide some suggestions about what I might consider doing. I started the TKRs when I was found to have a Tibial Plateau Fracture. If I knew then what I know now I would have never had my God given knee replaced! The knee I was born with even with the fracture, was infinitely better than a man-made joint! If you can avoid a TKR I hope you will, whether a 1st, 2nd or more. Things just seem to get worse.

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@lturn9

I am sorry to hear of your sister's TKR problems! The doctors never discuss the possibility that bones are "trimmer" to fit the prosthesis and normally they only trim a 1/4" or so. I have had 4 TKR's on my left knee and now that leg it almost 3" shorter than the right! I can only walk with a walker. I am posting here in the hopes someone will have a creative solution so I can walk again. My shoe being built up almost 3" is one problem, but the bigger problem is without the femur length I had, I have lost some of the muscle's lifting advantage making it impossible to straighten my leg the last 2" or so. On top of all this I have Neuropathy which affects my balance. I fear I will spend much of my remaining life in a wheelchair. I was told the 1st 2 knee joints failed because I am allergic to the Bone Cement used. #3 was put in place using a force fit without cement – it lasted the longest – almost 3.5 years. l am now on #4 and using Percocet to manage the pain. I'm hoping someone can provide some suggestions about what I might consider doing. I started the TKRs when I was found to have a Tibial Plateau Fracture. If I knew then what I know now I would have never had my God given knee replaced! The knee I was born with even with the fracture, was infinitely better than a man-made joint! If you can avoid a TKR I hope you will, whether a 1st, 2nd or more. Things just seem to get worse.

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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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Sorry to hear your sister is having problems i had a tkr done 18 months ago im in more pain now then before i am 2inches shorter in trk leg as a result im in pain with my back im totally off balance i have been told to get shoes made as well to help correct the problem i also need to have other knee done but am to scared to now

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@merillo

Sorry to hear your sister is having problems i had a tkr done 18 months ago im in more pain now then before i am 2inches shorter in trk leg as a result im in pain with my back im totally off balance i have been told to get shoes made as well to help correct the problem i also need to have other knee done but am to scared to now

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I had a problem (hip and femur) that left me with my leg 2 inches shorter than the other. The ortho could make my leg longer, which corrected the problem. Ask your ortho if there is a way to correct the same kind of problem with the knee.

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@merillo

Sorry to hear your sister is having problems i had a tkr done 18 months ago im in more pain now then before i am 2inches shorter in trk leg as a result im in pain with my back im totally off balance i have been told to get shoes made as well to help correct the problem i also need to have other knee done but am to scared to now

Jump to this post

I understand your problem only too well. I have had 4 TKRs on my left leg and a 5th surgery to install a antibiotic stint. My left leg is now almost 3" shorter than the right and I could not walk or do PT until I had a shoe modified. It made a big difference to have that shoe, but the height gives me balance problems. I was finally able to start putting weight on my leg and do important PT. I still have to use a walker and the doc says my joint will fail at some point but he's not sure when. His suggestion to fix things is to replace my hip (which is fine at the moment) and put a rod between the hip and another new knee which would restore my leg length and hopefully (not sure if they know) stop my knee joints failing. That would require multiple major surgeries and cause a lot of stress to my wife, kids and me. I still don't know what I'll do but hope I can learn some other options here. I suggest you ask your ortho to help you estimate how much lift a shoe might need and have one made. Trying to walk with a short leg is like walking while putting one foot in a hole. Best wishes.

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@lturn9

I understand your problem only too well. I have had 4 TKRs on my left leg and a 5th surgery to install a antibiotic stint. My left leg is now almost 3" shorter than the right and I could not walk or do PT until I had a shoe modified. It made a big difference to have that shoe, but the height gives me balance problems. I was finally able to start putting weight on my leg and do important PT. I still have to use a walker and the doc says my joint will fail at some point but he's not sure when. His suggestion to fix things is to replace my hip (which is fine at the moment) and put a rod between the hip and another new knee which would restore my leg length and hopefully (not sure if they know) stop my knee joints failing. That would require multiple major surgeries and cause a lot of stress to my wife, kids and me. I still don't know what I'll do but hope I can learn some other options here. I suggest you ask your ortho to help you estimate how much lift a shoe might need and have one made. Trying to walk with a short leg is like walking while putting one foot in a hole. Best wishes.

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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..

Liked by lioness

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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

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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@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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@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.

Jump to this post

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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@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,)

Jump to this post

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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