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, nlembeck

@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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@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 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

@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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@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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@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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@ellerbracke

@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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@ellerbracke Getting old is definitely not for sissies. I think of myself as doing well but then when I enumerate all of the things wrong with me I realize there's a lot going on. Thankfully nothing too major right now though, more nuisance things.
I hope the PT does help, no matter when the length difference occurred. I think it probably did occur with the TKR because if you had it all of your life you would simply have adjusted to it, as I have. I only notice it when I have pants hemmed and they one is not the right length.
JK

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@contentandwell

@ellerbracke Getting old is definitely not for sissies. I think of myself as doing well but then when I enumerate all of the things wrong with me I realize there's a lot going on. Thankfully nothing too major right now though, more nuisance things.
I hope the PT does help, no matter when the length difference occurred. I think it probably did occur with the TKR because if you had it all of your life you would simply have adjusted to it, as I have. I only notice it when I have pants hemmed and they one is not the right length.
JK

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@contentandwell : Here’s where I miss to respond privately, sometimes. I do my own pant hemming, so no reference from before TKR. This seems so insignificant compared to someone considering amputation of limb, so I sort of feel bad to just put minor, but to me very limiting and aggravating leg issues on here. I at least get the consensus that mostly, the surgeon who did the TKR is less than thrilled to deal with problems of any kind afterwards? Does this hold true? My OS is always available to see me and talk about any issues – not sure there are “issues”, surgery went fine, recovery reasonable, after that hip bursitis, etc.
Same OS went through shoulder surgery around 2009, close to when I did. He was extremely more in tune the next time I had my second shoulder surgery, and I also beat his range of motion by 10% at the time, him being 10 years younger than I am. Just saying, He actually opened the consulting room door and shouted down the hallway to his PA to show me off. A lot of good it did me. The super outcomes of 2 shoulder surgeries probably made me too confident of the TKR surgery and gave me high expectations. Did not do my homework. Never heard of stem cells…… my bad.

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@debbraw

@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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Thank you for those kind comments, It's True, it would be drastic and I will definitely get another opinion before I have any amputation.
The problem is the Neuropathy has damaged my bones (I'm told) which is why they were trimmed during each TKR. IMO, after 4 failed TKR's (still on #4 but it's time is limited) I think the surgeon's have given up on the idea of getting a TKR to work for me. Now that my Tibia is short, my present surgeon suggests he replace my (good) hip and run a rod between my hip and ankle. I will be unable to bend my leg at all but we avoid amputation. Lots to consider. I'm not seriously considering that option though. It would require probably 2 major surgeries which I don't want my wife to suffer through or me. ,
As Far As the way the docs act after the TKR, in my case I saw that. It was very subtle and may have been my imagination but I sensed a change.
As things are now I'll probably keep getting around on my walker trying to get my legs stronger and hopefully things will improve.
Thanks again,
Larry

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@lturn9

Thank you for those kind comments, It's True, it would be drastic and I will definitely get another opinion before I have any amputation.
The problem is the Neuropathy has damaged my bones (I'm told) which is why they were trimmed during each TKR. IMO, after 4 failed TKR's (still on #4 but it's time is limited) I think the surgeon's have given up on the idea of getting a TKR to work for me. Now that my Tibia is short, my present surgeon suggests he replace my (good) hip and run a rod between my hip and ankle. I will be unable to bend my leg at all but we avoid amputation. Lots to consider. I'm not seriously considering that option though. It would require probably 2 major surgeries which I don't want my wife to suffer through or me. ,
As Far As the way the docs act after the TKR, in my case I saw that. It was very subtle and may have been my imagination but I sensed a change.
As things are now I'll probably keep getting around on my walker trying to get my legs stronger and hopefully things will improve.
Thanks again,
Larry

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Hi @lturn9. I've only been visiting the forum on occasion but saw your post about your situation. Have you considered talking to anyone about bone lengthening to regrow some of the bone lost? I was looking at the website for the Hospital for Special Surgery, which apparently is the top site for orthopedic surgery in the U.S. and saw this information: https://www.hss.edu/limblengthening-about.asp
Perhaps you could ask your surgeon about it or find someone there to communicate with you to see if that is a possibility for your situation. Or perhaps someone at Mayo is familiar with the process. Best wishes!

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@lturn9

Thank you for those kind comments, It's True, it would be drastic and I will definitely get another opinion before I have any amputation.
The problem is the Neuropathy has damaged my bones (I'm told) which is why they were trimmed during each TKR. IMO, after 4 failed TKR's (still on #4 but it's time is limited) I think the surgeon's have given up on the idea of getting a TKR to work for me. Now that my Tibia is short, my present surgeon suggests he replace my (good) hip and run a rod between my hip and ankle. I will be unable to bend my leg at all but we avoid amputation. Lots to consider. I'm not seriously considering that option though. It would require probably 2 major surgeries which I don't want my wife to suffer through or me. ,
As Far As the way the docs act after the TKR, in my case I saw that. It was very subtle and may have been my imagination but I sensed a change.
As things are now I'll probably keep getting around on my walker trying to get my legs stronger and hopefully things will improve.
Thanks again,
Larry

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Hi Larry, @lturn9 – Your reply helped me understand more about your situation. And I like the suggestion that @mamie offered regarding bone lengthening. You mention that your Neuropathy may have led to the bone damage that caused them to trim some bone during the surgery. Here is a link to the Neuropathy Group on Connect in case this helps:
https://connect.mayoclinic.org/group/neuropathy/
I may have missed this, but are you still doing physical therapy for strength training?

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@ellerbracke

@contentandwell : Here’s where I miss to respond privately, sometimes. I do my own pant hemming, so no reference from before TKR. This seems so insignificant compared to someone considering amputation of limb, so I sort of feel bad to just put minor, but to me very limiting and aggravating leg issues on here. I at least get the consensus that mostly, the surgeon who did the TKR is less than thrilled to deal with problems of any kind afterwards? Does this hold true? My OS is always available to see me and talk about any issues – not sure there are “issues”, surgery went fine, recovery reasonable, after that hip bursitis, etc.
Same OS went through shoulder surgery around 2009, close to when I did. He was extremely more in tune the next time I had my second shoulder surgery, and I also beat his range of motion by 10% at the time, him being 10 years younger than I am. Just saying, He actually opened the consulting room door and shouted down the hallway to his PA to show me off. A lot of good it did me. The super outcomes of 2 shoulder surgeries probably made me too confident of the TKR surgery and gave me high expectations. Did not do my homework. Never heard of stem cells…… my bad.

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@ellerbracke The ortho who did my second TKR has also been great. He's sort of droll and dry but was very concerned when I was still in a lot of pain for a while.
I know of people who have had stem cell and not gotten good results, and that is not paid by insurance so it's a lot of money to pay and not get the desired results. For me, I am happy with both TKRs, my second one more so than my first one.
JK

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Not sure about my original post. Repeated hip bursitis flare ups, and general pain when walking, turned out that the non-TKR leg was shorter by a small margin. Probably not recognized initially, since the total extension took so long, and leg length measurements, which are not done on a routine basis anyway, did not show much of a discrepancy. Specific exercises to deal with muscle/joint tightness did not help, so I’m looking at custom orthotic inserts. I really hope that this will be the final step to a pain free knee. Not a lot of pain, not always in the knee, but not ever (yet) other than the 12 hour window with nerve block post surgery that there hasn’t been a twinge, a short pain, a dull ache…… even with very good function. Just once no ouch.. 10 months and counting.,. too much to ask?
To keep in perspective: knee pain, soreness, etc. within reason,
mostly sporadic, but I’d love one day without it. Just want the right TKR knee to feel like the original left one for a change. Meaning, not feel like anything. Just be a knee.

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That's frightening! We're they done by the same doctor? Now I'm worried about my next replacement !

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@lturn9

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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Sorry to hear of you TKR issues. I ended up w neurothapy in my right foot after my TKR in Feb. Not only was it numb but also had tingling like it was severely asleep. My surgeon keep telling me it was normal and give it a year or two. Not satisfied and in so much discomfort and going backwards in PT I kept reaching out to find an answer. Found out after 50 days my orthopedic suregon totally pinched off my popliteal artery behind my knee during my TKR. They did ABI test and then angiogram to find this. Then I had to have surgery on the back of my knee to open up the artery. Now I am back at PT to strengthen that leg as well as bend n flex and break down scar tissue on both scars. I went back to My TKR surgeon and he said "why did you wait 60 days do get it fixed?" Jerk! And "most people with this happening loose thier leg". WOW and he was saying give it a yr. or 2 REALLY! I too have 1 leg shorter n My balance is off as well but have only fallen once. I am 6 mo. out and walk worse than before TKR and in just as much pain as the knee clicks n hurts. He said that was normal too. Not, my 2013 L TKR never clicked n feels like a normal knee.

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@ellerbracke

Not sure about my original post. Repeated hip bursitis flare ups, and general pain when walking, turned out that the non-TKR leg was shorter by a small margin. Probably not recognized initially, since the total extension took so long, and leg length measurements, which are not done on a routine basis anyway, did not show much of a discrepancy. Specific exercises to deal with muscle/joint tightness did not help, so I’m looking at custom orthotic inserts. I really hope that this will be the final step to a pain free knee. Not a lot of pain, not always in the knee, but not ever (yet) other than the 12 hour window with nerve block post surgery that there hasn’t been a twinge, a short pain, a dull ache…… even with very good function. Just once no ouch.. 10 months and counting.,. too much to ask?
To keep in perspective: knee pain, soreness, etc. within reason,
mostly sporadic, but I’d love one day without it. Just want the right TKR knee to feel like the original left one for a change. Meaning, not feel like anything. Just be a knee.

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Update: custom orthotics helped with gait and hip issues. After initial acclimation period I found that while wearing the inserts mostly for extended outdoor activities the benefit lasts all day, even if I prefer to walk barefoot in the house. Feels good to be able to take full, easy strides again. Regarding the other issue – still daily twinges in the TKR knee. Usually not raising to the level of pain, but definitely still not like the remaining good one. But, much to my surprise, I’m halfway to getting over my aggravation with the clicking noise and feeling. Perhaps my hearing is going as well? Just kidding. All in all, things are pretty good right now. Can always be better, of course, but could also have been much, much worse.

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