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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@rah2435

Hi, I have the same issue. Following my left TKR in 2013 my LLD was 2.7 cm. After I had my right leg done it is now down to about 1-1.5 cm. MY dr told me "most people wouldn't notice this". I do!! Any ideas on how I can find someone who can fit me with a good corrective orthotic?
thanks

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@rah2435 : can only say how it worked for me. After several hip issues, once knee was fine, my physical therapist measured my leg length - actually, what he measured was where the heels align, so whether it was bone length, muscle mis-alingment, spine issues - the result was that the heels did not line up. Probably caused by TKR, since I never had any issues like that before.
Anyhow, PT took casts of my feet, and specified as to how much thicker the left (non-TKR) side orthotic insert should be made. Worked out for me. But difference in leg length was only maybe 1/2”, but with history of back pain and sciatica, that’s all that was needed to really mess me up.

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I had a tkr 14-months ago and my leg is 1 1/2" longer and I'm in chronic pain 24/7 with back and hips now. I just wanted to get back to hiking, but I can barely walk across the grocery store now.

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@sarahleemoore62

I had a tkr 14-months ago and my leg is 1 1/2" longer and I'm in chronic pain 24/7 with back and hips now. I just wanted to get back to hiking, but I can barely walk across the grocery store now.

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@sarahleemoore62 Welcome to Mayo Clinic Connect. What an awful thing to have to deal with. You'll see I moved your post to a discussion where they are talking about this exact problem.

I also thought you would like to read a post from one of our mentors.
Gait post by Sue - https://connect.mayoclinic.org/comment/635851/

And here is an article on the subject.
Change in Limb Length After Total Knee Arthroplasty - NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536512/

What has your doctor recommended?

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@sarahleemoore62

I had a tkr 14-months ago and my leg is 1 1/2" longer and I'm in chronic pain 24/7 with back and hips now. I just wanted to get back to hiking, but I can barely walk across the grocery store now.

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People look at me like I’m crazy when I tell them that. But I also feel my leg is longer and that is why two years later I still have pain. No other doctor wants to speak against the “renowned” I had who retired immediately after my surgery. Had I known he was retiring, I would have looked for another doctor. He left me with no one to help with post surgery problems not even a suggestion of who to see. But there was no measuring to make sure he was using the right size replacement for me. Did you have any measurements taken prior to your surgery?

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@bonniethompson1234

People look at me like I’m crazy when I tell them that. But I also feel my leg is longer and that is why two years later I still have pain. No other doctor wants to speak against the “renowned” I had who retired immediately after my surgery. Had I known he was retiring, I would have looked for another doctor. He left me with no one to help with post surgery problems not even a suggestion of who to see. But there was no measuring to make sure he was using the right size replacement for me. Did you have any measurements taken prior to your surgery?

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I didn't have any measurements taken before the surgery. I have wondered about that too.

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@bonniethompson1234

People look at me like I’m crazy when I tell them that. But I also feel my leg is longer and that is why two years later I still have pain. No other doctor wants to speak against the “renowned” I had who retired immediately after my surgery. Had I known he was retiring, I would have looked for another doctor. He left me with no one to help with post surgery problems not even a suggestion of who to see. But there was no measuring to make sure he was using the right size replacement for me. Did you have any measurements taken prior to your surgery?

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The difference in leg length is not so rare - after any orthopedic surgery to hip, knee, foot or bad fracture, etc. This was explained to me by my ortho, and reinforced by my PT after my hip replacement replacements. In my case, I needed a different sized femoral ball to stop dislocations, and that led to increasing the difference between my legs (which had always existed and been treated with a lift).

There are two ways we attacked the issue to relieve pain.
First gait training in PT to help me step correctly, straighten up, and quit "favoring" the replaced joint. This is done in PT and practiced in front of a mirror until it begins to feel natural. This corrects both the problem associated with leg length, and the "bad walking habits" developed over years walking with a deteriorating joint.
Second was a lift for the shoe on my shorter leg. Over time (about a year) the size of the lift was gradually decreased and my body accommodated to the 3/8"-1/2" difference, as long as I wear a shoe. Walking barefoot still (10 years later) produces hip and back pain.

Without guidance from your surgeon, perhaps your primary doc can help you find a good PT. Mine was affiliated with a system serving people with serious orthopedic and spinal issues.

Hve you discussed the problem with a physical therapist?
Sue

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I had a TKR 14-months ago and have been in so much pain. I used to hike 10 to 20 miles and I had bone on bone, this is why I had the surgery. 1-year later, I just found out my leg is 1 1/2" longer causing me to have major back and hip pain, sometimes I feel like my thighs are being crushed. I have been in chronic pain for a year. I can't even walk across the grocery store anymore. I just bought inserts and they are not helping.. I never knew I would be in worse pain, to be in pain 24/7 for a year now... I cry all the time and wish I never had a TKR

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@sarahleemoore62

I had a TKR 14-months ago and have been in so much pain. I used to hike 10 to 20 miles and I had bone on bone, this is why I had the surgery. 1-year later, I just found out my leg is 1 1/2" longer causing me to have major back and hip pain, sometimes I feel like my thighs are being crushed. I have been in chronic pain for a year. I can't even walk across the grocery store anymore. I just bought inserts and they are not helping.. I never knew I would be in worse pain, to be in pain 24/7 for a year now... I cry all the time and wish I never had a TKR

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I understand because I’m there too. I use the shopping cart in the supermarket as a Walker. I also am in more pain after than before surgery. It is saddening to say the least. I do know that physical therapy helped greatly. I’m at two years now and still in pain while my surgeon retired immediately after my surgery and left me without even follow up doctors. And sarcastically I say, I hope he’s enjoying every minute of his retirement.
I hope you can fine a good physical therapist. They can help the most.

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@bonniethompson1234

I understand because I’m there too. I use the shopping cart in the supermarket as a Walker. I also am in more pain after than before surgery. It is saddening to say the least. I do know that physical therapy helped greatly. I’m at two years now and still in pain while my surgeon retired immediately after my surgery and left me without even follow up doctors. And sarcastically I say, I hope he’s enjoying every minute of his retirement.
I hope you can fine a good physical therapist. They can help the most.

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I'm sorry to hear this! I've been so devastated because I'm so active now I feel handicapped.
I will try to find a good physical therapist. My question is how can they take care of one and a 1/2 inches?

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@sarahleemoore62

I'm sorry to hear this! I've been so devastated because I'm so active now I feel handicapped.
I will try to find a good physical therapist. My question is how can they take care of one and a 1/2 inches?

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They will probably show you how best to compensate. Limping due to the difference will cause hip problems. I’m sure they will be able to help.

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