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Hip replacement causing leg length difference

Discussion in 'Biomechanics, Sports and Foot orthoses' started by LuckyLisfranc, Mar 2, 2006.

  1. LuckyLisfranc

    LuckyLisfranc Well-Known Member

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    Hi all

    Just wondered how many people see patients post-THR, with either 'relatively' shortened or lengthened femurs, causing to SIJ, knee or other mechancial pain?

    I seem to see these sporadically, and the orthopaedic surgeons are often reluctant to suggest that the prosthesis may be contributory to a iatrogenic LLD and resultant symptoms. And it seems to be an even split in terms of a relative lengthening vs shortening of the femur on the affected side.

    Such an easy thing to settle, but is there much awareness of this issue?

  2. Admin2

    Admin2 Administrator Staff Member

  3. pgcarter

    pgcarter Well-Known Member

    I work at one of Melbournes rehab hospitals and see a fair few THR's or Knee replacements....have not kept figures but my impression is that shortening is more common on the replaced side. One flaw in the current system is that I believe that most of the resulting pathology in gait after THR does not show for at least 9 months or so and by this stage the system has already pronounced them a success and booted them out the other end....no further thinking done or linkage back to post surgical issues...."you're fixed.....get on with your life and make the best of it...after all it could have been worse" and this works because it probably was worse before the op....and not too many bother with the fact that it could be even better with a bit more attention to detail.
    Better get down off my soap box....before I say something I may regret
    Regards Phill
  4. davidh

    davidh Podiatry Arena Veteran


    Phil, the attitude you've come across is pretty common in the UK too.

    As a side issue, how many people see hip or SI-related dysfunction or symptomology following total knee replacement?

    Old and worn-out knee = lots of play. Nice tight new knee = little play, allowing transverse plane torque to carry on up the limb.

    I've seen several of these over the years, each one relatively easily fixed by stabilising the foot with an orthosis.

  5. Atlas

    Atlas Well-Known Member

    Good point.

    I would add that an old knee might lack 10 degrees extension for instance. If you cant straighten your knee, you are not going to extend your hip as much in gait. New knee. Suddenly full extension is available. New demand on a "normal" hip that has not extended as much for years.
  6. Freeman

    Freeman Active Member

    I see lots of LLD's after hip replacements and tend to hear that the surgeons believe it is not a majot issue. Patients most often say the surgeon has taken away the pain but left them with an imbalance they cannot tolerate well. I do suggest, even against the MD's suggestions otherwise, that the patient seek a physiotherpist who has good experience and talents in dealing with rehabbing hips. I generally undercorrect with the rasies until they hasve been discharged from physio and then see what they can live with.
  7. Atlas

    Atlas Well-Known Member

    My advice is that they take one shoe off and walk around for a while...a few years.
  8. NewsBot

    NewsBot The Admin that posts the news.

    Chronic psoas syndrome caused by the inappropriate use of a heel lift.
    Rancont CM.
    J Am Osteopath Assoc. 2007 Sep;107(9):415-8.
  9. Admin2

    Admin2 Administrator Staff Member

  10. Stanley

    Stanley Well-Known Member


    This case demonstrates the limitations of using heel lifts to balance the PSIS to the ground as a sole criteria in the evaluation of leg length. :wacko:
    In reading the article, it was found that the patient had a right anterior innominate rotation (which will elevate the PSIS on the right relative to the left), and was prescribed a lift on the left side.
    If the ASIS to the ground is evaluated at the same time, this mistake can be avoided.:D

  11. Boots n all

    Boots n all Well-Known Member

    We see quite a few due to the age of the clients in our area, it seems to be more the hip replacement clients than knee
    When we see these clients with LLD, we refer them to an Osteo first to be sure that it is not functional or habit from the past pain and that all important second opinion.

    We then treat with a heel lift half the height required with a review in a few weeks
    and suggest a second trip to the Osteo to see their body is coping with the change.
  12. Stanley

    Stanley Well-Known Member

    It would be easier just to check it yourself.

    There's an old article that explains how to.

    A Preliminary Study on Asymmetrical Forces at the Foot to Ground Interphase.
    J Am Podiatr Med Assoc 1985 75: 349-354.
    S Beekman, H Louis, JM Rosich, and N Coppola


  13. Boots n all

    Boots n all Well-Known Member

    l can and do but its good and it helps to assures the client they are getting the best advise possible, lets face it most are not happy with single opinion the surgeon gave of the outcome "they did not say l would end up with one leg shorter than the other"

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