Leg Length Discrepancy After Hip Replacement Surgery

Left total hip arthroplasty?

Hello Doctor: I was in a car accident last December and suffered a comminuted fracture of my left hip joint.
I had to undergo surgery to insert screws, but the fracture kept displacing, so I had no choice but to have a hip replacement.
However, after the surgery, I developed a leg length discrepancy.
When I asked my attending physician, he said it was due to muscle necrosis on the outer side of my left buttock, which prevents proper support of the pelvis, leading to the leg length difference.
However, even when lying down, the discrepancy remains the same.
I would like to know if this is really the case and if there is a way to achieve equal leg lengths.

Fang Didi, 10~19 year old female. Ask Date: 2020/12/13

Dr. Shi Guozheng reply Orthopedics

There are several reasons for leg length discrepancy after total hip replacement surgery, often related to the length of the bones.
It is essential to ensure that both sides are of equal length when implanting the artificial joint.
Sometimes, if the artificial joint is placed too long or sinks, it can result in a discrepancy in leg length.
For a detailed explanation of the causes, it is best to consult the original surgeon.

Reply Date: 2020/12/13

More Info

Leg length discrepancy (LLD) after hip replacement surgery is a common concern among patients, especially following complex procedures like total hip arthroplasty (THA). In your case, the situation is compounded by a prior traumatic injury and subsequent complications that led to the need for a hip replacement. Understanding the underlying causes of LLD and the potential for correction is essential for managing your expectations and planning your recovery.

Causes of Leg Length Discrepancy
1. Surgical Technique: During hip replacement surgery, the surgeon may intentionally adjust the length of the femur (thigh bone) to achieve optimal joint stability and function. This can sometimes result in a slight difference in leg length. Surgeons may do this to prevent dislocation or to accommodate for pre-existing deformities.

2. Muscle and Soft Tissue Changes: As your doctor mentioned, muscle atrophy or necrosis around the hip joint can lead to instability in the pelvis, which may contribute to perceived leg length discrepancies. If the muscles that support the pelvis are weakened or damaged, it can affect how the body aligns itself, leading to functional discrepancies even if the bones are of equal length.

3. Post-Surgical Healing: After surgery, inflammation and swelling can temporarily alter the way your body feels and functions. This can lead to a sensation of unevenness, especially if one side is more painful or stiff than the other.

4. Pre-existing Conditions: If you had pre-existing conditions or injuries that affected your hip or pelvis, these could also contribute to a discrepancy in leg length or function post-surgery.

Addressing Leg Length Discrepancy
1. Physical Therapy: Engaging in a structured rehabilitation program can help strengthen the muscles around the hip and pelvis. A physical therapist can provide exercises tailored to your specific needs, focusing on improving strength, flexibility, and balance. This may help in compensating for any functional discrepancies.

2. Orthotics and Shoe Lifts: If the discrepancy is significant and causing functional issues, shoe lifts can be used to help balance the lengths of your legs. This is a common non-invasive approach to manage LLD.

3. Surgical Options: In some cases, if the discrepancy is severe and causing significant functional impairment, surgical options may be considered. This could involve adjusting the length of the femur or pelvis, but such procedures are typically reserved for cases where conservative measures have failed.

4. Regular Follow-Up: Continuous monitoring by your orthopedic surgeon is crucial. They can assess your recovery and make recommendations based on your progress. If you have concerns about muscle atrophy or other complications, they may refer you to a specialist for further evaluation.

Conclusion
While it is possible for leg length discrepancies to improve over time with appropriate rehabilitation and care, the extent of recovery can vary based on individual circumstances. It is essential to maintain open communication with your healthcare team, including your orthopedic surgeon and physical therapist, to address your concerns and optimize your recovery plan. They can provide personalized guidance based on your specific situation, ensuring that you receive the best possible care and support as you heal.

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