Patient's Query
Hello doctor,
I had a hip replacement surgery. I still need to use a cane and have a significant limp. My operated leg is somewhere between 3/8 and 1/2 inches shorter. X-rays show the stem has subsided. I cannot lift my operated leg off the ground using just my abductors, but if I stand sideways on the edge of a step with my operated leg hanging over, I can lift my leg up and down about the same range of motion as my non-operated leg. It is just that the range of motion is shifted down, which seems to be why I cannot lift it off the ground.
If the stem has subsided significantly, would that not change the kinematics of the hip joint?
What would prevent my abductors from lifting the foot of the operated leg off the ground, resulting in my limp?
Is the best solution a corrective surgery to replace the ball with a different offset?
Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
This radiograph (attachments removed to protect the patient's identity) does not seem to be an immediate postoperative image. Kindly share the recent one for comparison.
Kindly revert in case of further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I have included two images: the one on the left is from five months ago, and the one on the right is four months old. I have attached it as two separate photos. Kindly help.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern(attachments removed to protect the patient's identity).
I have seen your radiographs. The surgery was well conducted, and I did not find any flaws in the radiographs. The stem has definitely subsided, and that is one of the characteristics, especially in non-cemented THR (total hip replacement). However, we are not concerned with that unless it is too much. In your case, as you have mentioned, there is half an inch of shortening. This is fine, and the body can manage up to one inch of shortening comfortably. So when we do surgical planning, our aim is not to make both limbs exactly similar (not possible for a human being). Our aim is to bring the discrepancy into a comfortable zone. In your case, I do not see any point to worry about.Your abductor weakness (weakness of these muscles results in an unstable pelvis while walking or attempting to stand on one leg) depends on several things.
First of all, the approach used for THR. Abductor weakness is commonly seen after the lateral approach. I am not sure which is used in your case, as there is no mention of that.
Another reason is if there is too much limb length discrepancy. This does not seem to be the case for you.
The third very important reason is the presence of abductor weakness prior to surgery. So, patients who have a very long-standing disease and are undergoing unnecessary delay in surgery develop atrophy of muscles, which takes a lot of time to recover after surgery.
I would like to know, in your case, what was the approach used, what was the indication of THR, and how long you were having that disease. Depending on your response, I will revert to you with the appropriate solution.
I hope this helps.
Thank you and take care.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I am six feet two inches tall and weigh 175 lbs. Prior to the surgery, I was alternating hiking and mountain biking a 4-mile loop almost every day. When the pan in my hip got in the way, I had surgery. I do not think I have abductor weakness. As mentioned, I can raise or lower the opposite leg with just my abductors if I am standing on a block. I can also do this while holding a 50-pound weight, so it does not seem to be an abductor weakness.
It is just that my range of motion has shifted downward, so I cannot raise the opposite leg of the ground. If the stem has greatly reduced, could this modify the kinematics of the hip joint, preventing my abductors from lifting my opposite leg's foot off the ground and causing my limp?
Kindly help.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
You are correct. If that subsidence is significant. As I can tell from your X-rays, it is within the predicted range. I am not sure about the current situation because the most recent X-rays are two months old. If that is the case, then I would like to suggest that you get a new X-ray done. I hope that makes sense. Moreover, I would suggest you continue with abductor strengthening exercises in the meantime.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
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Answered byDr. Anuj Gupta
Medically reviewed byiCliniq medical review team
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