Guest guest Posted April 18, 2004 Report Share Posted April 18, 2004 Eleanor I had my leg length measured to establish if my hips/pelvic bones were out of alignment. By measuring the leg length from the navel to the ankle bones and from the pelvic bone to the ankle bone (same side) and then by deducting and comparing the measurements (the pelvic bones are then at a 90 degrees to the spine and the assumption is that the spine column is straight), you get an accurate assessment of the leg length difference. Assuming symmetric leg length, then any limp / distortion / gait / posture anomaly is likely to be attributed to pelvic bones (non)alignment. BTW, these measurements can be very precise (up to 2mm precision; hence, a 2 mm difference in leg length shows generally). The leg length (difference) is the key factor in determining the insole raiser - no leg length difference and you may need pelvic bones re-alignment. That's how it was explained to me. Regards Dan leg length The xrays that were taken for my 6 weeks follow-up showed that my pelvis was sitting much higher on my left side (resurfaced side). Since then I've paid attention to my gait to see how I might be " favoring " that side. The gait I slowly adopted because of the pain is still the gait I will slip back into if I'm not paying attention. Before the op, my muscles were in extreme distress and some of them had " forgotten " how to do their jobs. The psoas muscle was chief among the non-functioning muscles. Anyway, I've gone back to my chiropractor to get my spine/hips back into alignment. This is an enormous help with the lower back pain I've been having. Poor alignment very well might be the culprit in the wearing away of cartilege of my left hip -- much the way front tires will wear if the front end of the car is out of alignment. Must be some truth to that since my right hip has no cartilege wear at all. Joyce (Dr Gross, LHR, 2/04) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2004 Report Share Posted April 18, 2004 Eleanor I had my leg length measured to establish if my hips/pelvic bones were out of alignment. By measuring the leg length from the navel to the ankle bones and from the pelvic bone to the ankle bone (same side) and then by deducting and comparing the measurements (the pelvic bones are then at a 90 degrees to the spine and the assumption is that the spine column is straight), you get an accurate assessment of the leg length difference. Assuming symmetric leg length, then any limp / distortion / gait / posture anomaly is likely to be attributed to pelvic bones (non)alignment. BTW, these measurements can be very precise (up to 2mm precision; hence, a 2 mm difference in leg length shows generally). The leg length (difference) is the key factor in determining the insole raiser - no leg length difference and you may need pelvic bones re-alignment. That's how it was explained to me. Regards Dan leg length The xrays that were taken for my 6 weeks follow-up showed that my pelvis was sitting much higher on my left side (resurfaced side). Since then I've paid attention to my gait to see how I might be " favoring " that side. The gait I slowly adopted because of the pain is still the gait I will slip back into if I'm not paying attention. Before the op, my muscles were in extreme distress and some of them had " forgotten " how to do their jobs. The psoas muscle was chief among the non-functioning muscles. Anyway, I've gone back to my chiropractor to get my spine/hips back into alignment. This is an enormous help with the lower back pain I've been having. Poor alignment very well might be the culprit in the wearing away of cartilege of my left hip -- much the way front tires will wear if the front end of the car is out of alignment. Must be some truth to that since my right hip has no cartilege wear at all. Joyce (Dr Gross, LHR, 2/04) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2004 Report Share Posted April 29, 2004 Leg length can not be easily addressed with any resurfacing device because they are merely putting a " cap " on the femoral head and a cup in the acetabular portion. If your leg length difference is only due to loss of cartilage and a small part of the bone, it may be corrected by the resurfacing. If the leg length difference is due to hip dysplasia, it could be fixed by use of the dysplasia cup which is only available out side of the US (by a surgeon using the BHR device). This allows repositioning of the acetabulum which has often " migrated " up on the pelvis resulting in a short leg. Leg length problems may come from other areas. The total hip devices permit correction of leg length more easily because the Femoral " stem " comes in different sizes. This allows the surgeon to lengthen or shorten the femur if necessary. You need to discuss this more with your surgeon. Small differences are usually corrected by altering shoes with " orthotic " inserts or thicker soles. Best wishes. michael (MD) in NC > After sending my x-rays for evaluation, I was contacted today and > was told that, even though I am a candidate for resurfacing, it > could not impact my leg length discrepency. > > This surgeon, who uses the Corin product, is highly touted on this > site. > > Previous postings led me to believe that leg length issues could be > corrected so, naturally, I was very dissappointed to get this > response. > > Has anyone else had leg length issues corrected through > resurfacing? What system and surgeon was used in your procedure? > > Are other systems (, BHR, etc) more suited to correct leg > length issues? > > Any input is greatly appreciated. > > Thanks. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2004 Report Share Posted April 30, 2004 Hi I have had similar problems and expectations. My leg was16mm shorter before the resurfacing. It is now about 7mm shorter. That’s how much was possible to achieve due to the bad condition of my hip (I have posted in March about this – you can check the posts as I believe I had explained that in greater detail then). Essentially, you can adjust leg length more/better with THR as you (rather, the OS) can choose how deep to insert the prosthesis shaft into the femur. With resurfacing you are restricted by the skeletal geometry. I don’t want to bore you to death with technical drawings and details but imagine the pelvic bone with the acetabulum as a piece which is fixed and then imagine the femur (with its head) slotted into the acetabulum. In many cases of OA the latter has shifted upwards as the separating cartilage (approx. 5-10 mm) has worn away or disintegrated. With long-term OA the femur head rubbing against the acetabulum (bone-on-bone) can and does often lead to compression and deformity of either or both parts with cysts forming where these parts connect. Now, the OS has to firstly make the acetabulum neat and nearly perfectly spherical (to a specific diameter) in order to fit TIGHTLY the respective component of the prosthesis –so, you probably lose a lit bit more of the length there while he ‘shaves’ away the damaged/imperfect parts. Then the same, but usually more drastically, happens to the femur head. So, you lost quite a bit more length. Then the OS fits the 2 parts of the prosthesis and their size (mainly thickness) adds to the leg length. But that’s all that the OS and the prosthesis can do for you – try to replace the lost bits of tissue with the prosthesis thickness. However, if due to extensive damage a lot of tissue has been wasted/lost not much can be done as the prosthesis thickness is proportional to the diameter rather than to the lost tissue, I understand (I assume the thickness is mainly determined by stress measurements and pressure and/or production/weight parameters). There’s nothing else that can be done using this technique and these implants. Any tinkering with additional thickness of either component would alter the body’s skeletal geometry as it would push your femur outwards in order to push it downwards as the femur sits ideally at 230 degrees to the vertical line going through your acetabulum. So, in theory, you could ‘push’ the leg further down, but you would be ‘pushing’ it away from the other leg as well. I assume that the accompanying problems must have been deemed unacceptable by professionals who designed the prosthesis and the operating protocols. I was also told not to worry about the leg length discrepancy of 7-8mm as both the OS and the physiotherapist believe there is still more adjustment to be had/made through physiotherapy (stretching contracted muscle/tendon groups; re-alignment of the pelvic bone etc.). I was also told that very few people have symmetrical leg lengths anyway regardless of OA (as no one seems to have identical size left & right foot) and that discrepancies of up to 5mm do not require treating. I hope this helps. Regards Dan * +44 (0)7974 981-407 * +44 (0)20 8501-2573 @ dan.milosevic@... _____ From: gard4279 Sent: 30 April 2004 04:39 To: surfacehippy Subject: Leg Length After sending my x-rays for evaluation, I was contacted today and was told that, even though I am a candidate for resurfacing, it could not impact my leg length discrepency. This surgeon, who uses the Corin product, is highly touted on this site. Previous postings led me to believe that leg length issues could be corrected so, naturally, I was very dissappointed to get this response. Has anyone else had leg length issues corrected through resurfacing? What system and surgeon was used in your procedure? Are other systems (, BHR, etc) more suited to correct leg length issues? Any input is greatly appreciated. Thanks. _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2004 Report Share Posted April 30, 2004 At 08:12 PM 4/30/2004 -0700, you wrote: >Hi Cindy, >I am wondering how your doctor was able to give you 2.5cm of leg length >with a resurfacing. Sherry, Both hips were higher than they should have been by a small amount. However, in the last 5 years before my surgeries, the left femur took to migrating up the side of the pelvis, thus creating the appearance of a short leg. When Dr. Boyd did the right hip (the better of the two), he dropped the socket down to where it should have been originally which made me even more off-kilter than I had been. Thank heavens for crutches ;-). When he did the left one, he dropped the socket down to match the right one, and all is well. Note that 2.5 cm is a large stretch, especially if one has always had a high hip, as the nerves can only stretch so far before they protest. Hope that makes it a little clearer. Cindy C+ 5/25/01 and 6/28/01 Dr. Boyd Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2004 Report Share Posted May 1, 2004 Dear , My legs were the same length when I had my resurfacing 5 months ago. The resurfaced one is now ½ “ longer and my hip alignment is fine. And lots of time has passed for ‘bedding in’. Annoying, and it is affecting my walking. I have an orthotic’s appointment soon and an appointment soon with my OS to discuss this, but am just curious about possible explanations why this has happened. Eleanor Re: Leg Length Leg length can not be easily addressed with any resurfacing device because they are merely putting a " cap " on the femoral head and a cup in the acetabular portion. If your leg length difference is only due to loss of cartilage and a small part of the bone, it may be corrected by the resurfacing. If the leg length difference is due to hip dysplasia, it could be fixed by use of the dysplasia cup which is only available out side of the US (by a surgeon using the BHR device). This allows repositioning of the acetabulum which has often " migrated " up on the pelvis resulting in a short leg. Leg length problems may come from other areas. The total hip devices permit correction of leg length more easily because the Femoral " stem " comes in different sizes. This allows the surgeon to lengthen or shorten the femur if necessary. You need to discuss this more with your surgeon. Small differences are usually corrected by altering shoes with " orthotic " inserts or thicker soles. Best wishes. michael (MD) in NC > After sending my x-rays for evaluation, I was contacted today and > was told that, even though I am a candidate for resurfacing, it > could not impact my leg length discrepency. > > This surgeon, who uses the Corin product, is highly touted on this > site. > > Previous postings led me to believe that leg length issues could be > corrected so, naturally, I was very dissappointed to get this > response. > > Has anyone else had leg length issues corrected through > resurfacing? What system and surgeon was used in your procedure? > > Are other systems (, BHR, etc) more suited to correct leg > length issues? > > Any input is greatly appreciated. > > Thanks. > > _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2004 Report Share Posted May 1, 2004 Dear Sheila, I also have had a leg made ½” longer as a result of resurfacing 5 months ago. How much longer is yours, how does it effect your walking, and do you do anything to correct it? Sorry—you’ve probably long since given this info before! eleanor Re: Leg Length Dear , I don't know the extent of your discrepancy or if you're a bilateral candidate, but I would consult with some more surf surgeons (De Smet, I think, is known for adjusting length) before throwing in the surgical sponge. Cindy on this list, I believe, has a leg length problem rectified via resurfacing & she was done in the U.S. And anyone who reads this regularly knows that my leg was (inadvertently) made longer as a result of surfing. So it can be done. It's true that THRs are much more suitable for adjusting and addressing frank leg length problems, but they also come with a bunch of other risks. If you think resurfacing is right for you, I would get a couple other opinions from docs who pride themselves on correcting for length. A lot of the folks stateside are new at it and haven't had a lot of experience yet in helping patients who present with a more elaborate set of problems than normal. That said, if you're talking a substantial difference, of say, 3 inches, I would think that a THR is probably the most logical solution to get you plumb. Good luck, Sheila > After sending my x-rays for evaluation, I was contacted today and > was told that, even though I am a candidate for resurfacing, it > could not impact my leg length discrepency. > > This surgeon, who uses the Corin product, is highly touted on this > site. > > Previous postings led me to believe that leg length issues could be > corrected so, naturally, I was very dissappointed to get this > response. > > Has anyone else had leg length issues corrected through > resurfacing? What system and surgeon was used in your procedure? > > Are other systems (, BHR, etc) more suited to correct leg > length issues? > > Any input is greatly appreciated. > > Thanks. > > _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2004 Report Share Posted May 1, 2004 Eleanor, May I ask, who did your resurfacing? 1/2 " is a huge length descrepancy. Chris > > After sending my x-rays for evaluation, I was contacted today and > > was told that, even though I am a candidate for resurfacing, it > > could not impact my leg length discrepency. > > > > This surgeon, who uses the Corin product, is highly touted on this > > site. > > > > Previous postings led me to believe that leg length issues could be > > corrected so, naturally, I was very dissappointed to get this > > response. > > > > Has anyone else had leg length issues corrected through > > resurfacing? What system and surgeon was used in your procedure? > > > > Are other systems (, BHR, etc) more suited to correct leg > > length issues? > > > > Any input is greatly appreciated. > > > > Thanks. > > > > > > > > _____ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2004 Report Share Posted May 1, 2004 At 08:16 AM 5/1/2004 -0700, you wrote: >Hi Cindy, >I understand that in OA, as the cartilage is worn away, and in severe >cases as the bone wears away, that the leg(s) shortens, as mine >have. However, I still don't understand what you mean when you say " he >dropped the socket down. " Do you know how that was accomplished? Sherry, I was born with both hips completely dislocated, although it wasn't discovered until I was nearly 18 months old. No, I did not crawl, stand, or walk, and the Dr. told my mother that I was just slow. It is the activities of crawling, standing, and walking that really help develop a good deep socket. My hips finally settled into not the actual socket, but higher up on my pelvis and made pseudo-acetabulum (fake sockets). So in my resurfacing surgeries, Dr. Boyd put the metal acetabular component where it should have been originally, thus " dropping the sockets " . Think of it as someone hanging a picture too high on the wall. You move the nail down to where it should have been, and the picture hangs where it should be. Am I clear as mud now? Cindy C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 At 06:11 PM 5/2/2004 +1000, you wrote: >Hi Cindy, > >Interested in what you said about not crawling....... My son didn't crawl >but has perfectly good hips.........He just stood up and walked just before >he was 9 months old.......... My niece never crawled either. She did butt-scoot though, nearly as fast as any baby that crawled on all fours. >However, from what I have understood over the years the activity of crawling >is very important to kniting hemispheres in brains and there is some >evidence that babies who don't crawl end up with hassles dealing with the >structure of language as reading and writing.......... so he ended up with >troubles of another sort later when he went to school.......... Just >wondering if you had any of these later from not crawling..........?? Not I. Other than math skills, I was way ahead in all areas of school and got put ahead a grade and put in MGM (mentally gifted minors) classes where I got stuck with all the geeks. Those supposed " classes " were an absolute waste for me, as it was totally unstructured time in which we were supposed to " enrich ourselves " . I just used the time to read more books as I need a lot of structure, and just wasn't getting it there. I'm an avid reader. My favorite thing is to go to the library, find a subject that catches my attention at that moment, and read about ten books on the subject. Could be health, gardening, animals, history, science, cooking--whatever caught my fancy that day. Had they sent me off to actually take real classes, I might have done a lot more, but I enjoyed the extra book time ;-). The brain training that you are talking about is cross-patterning, and I did get around by pulling with my arms and moving my leg muscles in the cross pattern, so my brain actually did get that learning. It was just different in that my hips would not support me, so I got there in a different manner than others. I still do cross-training on the stability ball since I had that nerve issue with my left leg. I lie on the ball on my stomach and raise one leg and the opposite arm and try to maintain my balance. I've dumped myself onto the floor more than once, and I still have to work at it, but it helped a lot with the balance issues I had after surgery. Cindy C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 Dear My surgery was done by Mr. Skinner at the Royal National Orthopaedic Hospital in London (England). He is a senior, very experienced surgeon and I have also found him a very nice man who listens to his patients and does not pressure for what he thinks best. For various complicated administrative reasons, I have not seen him since my surgery, but will on May 10th (have seen another consultant), so am not sure why he thinks the leg is longer. Also—it has been measured by the PT, and I hope I have remembered the correct measurement—but it will be between 1/3” – ½” difference. Eleanor Re: Leg Length Eleanor, May I ask, who did your resurfacing? 1/2 " is a huge length descrepancy. Chris > > After sending my x-rays for evaluation, I was contacted today and > > was told that, even though I am a candidate for resurfacing, it > > could not impact my leg length discrepency. > > > > This surgeon, who uses the Corin product, is highly touted on this > > site. > > > > Previous postings led me to believe that leg length issues could be > > corrected so, naturally, I was very dissappointed to get this > > response. > > > > Has anyone else had leg length issues corrected through > > resurfacing? What system and surgeon was used in your procedure? > > > > Are other systems (, BHR, etc) more suited to correct leg > > length issues? > > > > Any input is greatly appreciated. > > > > Thanks. > > > > > > > > _____ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 Hi Cindy, Very glad to hear that you didn't suffer any fallouts of not crawling............though what a pain to end up being worse off via the MGM classes........... Never thought of using my exercise ball for cross patterning my brain after the op........... That was one of my biggest first hurdles and I spent my time doing Aussie crawl swimming up and down the pool............ which also proved effective and provided a bit of extra exercise.............. It initially took quite a bit of concentration to get the coordination happening again........... and it is so nice it happens automatically now........... And I am sure spills off the exercise ball are not nice but must admit it did make a mental picture worth a chuckle.......... Edith LBHR Dr. L Walter Syd Aust 8/02 > > > >Interested in what you said about not crawling....... My son didn't crawl > >but has perfectly good hips.........He just stood up and walked just before > >he was 9 months old.......... > > My niece never crawled either. She did butt-scoot though, nearly as fast > as any baby that crawled on all fours. > > > >However, from what I have understood over the years the activity of crawling > >is very important to kniting hemispheres in brains and there is some > >evidence that babies who don't crawl end up with hassles dealing with the > >structure of language as reading and writing.......... so he ended up with > >troubles of another sort later when he went to school.......... Just > >wondering if you had any of these later from not crawling..........?? > Not I. Other than math skills, I was way ahead in all areas of school and > got put ahead a grade and put in MGM (mentally gifted minors) classes where > I got stuck with all the geeks. Those supposed " classes " were an absolute > waste for me, as it was totally unstructured time in which we were supposed > to " enrich ourselves " . I just used the time to read more books as I need a > lot of structure, and just wasn't getting it there. I'm an avid > reader. My favorite thing is to go to the library, find a subject that > catches my attention at that moment, and read about ten books on the > subject. Could be health, gardening, animals, history, science, > cooking--whatever caught my fancy that day. Had they sent me off to > actually take real classes, I might have done a lot more, but I enjoyed the > extra book time ;-). The brain training that you are talking about is > cross-patterning, and I did get around by pulling with my arms and moving > my leg muscles in the cross pattern, so my brain actually did get that > learning. It was just different in that my hips would not support me, so I > got there in a different manner than others. I still do cross-training on > the stability ball since I had that nerve issue with my left leg. I lie on > the ball on my stomach and raise one leg and the opposite arm and try to > maintain my balance. I've dumped myself onto the floor more than once, and > I still have to work at it, but it helped a lot with the balance issues I > had after surgery. > > Cindy > C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 Hi Cindy, Very glad to hear that you didn't suffer any fallouts of not crawling............though what a pain to end up being worse off via the MGM classes........... Never thought of using my exercise ball for cross patterning my brain after the op........... That was one of my biggest first hurdles and I spent my time doing Aussie crawl swimming up and down the pool............ which also proved effective and provided a bit of extra exercise.............. It initially took quite a bit of concentration to get the coordination happening again........... and it is so nice it happens automatically now........... And I am sure spills off the exercise ball are not nice but must admit it did make a mental picture worth a chuckle.......... Edith LBHR Dr. L Walter Syd Aust 8/02 > > > >Interested in what you said about not crawling....... My son didn't crawl > >but has perfectly good hips.........He just stood up and walked just before > >he was 9 months old.......... > > My niece never crawled either. She did butt-scoot though, nearly as fast > as any baby that crawled on all fours. > > > >However, from what I have understood over the years the activity of crawling > >is very important to kniting hemispheres in brains and there is some > >evidence that babies who don't crawl end up with hassles dealing with the > >structure of language as reading and writing.......... so he ended up with > >troubles of another sort later when he went to school.......... Just > >wondering if you had any of these later from not crawling..........?? > Not I. Other than math skills, I was way ahead in all areas of school and > got put ahead a grade and put in MGM (mentally gifted minors) classes where > I got stuck with all the geeks. Those supposed " classes " were an absolute > waste for me, as it was totally unstructured time in which we were supposed > to " enrich ourselves " . I just used the time to read more books as I need a > lot of structure, and just wasn't getting it there. I'm an avid > reader. My favorite thing is to go to the library, find a subject that > catches my attention at that moment, and read about ten books on the > subject. Could be health, gardening, animals, history, science, > cooking--whatever caught my fancy that day. Had they sent me off to > actually take real classes, I might have done a lot more, but I enjoyed the > extra book time ;-). The brain training that you are talking about is > cross-patterning, and I did get around by pulling with my arms and moving > my leg muscles in the cross pattern, so my brain actually did get that > learning. It was just different in that my hips would not support me, so I > got there in a different manner than others. I still do cross-training on > the stability ball since I had that nerve issue with my left leg. I lie on > the ball on my stomach and raise one leg and the opposite arm and try to > maintain my balance. I've dumped myself onto the floor more than once, and > I still have to work at it, but it helped a lot with the balance issues I > had after surgery. > > Cindy > C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 ; In answer to your question re leg length. Resurfacing definitely can impact leg length. An arthritic hip , due to all the joint biomechanics involved (hips,knees,ankles,spine etc), can cause a " functional " short leg . For example and very simply stated , with the limp we typically develope , the knee joint is unable to extend fully and as a result we walk with the knee not quite at full length and therefore somewhat shortened . The leg hasn't become suddenly anatomically shortened just the function of the leg .Add the effect on other joints and the shortening is significant. Further , there is anatomical shortening in the leg of our gimby hip in that we're bone on bone in the hip (acetabular) joint . The cartiledge that is worn down is a fair thickness and again we lose about a 1/4 " +- leg length from this. BUT When we have the resurfacing done , all things being as they should a/. The dysfunction in the leg is gone and we regain this lost length. b/. The prosthesis is such and the skill of the surgeon is such that we regain that leg length lost that was due to the worn cartiledge factor c/. A surgeon such as Dr.DeSmet can reposition acetabulae as he did with me . Mine was retroverted . THis must have some effect on leg length as well . So leg length is shortened by our gimpy hips and it's possible to regain proper leg length lost by the above factors . I know this happened in my case. Go see the Dr.DeSmet in Belgium or at lest send him your X-Rays for an opinion (gratis!) Freddie. Quote Link to comment Share on other sites More sharing options...
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