Case Study: Pain In The Opposite Leg After Surgery

Meet Brad

• 55-year old male
• Works full time as a builders labourer
• Enjoys cycling and cricket on weekends
• Painful left hip

Meet Brad

Brad’s Treatment Goals:

• Work a full day without hip pain
• Try to prevent a future hip replacement on this left hip

We first met Brad when he came in for an appointment with our Podiatrist, Martin. Brad had been suffering from a painful left hip for the past four months, following a hip replacement for his right hip. The pain began as a dull ache and was slowly getting worse, with the occasional “locking” sensation present too.

Brad described the pain as being worse first a thing in the morning and then improving after ten minutes of movement. However, by lunchtime, the pain is back and causes Brad to limp and move differently to try to avoid the pain.

Brad was getting worried about his ability to continue working until retirement and being able to stay active. Brad was thinking that the pain may be due to his previous surgery on the opposite hip but was unsure as to how this could be possible.

Clinical Assessment

During the examination, Martin noticed that when Brad stood in a relaxed position, his left knee significantly bent and the arch of his left foot was flattened. The video pressure analysis clearly showed how Brad was favouring his right leg when he walked, avoiding using the left leg.

Martin measured the length of Brad’s legs to find that there was a 10 mm difference, with his right leg shorter than his left. This explained exactly why Brad was bending his left leg when he stood, attempting to reduce the pain by correcting this difference and bringing his body to a straighter alignment, instead of leaving the pelvis tilted toward the right (shorter leg), which it did when Brad stood completely straight.

The Link Between Hip Replacements and Leg Length Differences

In a total hip replacement, the prosthetic joint is placed in the best position for the original, healthy joint. While the best effort is made to have the joint looking and performing identically to the contralateral joint, it is not uncommon for a limb length discrepancy to result and depending on the size of the difference, cause painful problems.

Diagnosis and Cause

Brad was diagnosed with a Limb Length Discrepancy, which means that one leg is significantly shorter than the other to the point where it can cause problems and pain.

It was the right hip replacement that had resulted in the shortening of Brad’s right leg. With the left leg being ‘longer’ and the left hip sitting higher than the right, the left hip was taking on much more load and pressure during when Brad was walking, moving or just standing. It is this excess loading that was causing Brad’s pain. Because Brad was constantly bending his left (longer) leg, he was also putting his knee and foot at risk of injury too.

Treatment

There were two aims for Brad’s treatment:

• Account for and correct his leg length difference to alleviate the current pain
• Prevent the compensatory movements to reduce the risk of future injury
• With any treatment here at The Podiatrist, we work to not only manage the current symptoms but to also reduce the likelihood of future problems and pains to get the very best outcomes for our patients.

Custom Orthotics

To achieve the treatment aims, Brad was prescribed custom foot orthotics. The prescription contained a full-length raise on the right orthotic to correct his leg length difference and bring the right hip into alignment with the left hip.

The orthotics also featured symmetrical arch heights to prevent his left foot and knee compensations. Upon fitting his orthotics, Brad immediately felt “leveled” while walking in them for the first time.

The Outcome

At his two week review, Brad reported a 70% improvement in the pain in his left hip. He felt much more capable with his work duties and could finish a full days work without limping to his front door.

An x-ray of Brad’s left hip was taken at four weeks after issuing his orthotics, which showed minimal arthritic changes or joint damage over the past six months. We are continuing to work with Brad to keep his left hip joint as healthy as possible, prevent the development of hip arthritis and avoid a future hip replacement on this side.

Brad is stoked with the results and is looking forward to retiring at a time that suits him, without his decision being influenced by pain. Brad’s case is not unique, as it’s common to have the skeletal alignment and length altered following a hip, knee or ankle surgery. If you’ve had a lower limb surgery and haven’t had an assessment already, we highly recommend that you do once you have recovered from your surgery.