Question
QUESTION: Hi..its going to b three yrs in May that i was diagnosed with AVN from steriods that was part of my ALL treatment..i have AVN in both hips,knees, shoulders, and elbows..i recently turned 21 and im 6 weeks post op of my first THR on the right hip..in two weeks i will b having my left hip replaced..i have done alot of research online about THR..but alot of the info refers to older patients..and i feel out of the loop..i have soo many questions regarding everything =/ but a big problem that ive been having since the surgery is that i thought my operated leg was longer than the left and when i went to see my ortho to have my staples removed in the new xray what i was told was that my legs r even, but my pelvis is tilted to one side making my right leg look longer..im not sure if that is normal? and i was told with physical therapy and when i have my left side done it should get better, but what im worried about is that it wont and ill be limping from now on..because its a very big difference..im 4'11" and when i stand on my operated leg im atleast 5'1" and my normal height wen i stand on my left leg..if you have any information about this it would be soo helpful and any other advice you have for me since you know about being young and having THR..Thank You!

ANSWER: Nikki

Has your surgeon actually measured your legs?  If not, have someone do it for you.  Here's how you do it.  Use a tape measure.  Lie on the bed on your back and keep your legs straight.  Take the tape measure from your belly button to your left ankle, not the foot, the belly button to the ankle bone.  Then do it for your right leg.  That will give you an accurate measure of your leg length.

I have never heard of a tilted pelvis making the leg seem longer.  I'm not saying that it's not true, I'm just saying I never heard of it.  The difference in leg length may be due to atrophied muscles, and the actual hip replacement.  When a hip is replaced sometimes the leg becomes longer.  And your surgeon is correct that once the other hip is done, you will probably see less of a difference in leg length.

Remember also, that because your are still having pain in your bad leg, you are probably not walking correctly and that might also be causing you to limp more too.

Once both hips have been replaced, and you begin to exercise, you should see your legs even out a bit more.  What you might want to do in the meantime is to get an insertable lift in your shoe of the shorter leg.  They make lifts up to 1/2 inch.  You can also get 1/4 inch lift and a 1/2 inch lift and put both into your shoe to give you a 3/4 inch lift.  You really can't put any more of a lift into your shoe of more than 3/4 inches.  

If you are wearing tennis shoes, you may be able to find a shoemaker to put an outside lift on your shoe of the shorter leg until you have taken care of the leg length problem until you have your second leg done.

If you have any other questions about hips please let me know as I have AVN of the hips too.  Unfortunately I cannot answer any questions about joints in the knees and shoulders but I can address the hip concerns.

The one thing I would suggest is that you look into getting on a drug like Fosamax to build bone density while you are on the prednisone.

Best of luck to you nikki and if you need me just email me.

---------- FOLLOW-UP ----------

QUESTION: THANK YOU SOOO MUCH!! I can't believe how quick you were able to answer.

My legs have been measured at the orthos office n as of now there is a 2mm difference which they say is normal and when I have my second hip done any little difference will be fixed by my ortho.

I am hoping after the surgery it will all be better. I do not even know where to begin in asking questions..I do not want to be a bother either asking...

Im no were near having children, but I was thinking maybe it would be better to not have any because of my THR...did childbearing have an affect of the length that your THR lasted?

I also would like to ask what are your thoughts on dancing..im still very young and enjoy dancing! It is also a very large part of my culture..being hispanic most of it is salsa and other quick movement type of things..do i have to give that up?

My THR are plastic on ceramic..have you had this type of THR?... or do you know if this type might last a bit longer?

I know this next question varies..but at my age being 21 have my first THR's..how many do you predit i might have in my lifetime?....along with this question id like to know how ill know when it is time for a revision..becuase when i asked my ortho he basically told me not to worry about that until it was time..im guessing he just did not want to worry me since ill prob b having more than one revision in my future..id like to know if it is that bad that he doenst want me worrying about it..?

Id also like to know if its okay for me to wear high healed shoes once i am better or flat sandals? ive heard alot of mixed opinions

I am so sorry if these are alot of questions..this is just the first time i feel like i can get my person questions answered from someone whos lived it.

Also the Fosamax...i have been of steriods for over 2 yrs...does that mean i should not bother looking into Fosamax?

Thanks again Sharon..you dont know how greatful i am to be able to ask you these questions

Answer
Nikki

Most adults have a difference of about a quarter of an inch and eventually they compensate normally with that.  In order to ascertain if you have a true difference in length, you will have to wait until your surgery on your second leg is done and you are healed.  I have a ?of an inch difference and I wear an insertable lift of one half inch and compensate for the other ?inch on my own.  I do sometimes limp when I am tired.

The other thin you can do with heeled shoes is find a shoemaker who can cut down the heel of the longer leg (if the shoe is a strappy sandal), and then you won抰 need a lift.  I抳e done that before with dress shoes.

Do not give up hope of having children.  I had two children and they are fine.  You may need to have a C section due to the muscles of the hip not being strong enough and that you have to put your legs in crazy positions when you give birth, so I 慸 say a C section is a better option for you.  I had one normal birth and one C section and I抎 the C section faster than a normal birth as I thought it was easier for me.  If there is no genetic reason to not have children, do not deny yourself the joys of children.  Just be careful not to gain a large amount of weight during pregnancy.

I have had both cement and ceramic.   The ceramic is a harder recovery and a longer recovery but they are used mostly in younger people because they give you more range of motion.  They are a better option for people your age.  Most hips will last up to 20 years the first time around.  If you have revisions, the revisions last a shorter time.  My first set was put in when I was 16 and they lasted until I was well into my late 20抯.  Then I have had four revisions on each side, each lasting about 10 years each.  It抯 not that bad.  The reason the revisions do not last as long is because each time they revise, you will lose bone mass and they may have to do bone grafting, especially with AVN.  That happens.  But you should  not have to worry about this until you are on your second set which will probably be sometime in your 40抯.  Don抰 obsess about it and when it happens that you need the revision, keep your chin up and just thank God that you are able to be fixed.  

Count yourself lucky that you live in a day that things like this can be done.  With my first set of hips, I dated, married, had a full time job, went to graduate school and toured England and France and had two kids.  I抎 say that抯 pretty good.  There were things I could not do, like skiing, racing, tennis, stuff like that, but it抯 all good.

You can certainly wear heels, but I抎 warn against very high heels in the beginning.  It will throw you off balance.  I wear up to 2 inch heels.  Sandals are fine.  Just be careful with flip flops that you don抰 trip on them.  

As far as foxamax, I would suggest getting a bone density test to determine your baseline and then your doctor can advise you if you need it or not.  I had a kidney transplant at age 14 and have been on prednisone for over 34 years.  So my bones are not good at all.  If you are off the prednisone, you should check with your doctor.

Never feel as if you are bothering me.  I know how scared you are.  Feel free to email me at home at [email protected]