New ~ 5cm leg length discrepancy. What to do?
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ignominious poltroon
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New ~ 5cm leg length discrepancy. What to do?
My wife just had a hip replacement. Her right femur is now about 5cm longer than her left. Her PT is alarmed. We will talk to the surgeon in a few days. Even if this does settle in a bit, somehow, it looks like she now has a significant difference that will need to be considered. She currently is using a 165mm GRX crankset and flat pedals.
Would it make any sense to have a 172.5 or 175 mm right-side crank-arm and a 165 mm on the left? This still is only 20% of the length difference.
I can't imagine having a huge shim. I tried a 3mm shim once and it drove me nuts; I had to take it out mid-ride. 25 to 50 mm seems extreme. Also, her knees will be in different places if it is shimmed like this.
The irony is that before the hip replacement, biking was her escape from pain. Walking was the main problem. She did a 50 mile ride with 120 Strava achievements 4 days before the operation. Now I worry biking will be torture.
Would it make any sense to have a 172.5 or 175 mm right-side crank-arm and a 165 mm on the left? This still is only 20% of the length difference.
I can't imagine having a huge shim. I tried a 3mm shim once and it drove me nuts; I had to take it out mid-ride. 25 to 50 mm seems extreme. Also, her knees will be in different places if it is shimmed like this.
The irony is that before the hip replacement, biking was her escape from pain. Walking was the main problem. She did a 50 mile ride with 120 Strava achievements 4 days before the operation. Now I worry biking will be torture.
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WOW! - Unfortunately its one of those wait and see dilemmas... RATS!
Also try to remember that a majority of people have almost 2cm leg length differences naturally and have no problems at all. So really you are only looking at about 2.5 cm of critical differences.
Again, you are still at the have to wait and see stage of this whole thing. As an active woman she has a great advantage in recovery. When she gets back to ridding again be sure to drop the seat about 2cm at the start and no mashing. Remember that Docs often forget the importance of Calcium Magnesium and Zinc supplementation along with Glucosamine and Chondroitin. Also remember that if she has low estrogen levels she will not be able to absorb the extra calcium supplements she is taking.
As a PA-C I usually end up addressing these things in my post hip surgical patients.
Also try to remember that a majority of people have almost 2cm leg length differences naturally and have no problems at all. So really you are only looking at about 2.5 cm of critical differences.
Again, you are still at the have to wait and see stage of this whole thing. As an active woman she has a great advantage in recovery. When she gets back to ridding again be sure to drop the seat about 2cm at the start and no mashing. Remember that Docs often forget the importance of Calcium Magnesium and Zinc supplementation along with Glucosamine and Chondroitin. Also remember that if she has low estrogen levels she will not be able to absorb the extra calcium supplements she is taking.
As a PA-C I usually end up addressing these things in my post hip surgical patients.
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She is 8 days out, so I agree it is early. Apart from that, the recovery has been going really well.
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Can always do a couple of origin8 crank sets and go square taper. They have a 140mm that you could pair with a 165 or 170 to make up most of the difference. Other than that, it is possible to find a halfway decent crankset that can be cut down on one side, drilled and tapped. Its been a few years but I ended up recommending this with I think an sr suntour crankset for the wife's cousin. He's got a birth defect that resulted in a 4cm difference, once we found the crank he managed to find a LBS that was willing to drill and tap. You're looking for a crank that isn't hollow and doesn't have a lot of relief cutout on the back of the arms, something that's flat and solidly square front to back. Sram s300 cranks had been good for this as well.
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I would think that cycling will be the least of her adaptations after something like this. I would not be looking at crank or pedal solutions just yet because, if it were me, I would be pursuing a surgical correction of the issue. It does not sound like it was foreseen. It's not the most informative or helpful article ever, but I found this during a Google search on your behalf.
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5 cm? Almost 2 inches? If you are correct on the units and didn't mean mm, then I'd be asking a lot of questions of all the doctors and medical staff involved with the replacement.
Was there any advance notice by the doctors that there'd be a big difference in leg length?
Was there any advance notice by the doctors that there'd be a big difference in leg length?
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5 cm? Almost 2 inches? If you are correct on the units and didn't mean mm, then I'd be asking a lot of questions of all the doctors and medical staff involved with the replacement.
Was there any advance notice by the doctors that there'd be a big difference in leg length?
Was there any advance notice by the doctors that there'd be a big difference in leg length?
Probably the best correction is doing the other hip when the time comes (it is well on its way) and matching them. But if their error bars for matching are 2", who knows?
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All in all its is unfortunately a wait and see problem. To bad we can't kick the can down the road about 18 months for an observation and try to fix things now.
Here is a good German Publication from more than 20 years ago for an illustration.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477698/
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Femur differences are best dealt with via fore/aft cleat location. (Long femur has aft cleat, short femur gets forward cleat.)
Shin length differences with cleat shims.
This may require a bit of both.
Shin length differences with cleat shims.
This may require a bit of both.
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Sorry, only just saw this. She is on flat pedals at the moment, and appears to be doing naturally what you suggest for the femur length difference. (Her shin lengths are the same).
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After my left hip replacement was re-done (due to four dislocations, ugh), I had to wear a right shoe with a 3/4" thicker sole (just took it to a shoe repair place to add the needed sole thickness).
You have already surmised the remedy - get the other hip done. My doctor did not want me cycling until both were finished and healed.
You have already surmised the remedy - get the other hip done. My doctor did not want me cycling until both were finished and healed.
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