Knee replacement complications

Martin

My wife had a knee replacement 4 years ago due to arthritis. Since then she has had considerable difficulty walking, and suffers constant backache. Covid has not helped as access to swimming and the gym has not been possible. She is unable to stand or walk for long. In those 4 years she has had numerous doctor and physio appointments all of whom have basically told her her to suck it up and get on with life. She refuses to take opiate painkillers for obvious reasons.

A year ago she went back to the doctor for more help, and eventually got different physio support. There the physio suggested she had one leg longer than the other. Indeed on further examination this turned out to be 1.5cm.

This is a known complication of hip replacements, and research by myself shows an 86% likelyhood of an average of 1.5cm leg lengthening in total knee replacements, indeed higher than in hip replacements.

Neither your advice leaflet nor the local NHS leaflet mention this as a complication, and certainly my wife was not informed of this complication.

Had she known about this 4 years ago, she might well have got a considerable improvement in her quality of life and freedom from pain by the simple expedient of either insoles or built up shoes.

Why haven't Versus Arthritis highlighted this?

frogmorton

No idea @Martin

But you would have thought, if your wife didn't need a knee replacement her consultant wouldn't have done one??

Are you planning on taking the issue up with your local health authority?

Martin

You've missed the point. She did need the knee replacement. The point is she was not told about this complication, and only recently has the problem been found: - That's after 4 years of constant back pain and numerous doctors' appointments, back pain clinics and physio support.

Had this complication been noted, as it is with hip replacements, she probably would not have had 4 years of constant back pain, and most probably damage to her back.

anneb82

Dear @Martin

Thank you for joining the online community. I hope that you find it of benefit to yourself and to your wife.

I am one of the volunteer moderators so am unable to fully answer the comment you have made but I have made a note of it and a member of staff will get back to you as soon as possible, hopefully on Monday.

Thank you

Anne (moderator)

frogmorton

@Martin

I see what you mean now sorry I did misunderstand you.

I had no idea knee surgery could result in different length of legs either this is very useful to know. Have Versus arthritis advised differing leg lengths as a possible surgical complication with hip surgery then?

Have you (you probably have) read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911931/

I tend only to read UK and ideally NHS articles.

My own Mum lived with different length legs for 40+ years after a motorbike accident and resulting compound fracture of her leg. She was given one pair of shoes one shoe built up, but rarely wore them. She was fortunate and never had any issues with her back though I am so sorry your wife is suffering with hers.

Having had back surgery myself after 20 years of back issues she has my genuine sympathy.

Martin

Hi Toni

Yes I did read it, many thanks though. Check out the Versus pamphlets on both knee and hip surgery. The latter documents differing leg length as a complication, the former does not, neither does the NHS knee replacement booklet.

Two completely differing views on the subject here from specialists in the UK:

https://www.manchesterhipandkneereplacement.co.uk/total-knee-replacement-tkr.html

https://yorkshirekneeclinic.com/could-having-a-knee-replacement-alter-leg-length/

Two specialists, 40 miles apart. One must be wrong.

frogmorton

Blimey! That is conflicting.

Is your wife more comfortable now with her insole/built up shoe?

I can certainly see why you are upset it's awful seeing someone you love struggling.

My best wishes to your wife

Martin

Hi Toni. Insole arrived earlier this week, but initial result looks encouraging. However, it is going to take weeks/months for OH to get used to wearing it, and to start to regain a better mobility expectation. Probably will need a lot more physio.

No response at yet from Versus. Why am I not surprised?

Brynmor

Hi @Martin

So glad to hear that there looks to be some progress and help available from wearing an insole.

Also, thank you for pointing out the gap in our information. The lack of information that we have about the impact on leg length after hip surgery has been passed on to our health information team to ask them to review the materials we publish. I will let you know what the outcome is from this as soon as I know.

Do let us all know of any progress. It would be great if there was some information available here on the Online Community for others who also come across this problem.

All best wishes

Brynmor

Martin

https://community.versusarthritis.org/discussion/comment/678830#Comment_678830

Don't you mean knee surgery? Leg length difference is already a recognised complication of hip surgery.

Brynmor

Hi @Martin

Yes, I did indeed mean knee surgery! Not sure what I was thinking there...

There seems to be a severe lack of information on the issue across the usual NHS channels. This is our standard point of information for our volunteers at the Online Community if we cannot find materials on our own web site. For example, it does not seem to be mentioned at all here: https://www.nhs.uk/conditions/knee-replacement/

I have spent some time looking through past discussions here regarding Total Knee Replacement but have not found anyone who has had a similar experience: Search results: https://community.versusarthritis.org/search?Page=&Search=knee+replacement

I am now hoping other members who have had this operation will be able to contribute to the discussion.

General shout out to all members: Any further links to sources of information or personal experience would be very much appreciated!

frogmorton

https://community.versusarthritis.org/discussion/comment/678682#Comment_678682

Hi @Martin

Glad your wife has her insole. How is she doing now? Any improvement at all for her? I expect it will take a good while for her to adjust.

I hope we get some responses from anyone who has had their knee replaced. I think your wife would feel better knowing she isn't alone.

@Brynmor

Is it possible to shout out across all Versus Arthritis media? There is twitter (I don't use it) and facebook I know.

Martin

https://community.versusarthritis.org/discussion/comment/678855#Comment_678855

Hi @Brynmor

I have been looking carefully at this and have found one hospital that does not use what seems to be the standard NHS leaflet, and does state altered leg length as a rare complication: https://www.fhft.nhs.uk/media/4655/total-knee-replacement-surgery.pdf

Ironically, some years ago this used to be our local hospital. I think this sums up the whole situation, frankly its a mess, and nobody seems to be bothered. I shall certainly be rattling a few cages with our local hospital.

The silly think about this is that research into the complication would actually be relatively simple. The few studies that exist seem to compare having one knee operated on and having both knees done. It comes as no surprise to find that altered leg length is more common when just one knee is done. Other studies look at just one surgeon's operating list, yet this contains an obvious flaw, it could be something unique to just this surgeon or the type of implant he/she used. Surely a simple study would be to look at the number of people referred to a clinic with a significant leg length difference after either hip or knee operations and see what proportion had knee operations.

stickywicket

I'm sorry your wife has has so much post-op difficulty..We invest a great deal of hope in our othopaedic ops and in that scary, post-op period of pushing through painful exercises. I've been incredibly lucky with all my replacements (two THRs and three TKRs). I do hope the insole is now taking effect and enabling her to walk more as that, in itself, will be of great benefit to her general health.

To deal with your own problem - should sites advise of the potential for leg length discrepancy - I've had a quick google and it seems fairly evenly distributed between 'there might be' and either 'it's simply perceived rather than actual' or 'most people in the population have leg length discrepancies anyway'. Because of this, although I can feel your frustration, I'd doubt there'd be any mileage in pursuing the matter. I'm sure you'd be unlikely to find any similar outcomes on Versus Arthritis as, in years on here, I can't remember any and, in any case, once people are 'fixed' or learn to deal with their new situations, they tend to disappear and not return to the site.

I confess my main thought, when I read your posts, is "What does your wife want?" This is because, twenty odd years ago, when I had breast cancer, my mastectomy was delayed for three months as I kept running into cancelled clinics - metaphorically speaking😉. Afterwards, although they knew my lymph glands were affected, they could only extract three and couldn't give me radiotherapy due to the arthritis in my shoulder. My husband was very upset and wanted to complain and possibly sue if the cancer was still there. I refused to let him, though, on the grounds that, if I only had a short time to live, I didn't want to waste it in anger and litigation.

Of course, your wife's situation is not so extreme and I readily understand and applaud the desire to use one's own misfortune to improve the lives of others but..... I just feel this could take a big chunk out of both your lives and, personally, I'd just want to enjoy together the improving situation for both of you. How does your wife feel?

Brynmor

Hi @Martin

Success!

The issue you first raised about the lack of information has been noted!

Our Health Information Team have responded as a result of this discussion. All information we provide goes to an external review team who have the medical knowledge for checking the advice we make available. It turns out that the issue wasn’t raised at the time that the information was first produced – either by the author or the reviewers who looked at it.

We now know that our knee replacement information is currently under review and that we can therefore look at including information on this particular complication in the very near future. This will be raised with the medical panel so they consider it when the review takes place.

It's not often that we are able to highlight a gap in the support information offered on the Versus Arthritis website. Hopefully this gap will be filled for the future so the information is better for those who are having total knee replacement surgery.

Best wishes

Brynmor

Mini

https://community.versusarthritis.org/discussion/53892/knee-replacement-complications

Good Evening Martin I had same problem when I first had my left knee replaced was longer in one leg I have osteoarthritis then was diagnosed with fibromyalgia then 2 years later had to have my hip replaced in 2018 I was limping really badly but still same now then I started getting electric shocks in my legs spasms and in my arms they hurt so much unbelievable only thing I have found to relieve the shocks is to do the plank 2 times a day holding for 1 minute each time then if shocks in arms hold a broom handle or stretch band behind back in hands and slowly rotate to the right hold 15 secs then to the left 15 secs do 2 times each way stops the shocks I was then diagnosed with spinal stenosis I have narrowing of the spine , then had surgery on my right knee total knee replacement in 2019 .

I have just had another knee camera op 2 weeks ago awaiting results as I have already had my left knee replaced twice and now has corrosion and won’t bend and my bone is crumbling around it so awaiting results get on the 26th April when they fitted my right knee replacement I have total different knee replacement to left one and get no burning from it but my hip and left knee are so painful on fire 🔥 burns so much really painful

I went to hospital yesterday to see my spinal surgeon and he has put me 4 ward for spinal infusion operation I was really not expecting that yesterday even thou my pain is so so bad just at rock bottom at the moment and I can’t take prescription drugs they try to give me as side affects are terrible I get wild thoughts and low mood black cloud comes over me keep 4 getting things to even hit a van driving once so gave them up been on just Ibrobufen and paracetamol even the ibrofen thou if I have 3 a day 500mg can affect my mood so have just 2 and I’m fine but my pain is sky high with my spinal stenosis .

my gym 2 has closed in lockdown find walking the pool really helps and light weight exercise like your wife doe’s I have been following Lucy Wyndham-Read on Instagram she does mobility exercises which are really good I make a coconut oil to rub in essential oil black pepper 10 to 15 drops with about 3 to 4 tablespoons of coconut oil looks like lard and mix together also on my repeat prescriptions I have capsaicin cream it’s a hot 🌶 cream but make sure you wash hands after as if u get in your eyes burns a lot.

I have also cut out all wheat from my diet and have gluten free products and only eat that bread now I eat gluten free porridge to for breakfast my personal trainer at gym told me to go on a wheat free diet as cuts inflammation down and I must admit it has helped I have full fat natural Greek youghurt and fruit or nuts for breakfast with cinnamon on or gluten free cereals

one thing I did was after 1st knee replaced I was limping so I went to a podiatrist and he made me inserts 4 my shoes which stopped me from limping until I had other knee replaced but to be honest I will always walk with a limp now I’m 51 but feel like I’m 97 hope this helps 💖 2 u both

frogmorton

https://community.versusarthritis.org/discussion/comment/678934#Comment_678934

It may be too late for your wife @Martin but you should be proud of yourself that you have probably helped change something and helped future people make informed decisions.

I hope you are proud of yourself and that your wife is doing better.

Jenwren

I've found this with my knee replacement that my right leg is longer, I was told about this but I'm waiting for my left knee replacement so hopefully they will be the same length. My problem is the bend. My physio said I've got the strength but I can't bend it too far, I'm sure he thinks I'm not trying but I just can't bend it further than a sitting position, even then it's painful & seems to stick when I try to move it. Has anyone got any suggestions of how I can get the bend. My op was at the end of November it's now February.

suelema

Yes, use the bottom stair for your foot when putting shoes and socks on, once you can do that then use the next stair up. I did that with my torn meniscus as gradual stretching of the knee over weeks is essential. I don't know when you had your op but doing the exercises during the early weeks is essential however painful otherwise the vertical cut heals too tightly and then the knee is unable to bend further than the healed skin allows.