In august 2016 i managed to fall off my bicycle and broke my femur bone (right greater trochanter). It was an accident and nobody else was involved.

Urgent surgery followed approx. 12 hours after the accident which left me with a 11x420mm Stryker titanium rod inside the right femur. More or less from the hip down to the knee.

Then, 2 weeks hospital care, then home recovery. This went well and i worked with a physical therapist which gradually introduced new exercises, etc. Then I moved to a normal gym which i am still doing after 7 months. I am now almost ok, climbing stairs and walking around, but there is a slight limping i am not able to get rid of.

Now during these 7 months there were a few intermediate checks with the doctor and his team. Two times they measured my hip-to-knee distance with a ruler and compared with the other leg, and it seemed to be ok. I didn't know what that really was about at the time.

Todays x-ray check showed the fracture well recovered, however the doctor finally concluded that my right leg appears shorter by 5mm. That there's nothing to be done at this point and i should keep doing recovery and possibly try wearing a foot silicone pad inside my right shoe. No more checks have been scheduled and i am free to move on with my life.

Now, the questions:

  • is it normal to expect this "alignment margin" in this type of surgery? any statistics that says a broken femur is likely to remain slightly off after surgery?
  • is this something i could potentially never be able to correct either via exercising or possibly other kinds of medical intervention?
  • could the difference in length be more than 5mm, and they said that to sound "optimistic"?
  • if the difference is real (and it feels like it could be, since i am still limping a bit) and i am never able to correct it in any way, what kind of side effects should i expect?
  • should i double check with another doctor?
  • what are my options?

Thanks for any kind of insight you could provide!

  • 1
    well i can't give an expert opinion on this, but i heard sometimes in surgeries involving the femur (specially if the femur was badly broken) that pacients get this kind of sequels. That being said, you should always ask for a second opinion. Specially in the medical field. Waste no time and look for a Traumatologist that have an specialization on legs.
    – holyknight
    Commented Feb 28, 2017 at 20:04
  • Welcome to health SE :-). I'm very sorry to hear about your accident. Just to clarify, what do you mean by that if feels like the difference is real? Do you get such a feeling from the conversation with your doctor or do you actually feel the difference when you are walking. I'm asking because a difference of about 0.5cm is usually not subjectively felt, but that mostly goes for the people who have had the difference from birth, it might be different when it is acquired later in life.
    – Lucky
    Commented Mar 1, 2017 at 10:49
  • As i mentioned after 7 months recovery i still DO have a slight limp in my injured leg, it is visible i am leaning to the right a bit when walking. This i assumed was a muscle-in-recovery thing and will go away with time, but i have doubts about this now since being informed of the shorter bone. This limp was definitely never ever there before the accident. thnx
    – lmlmlm
    Commented Mar 1, 2017 at 10:57
  • I'd definitely go for a second and even a third opinion if need be - it can't hurt and it is really difficult to say over the internet what is the best course of action. The limp sounds a bit odd for such a "small" difference in length, but it doesn't have to mean that the difference is larger, your gait patter may not have recovered fully yet. I would suggest slightly editing your question so it doesn't get closed as personal medical advice - e.g. instead of asking if your case was malpractice you can ask for the statistics on how common this complication occurs with your type of surgery.
    – Lucky
    Commented Mar 1, 2017 at 11:10
  • Well, I had a bad hip and femur break 13 yrs. ago. The hip had a 'nail' in it into the femur. This year I saw an Orthopedic Dr. as my hip hurt going into my pelvic area. I needed the old hardware removed and a total hip replacement and attached rod into my my femur. This was done Mar. 27, 2018. The Dr. did not even see me in the hospital after surgery the 2 days I was there. I had bad scar tissue pain and a very red place which the the nurse referred to as angry. Now just over 4 mos .later, after rehab and lots of exercise I have a bad limp when I try walking without my cane. I can see one sid
    – Nancy
    Commented Aug 2, 2018 at 23:31

2 Answers 2


I am certainly no expert, however I had a hip replacement in August 2015 and I know I have a slight leg length difference now. It's very common in hip surgery but I think we are so pleased to be out of pain it doesn't seem important until we are fully recovered as you are and then possibly left with a limp.

I was measured about 8 weeks after surgery and there was a difference but they said it can a couple of years for everything to 'bed in' and I think they were right except I feel that my left leg is longer than my right and some days it seems more apparent than others. For me I think unless I start getting pain somewhere I'm not worried, I have got used to it. Saying that I did have to retrain myself to stop limping as it had become a habit. Have you had help with strengthening your core and your leg? Once you find the right physiotherapist they are amazing. I go to Pilates and it has made such a difference.

I know people who use the little insole in their shoes and they work fantastically. A friend of mine had a really bad back and sciatica and could hardly walk but just by wearing an insole and levelling him up, he is now pain free and has been for years. He has one pair for his shoes, another for his wellies and a third for his trainers now!

I would definitely go for a second opinion as it is your health and you have a right to ask questions and be in control. Sometimes we just need to speak to the right person and get peace of mind. I think it is different for everyone, some don't notice or can live with it and some people are more aware, as I am.

Sorry to hear you have been through so much but sounds like you have recovered really well which is fantastic. Good luck!

Take care

  • Question: Is it normal to expect this "alignment margin" in this type of surgery? Any statistics that says a broken femur is likely to remain slightly off after surgery?

Faye Loughenbury, Anthony McWilliams and their colleagues have conducted several studies that may in part answer your questions. I quote from "Hip surgeons and leg length inequality after primary hip replacement":

"89% of surgeons agreed that 15 mm of leg length inequality (LLI) after primary uncomplicated total hip replacement (THR) was always acceptable. 90% of surgeons felt that LLI more than 22.74 mm was never acceptable."

  • Question: Is this something i could potentially never be able to correct either via exercising or possibly other kinds of medical intervention?

While you cannot correct the relative difference that the operated leg has towards the other, a heel lift with the specific - exact (!) - height offers a tolerable compensation. Current focus is on leg length inequalities not mattering much if lower than 1,5 cm or 1 cm or, at best, 5 mm. If all lower extremity joints are examined for sufficient support of range of movement (patients may ask their physiotherapists) contributing to a well compensated overall functional leg length (that includes slightly extension-limited knee joints you might not have noticed, or missing arch support on the side of the (previously) anatomically longer leg) - you should live a happy life after all. If you are very technical about your question, and should doctors recommend THR of the second hip, some counter-compensation may be achieved when well planned. It may also help to be aware that the average LLI/LLD of the general population is 5 mm. However, the sensation of "limping" may intensify if the naturally shorter leg has become even shorter or the longer even longer. Anybody should use a heel lift, for fun, and compare sides. Most people will notice "a funny feeling" only with the heel lift under one of the two legs, specifically, as compared to the lift under the other heel. (It also may help to know that, clinically, hip arthroplasty patients that have a referring pain from the spine (reacting to the hip via the mediation of the pelvis) are not too seldom - at the same time there seems to be evidence that this would not matter - circumstances are unique, that is why stackexchange is serious about avoiding personal medical advice).

  • Could the difference in length be more than 5mm, and they said that to sound "optimistic"?

A tough question, to me, because we cannot know what "they" really thought. Considering the cited statistics, a patient with 5 mm length difference after THR is lucky with a relatively small "off" value. However, since in the general population the left leg is longer than the shorter right leg, it may add up to a centimetre in your case. To my personal clinical experience - that will most likely sound blasphemic - every millimeter matters, even less than a tenth. If clinical collaborateurs learn to palpate the effect of marginal leg length on the joints of the spine in bilateral comparison and for several segments, they may easily reproduce the causes for my judgment to consider less than a tenth of a millimeter important. I believe that future direction of reasearch will head there - however, I experience disbelief in clinical partners whenever I tell them what I palpate there - you can hardly find any reference in the literature to such manual precision yet, also not in functional radiography or MRI. Given the likelyhood of pain overlooked in its functional genesis, it is very likely that doctors really think that patients should not have pain (while they may have) after THR, as we may also think that patients should accept a limp if they would not wear a heel lift or have their shoes prepared by a orthopedic shoe specialist, which can most certainly be a fantastic relief in having done (if as exact as is possible).

  • Question: If the difference is real (and it feels like it could be, since i am still limping a bit) and i am never able to correct it in any way, what kind of side effects should i expect?

You'll see that my answers will repeat a little bit, but that should not matter much. If the patient made sure that his or her joints have no movement restrictions (knee joint extension in particular), checks if an arch support would be necessary and makes sure the person asked sees him/her as well walking as standing - that should correct quite a bit of limping, when also the correct (!) amount of the heel lift is found (for example, I use layers of different thicknesses of tape to add - subtract, on contralateral side - some necessary bits - sometimes, a single layer). If all shoes are lifted (a patient could place a lift in a sock, if he or she wouldn't want to avoid being "barefoot"), I would not expect major caveats. There may be individual things only an experienced examiner finds. At the same time, if a patient just gives in to leg length difference and does nothing about it - just goes limping - this amounts to asymmetric load transfer and greater asymmetric joint use all over the body than necessary, most importantly the (lumbar) spine, knees and (other) hip. We always try to establish a somewhat symmetrical movement - within its borders, deviations are alright, but if you ask clinicians, the definition of "deviation" can differ quite a bit. My suggestion would be to prevent unilateralization for the lumbar spine and neighboring joints of the hip with the help of an experienced manual therapist or doctor of osteopathic medicine having specifically stated experiences with leg length differences.

  • Question: Should i double check with another doctor?

Most doctors would probably tell you that 5 mm is no big deal. If you read the survey responses gathered by Anthony McWilliams and his colleagues, some doctors think that double that amount is no big deal, and some think that even more is still acceptable. user8412 said that we deserve to be in control and provided appropriate information. Unfortunately the expertise about leg length differences has not yet enabled many clinicians to provide sufficient information, due to a rather growing evidence base. A physiotherapist with special training (there are orthopedic manual therapists, for example) or an informed osteopath might as well provide further help. Sometimes they work together with orthoticists. However, somebody should also entertain the difficult work to inform surgeons and orthopedists so that they might become sensitized for the fact that "millimeters" do matter - if, apparently, little - at least to stimulate new and open research questions. The patients and their therapy experiences may inform resarch - so patients theirselves, in their responses to and articulations of outcomes are most likely the very key for future patient experiences, also in the domain of leg length difference / inequality.

  • Question: What are my options?

Only if the options referred to until here seem to leave open an essential gap, it might be beneficial to actually write to some of the doctors conducting resarch for the topic, offering your participation in trials and on the way get adequate "on the edge" diagnosis - many doctors with a hunch for this specific topic, as it is seldom enough, actually treat real patients :) ... however, as, for example, spine symptoms - "unspecific low back pain" - can be a consequence of THR, asymptomatic patients in matters of pain might just be fine with a general screening of a physiotherapist, orthoticist and/or orthopedist. It could very well be, that a specialist can only point to what part of a problem is explicity not falling in his or her domain.

While this can look like dry information, I hope it does not suck you into some mills of drifting into too much reflection but provide someone with a little hand of helping overview where needed.

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