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Trendelenburg Gait after hip replacement

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diannemcgee
diannemcgee

I am 9+ weeks post op THR and am experiencing a Trendelenburg Gait as the result of a severed gluteus medius (and minimus) from a lateral surgical approach. I'm getting blank stares from the surgeon and PT when I ask if it will ever go away if I exercise well. I have not spoken to anyone else who has had this problem but would love to know what prognosis to expect down the road. Can anyone relate to this? I am 71 years young (the new 51!) and otherwise have had a spectacular recovery. I still use a cane and sometimes a walker when I need to go faster without limping. The Trendelenburg Gait (without a cane/walker) will eventually damage my back, hips, pelvis. I'd like to correct it before it does damage.

10 likes, 76 replies

76 Replies

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  • nic99752
    nic99752 diannemcgee

    Posted

    Hi Dianne38189...I can relate.....I experienced a similar painful gate about 4 months after the opp. The Gluteus medius contracts to keep the hip level during the swing phase so that that leg can swing through......the Gluteus medius inserts on the Greater Trochanter and the action of contracting is very painfull....unfortunately , the stretches required for the GM is not recommended because it can cause dislocation. I am still active in athletics and this causes a delay in my preparation....a sonar scan of my GM shows multiple tears ...that is when the muscle heals it leaves scar tissue and without proper stretching this remains a bit tight and with sudden movement it tears again next to the scar tissue...so in fact a catch 22 situation....by the way I am " the new 50 "...I have been advised to use heat frequently....I use a bean bag heated in the mocrowave for 2 min. That seems to provide some relieve......My cowboy stride ( hehehe) is gone and apparently only time will correct it. My problem was as a result of the disecting the Maximus from the Medius to allow separation of the muscles to get to the Femoral head.I suppose this problem will test our patience.....
  • bonny49088
    bonny49088 diannemcgee

    Posted

    Hi Dianne

    I'm 10+ weeks and have the same. My pt instructor has been really helpful, will not let me walk distances without the stick as that helps me walk straight. I'm working hard on glut exercises, am on the static bike for half an hour a day and have just started strength training. I use a step with a 4.5kg weight in one hand then the other and step up onto the step making sure my knee locks. I've been working really hard to ensure the motion is correct not just launching myself but it's very hard! This strength training I think is helping my progression. 

    It's frustrating, but you're right - if you walk with an odd gait, you will be compensating elsewhere. What exercises are you doing?

    • diannemcgee
      diannemcgee bonny49088

      Posted

      The first few steps in the morning are awkward, then my gait improves throughout the day until evening when I'm tired out. It gets slow and awkward again. The whole time I'm still doing the T-gait but minimizing it with the cane or, better yet with a walker. I can stride smoothly and almost tirelessly with the walker. Problem is I don't have long distances in my house and I live on an acreage with dirt, gravel and grass. I go to our local recreation center and use the walking pool which makes me feel like I have a normal stride!!!! Morning and night I "try" to do straight leg raises while laying on my good side. It is quite painful to raise my leg off the bed while in a straight body position. I can wiggle around a bit and get the leg a  ways into the air and hold it for a bit which I figure is better than not doing it at all. I also do the "clam" exercise which is easy. Also easy is the abducter exercise where you move your affected leg forward, back and sideways while standing with a stretchy band around your ankles. I also walk on the treadmill at the rec center, walk in place at the kitchen counter   plus do a few sieways stair steps. Oh, I can't forget that I use my spinning wheel every chance I get!!! <(~_~)>
  • bonny49088
    bonny49088 diannemcgee

    Posted

    Oh and my gait is terrible first thing but gets better throughout the day
  • ros007
    ros007 diannemcgee

    Posted

    You need to strengthen the hip abductors and also get someone to check that your pelvis is sitting properly on your spine.  To strengthen the abuctors first start by moving your leg outwards while lying flat on the bed. You can also move it outwards while standing but there is a tendency to 'recruit' other muscles to help if you aren't careful.

    Then you can lie on your side and raise the leg to the side, again you need to take care to keep your leg in line with your body.

    Finally you can build to one leg stance. Put one hand on your unoperated hip and the other on something solid. Raise your unoperated leg off the ground and keep your pelvis level. Put the leg down as soon as the pelvis starts to drop if you can't pull the pelvis back up using the muscles on the operated side.

    I had Trendelenburg gait pre-op and pre-op exercises and these post-op ones mean that my gait is now almost normal but it took months of work and I still have to do some exercises each day to maintain it.

    Good luck to you both because it is slow and to be honest tedious but the results are worth it.

    • bonny49088
      bonny49088 ros007

      Posted

      My pelvis is rotated on the non op side which means my operated leg feels longer - this is making life really hard and my back really hurts. Getting osteopath to help with very gentle work. Some days my hips look straight, other days really wonky!!
  • ros007
    ros007 diannemcgee

    Posted

    Poor had a similar experience pre-op which sorted itself out during all the tugging during the op! The muscle imbalance was still there though and you need to get some expert advice on which muscles to work on and how so that your pelvis becomes stable once it is manipulated into position.

    Good luck and I hope it sorts itself out even if you have to work at it for ages.

    • cathie38426
      cathie38426 ros007

      Posted

      I quoted your advice about balancing on one leg in

      a note to Mark yesterday, and now your other tips have

      shown up on the first page, though a year old and about

      Trendelberg gait.

      Your advice is so good and your

      experience is só beneficial I hope you will post to let us

      know how you got on after your last op.

  • kaleani75551
    kaleani75551 diannemcgee

    Posted

    Hi Dianne, it has to do with your pelvis that needs to get pushed back into its normal place, that is the best way i can explain it.  There is one particular exercise that i did and still do, that can help.  Google it so that you get the picture on how to do it correctly.  Very easy.
  • kaleani75551
    kaleani75551 diannemcgee

    Posted

    Should have also said this on my previous note: the two exercises i do most that i believe corrrected my gait are the one standing on the operated led while keeping the other leg bent and off the floor, i usually count to 50 in that position.  Difficult to do at first but it gets easier as you improve.   The other exercise is the clamshell, laying down on the bed.  

     

    • rose0000
      rose0000 kaleani75551

      Posted

      What is a clamshell? Am following your exercise plan, as although I am completely free from penguin walk ~ I still have a small limp even though I am cycling tons....I don't know if this is the same as Dianne or not....going to ask my physio. Thanks for the tip. I have been quietly worrying about this for a few weeks..
  • kaleani75551
    kaleani75551 diannemcgee

    Posted

    Ok this is my last note on the subject i promise.  For the standing on one leg exercise, you must not hold or lean on anything and you must try to stand as straight as possible, you will notice that the tendency for the body will be to lean towards the weak side (operative leg).  I do not know abt other people but this has helped my gait tremendously.  I do not understand why anyone in the medical field has not suggested this to you.   Amen.
    • diannemcgee
      diannemcgee kaleani75551

      Posted

      It doesn't have to be your last note, Kalean! Your advice is helpful. I tried the standing on one leg thing and it helps. So far I am still wobbly but never have had great balance. I can do the one-legged stance for a few seconds so that's a start. I'll work on it.
    • cathy96004
      cathy96004 kaleani75551

      Posted

      Hello Kalean, I've been waddling around like a duck for 3 yrs!  It started with my left hip replacement in 2013.  As soon as I was off the walker and cane, there it was. No one including the therapists could figure out why... Fast forward to Dec. 2015 to my right replacement, except this time the surgery was done in front of my hip. Oh my gosh, the difference in my recovery was remarkable! I feel there was less pain, easier to sleep at night, easier to get into and out of bed, and easier to walk. However, my 1st day of therapy at the live-in facility, and I immediately returned to my waddle gait. The PT said I had walked that way for so long, I had to retrain my brain to walk normally again. So he had me doing a high stepping march, to retrain my brain to use the front muscles of my legs. It didn't take very long, and I was walking normally with the walker. I was so excited, thinking this was all I had to do to walk normal, was some marching step?! Wow!!  However, when it came time to transfer to a cane, putting the cane in the left hand for my right hip, I immediately started waddling again. We stopped, and he told me to lift my right leg. I could barely lift it off of the floor. I told him, for some reason it feels like I could do better with the cane in my right hand, he said, okay, let's try it. With the cane in my right hand I could easily lift my right foot highly off the floor. We started off walking, and everything was fine, a little wobbly, but no trace of waddling. The waddling and weakness of my left side bothered me a great deal, I couldn't stop thinking about it, and couldn't shake the sinking feeling that I still wouldn't be able to walk normally, after I was supposed to get off of the cane.  I told the therapist that after I had recovered from my left hip, I noticed that when lying down on my right hip, I was hardly able to lift my left leg at all, and asked if that weakness of my outer leg could be the cause of the hitch in my walk. He didn't know, and the subject was closed then. Fast forward ahead, and I was released last week. I'm home faithfully doing my strengthening exercises everyday, and today it occurred to me to google the problem with my walk. It took awhile, but I finally asked a question in a different manner, and I finally found what I was looking for.  I read everything, and watched the video, and was so elated to find that my walking problem has a name! Trendelenberg Gait! What a Relief, because if there's a name for it, there must be a therapy for it also!  I've been reading these letters, and have found yours to be the most informative and helpful. You describe the exercises so well, and what not to do. I sure wish I had had this info with me at PT, but didn't have my computer with me there. I could have been working on this as well 6 wks. ago. I'm hoping to go back to work in March, so I don't have much time now. I have an appt. with my surgeon tomorrow, and plan on informing him about this.  I feel so much better today, because now I have a name for the problem, and Thanks to you Kaleani I also have tried and true exercises to repair the problem. Do you know if these exercises have to be a lifelong therapy, or after the walk is back to normal, will just "walking" keep it strengthened? Thank You so much, for giving me hope again!           
    • kaleani75551
      kaleani75551 cathy96004

      Posted

      Hello Cathy,  I had my right hip done in 2013 and my left hip done in 2014 the front side, just like you.  I found out about the Trendelenburg gait almost immediately after the 2014 surgery.  I was walking like a duck and i did not like it.  The exercise I mentioned above is the only one that I found and that, I feel, has helped me regain a normal gait.  The hips and legs have to be retrained after surgeries like our. It includes the pelvic.  Yes, I still do one or two of every day and probably will always.  I also still do some of the other leg exercises.  A small price to pay to keep this body going...straight.
    • rose0000
      rose0000 kaleani75551

      Posted

      Kaleni you should post your own you tube clip but for now to clarify you do the clamshell which I am not sure what that is...leg raisers and standing on one leg and counting as far as you can..cycling anything else I have missed? 
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