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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

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  • kevoowen
    kevoowen diannemcgee

    Posted

    Hi Dianne

    First I heard about Trendelenburg was when I received a copy of my six week checkup when the physio had included the term "Trendelenburg Positive".

    I thought I was too young to die then the panic passed and I researched it and found that I basically had a limp! He he

    I was exactly like you but with the help of my Physio I am walking reasonably straight for short distances not (currently week 11). I am under strict orders to use a crutch or stick when walking outside to make sure I dont get back into the habit I had got into before the op. She also said that the leg muscles need to be woken up again onhow to walk properly.

    So, if you are ever in Chester and you see someone walking while mumbling "heel......heel......heel" then that is me. I thought it was daft but she has been spot on. I will be back in work at the end of next week and feel ready for it too.

    Th exercises she has given me are to strengthen the Gluteus and also the muscles around the knee but we are all different.

    I would suggest you keep giving the physios hassle until you get some sense. 

    Good luck and take care.

    • diannemcgee
      diannemcgee kevoowen

      Posted

      Miracle of miracles happened today! I had a friend over to help me put a hook in one of the ceiling beams so I could attach a small pulley and rope above my bed thus do passive exercises with a sling around my ankle. I got into the correct position . . . bottom leg bent, top leg (operated leg) straight and my body in straight alignment. As Trina and I giggled at me trying to get my foot into the sling UP went my op leg all by itself!!!! I couldn't believe it. That's the first time my gluteus medius has cooperated. No I didn't kick Trina in the nose but probably can by next week. I'm so happy my GM is functional again. I don't care how good it is at this point. I'm just glad it shows potential which I was beginning to doubt.

      I still limp when not using my cane but now I have a pulley installed so I can do passive exercises as well as attempt some active ones. YEAH!!!!

      What are the Glut exercises your physio showed you?

    • kevoowen
      kevoowen diannemcgee

      Posted

      ITs the straight leg lifts and Quadriceps sets mainly on top of the others to help mobility etc. Am actually suffering today as I think I over did it yesterday with quite a hard walk last night. I will learn one day!

      I'm at the stage now when I forget at times and its either a pain or one of the family shouting that will remind me. Never knew I had a gluteus medius before the op. He he

      Here's the link

      http://orthoinfo.aaos.org/topic.cfm?topic=a00303

  • jill48316
    jill48316 diannemcgee

    Posted

    Dear dianne,  Like yu I have had a THP BUT UNLIKE YOU, MINE WAS NOW JUST ONE YEAR AGO ANDF ALSO, UNLIKE YO, i AM 82

    Dear Dianne,

    I was very interested to learn about your problem with Trendelenburg Gait.  I had never heard of it until I saw it mentioned first in a letter in the SAGA mag and I am sure now I have it too.  For me perhaps, unfortunately, I am 10 years olderthan you and have had my new hip for just a year now.Like you I have been delighted to cope without pain and move freely and it is only more recently when I have been walking either with or without a cane that I have realized this failing so much.  Another problem I have,  I wonder if you have experienced, is if when walking, I am hailed from behind I have to watch myself how I turn to address someone I have the sensation I could easily lose balance.  I am about to start physiotherapy next week but I hope all is going very well for you and woould be very interedsted to hear of progress.

     

  • diannemcgee
    diannemcgee

    Posted

    Hi, everybody!! It's Dianne and I'm back. It was interesting rereading all the posts in response to my original post of 7 months ago. Just want you to know my gait has improved considerably. If I concentrate on walking, I can do it without limping (Trendelenburg Gait). My muscles tire easily and I'm pooped by the end of the day. It will be 1 year on April 6 since the hip replacement. I was skeptical when people kept telling me that recovery will take up to a full year before you feel like your old self. Course I'd rather feel like my young self. I'll keep on truckin'.
    • HippiechicUK
      HippiechicUK diannemcgee

      Posted

      That is good to know Dianne. I also have Trendelenburg Gait for the same reason as you. I am 5+ months post op and had thought around Christmas that I was well on the mend but am limping again. I think I am better when I can get out and exercise with walking more but with the colder and frontier days I am a little scared of slipping. I am in UK and having physio. I also walk outdoors with a stick (cane) and hobble about indoors without. My knees have become a bit painful. Roll on the better weather. My surgeon also said not to expect full recovery for 6-12 months. I also had the lateral approach. Keep on truckin'😊
  • diannemcgee
    diannemcgee

    Posted

    I have been so careful so I don't fall while walking, etc. However, I have fallen twice and both times it was stupid. I had the vet out to check one of my donkeys simply because I didn't want to take a chance being around him. Guess what? He jumped and I jumped back. Down I went . . . with the vet watching us. Best laid plans of mice and men . . .  The second time I tripped over a length of twine and did a four-point landing avoiding a face plant by 1/2 cm. And I'm CAREFUL! Just thought I'd mention this as a reminder to all to be cautious. The good news is that I now know how healthy and strong my bones are. But no more tests, please. I'm in western Colorado, USA where it is cold, cold, cold.
  • shushu100
    shushu100 diannemcgee

    Posted

    dianne: i've read your blog with much interest. i've been feeling bad about my progress and now know that at least i'm not alone! i'm 11 weeks post op THR (minimally invasive, posterior). i fell for all the hipe about minimally invasive THR (6 weeks and you're like new) so now 11 weeks into it and still limping, i've been feeling like a failure. i've faithfully doing exercises and am up to 2 miles walking with a cane. it's w/o the cane that's the problem. That dang T-gait! i can 'suck it up' and tighten my core muscles allowing a fairly normal gait w/o the cane for about 5" then i get tired and the limp comes back. i didn't have a limp pre-op. i'm 64 but very active pre-op. My leg muscles and gluts were very strong from hiking and the gym. But they're not now. i've never been told by anyone from my surgeon to my PT that it could take up to a year! i was stunned by the many posts to your blog stating that. Kinda disheartening but i'd rather have the truth and work toward that than feel like i'm doing something wrong and that's way i'm limping.

    i'm being told to get myself off the cane. What are others hearing? Use the cane until the T-gait is gone? thank you for this blog!

    • diannemcgee
      diannemcgee shushu100

      Posted

      I would say not to get off the cane until you are walking with it over your shoulder and NOT limping. Despite my own advice I tried to take short cuts and am now back to straightening myself out. It's so hard to hear others talk about how wonderful they are doing while implying that you are "behind schedule". I changed physical therapists when I still was not getting acknowledgment about my inability to fully utilize my operative leg. However, I still rushed into recovering and shouldn't have. My op leg is 3/4"+ longer than my good leg and my pelvis is crooked and I get exhausted after walking 300-400 yards. I'm going to a chiropractor for the first time in my life - they don't necessarily have favor with M.D.s in the USA - and feel improvement already in 3 weeks. First thing he did was give me a 1/2" lift to put in my shoe. The surgeon doc said "everyone has a slight leg length discrepency and it's hardly noticeable to most." I guess his leg lengths must be perfect, or he'd notice.

      I'm rambling so I'll close. Just folllow your instincts and remember that you are healing your body the way it needs to heal. Don't listen to ANYONE else about the speed you're doing it. D

    • shushu100
      shushu100 diannemcgee

      Posted

      thank you Dianne! after reading your blog i went online and did a lot of research re: trendelenberg gait. There's some debated evidently in the professional community about which exercise best correct T-gait. what i've read so far is the the clam (with 0 degree hip flexion) really isolates the gluteus medius (the main culprit in T-gait) the best. The website explains it and has videos showing correct technique. Best regards.

      ps: give your surgeon a 1/2" lift and ask how they like how having one leg longer feels!

      Emis Moderator comment: I have removed the link as it was to a site unsuitable for inclusion in the forums. If users want this information please use the Private Message service to request the details.

      http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

    • pamela81726
      pamela81726 shushu100

      Posted

      Hello everyone.  Ihad my hip replacement in may last year, 2014.  I have pronounced trendelenberg gait.  Unfortunately, my other hip needs an op' too, which makes it difficult to do most, if not all the excersises recommended.  I am having a hoist installed above my bed so that I can pull the leg up And use gravity to strengthen the gluteus medius.  Can any one suggest anything else ?
    • diannemcgee
      diannemcgee pamela81726

      Posted

      That is an excellent idea to put a pulley above your bed. I did that in desperation when my gluteus medius refused to cooperate. I figured training it with some passive exercise was a good idea. It worked and didn't take too long before I was able to start doing clam shell exercises. It was slow going and took work, energy and lots of patience to get back some response in my gm. Apparently it was cut during surgery. I wasn't told this until I dug it out of the surgeon. It's easier to improve when you know what you're working with or against.
    • patty6412
      patty6412 shushu100

      Posted

      I'm 10 weeks post THR anterior approach with significant trendelenburg gait if I don't use the cane.  Very interested to hear a year out how you are doing.  I'm still doing PT twice a day.  Good with everything but the walking.  Able to bike about 9 miles a day and swim with a minimal kick, but I can not walk! I'm hoping this is not a permanent condition so anxious to hear how others with this gait are doing now.

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