For years I’ve lived with worsening hip pain and avascular necrosis. Walking, standing, even just shifting from one chair to another could be exhausting or painful. My gait has been uneven for a long time, and over the years I’ve had to adapt to the discomfort by changing how I step and balance. I’m now preparing for my first hip replacement in South-East Asia (I was advised to do two but spaced out). While researching what to expect, one issue kept appearing on forums: leg length discrepancy. Surprisingly, most surgeons don’t mention it, even though it can cause significant misery after surgery. Reading patient experiences online, it’s clear this is a problem many face but rarely get warned about.

Why leg length can change

During a hip replacement, the surgeon has to manage several factors simultaneously: placing the new cup and stem in the correct position, keeping the joint stable, and aiming to make both legs equal in length. Sometimes the new hip is intentionally left slightly longer. This may sound counterintuitive, but the reason is stability — a slightly longer leg can help tighten the muscles and soft tissues around the joint, which reduces the risk of dislocation. A difference of a few millimetres is common and often goes unnoticed, but larger discrepancies can affect walking, posture, and comfort, especially if the patient already has other musculoskeletal issues.

For someone like me, who has been dealing with necrosis and joint collapse for years, even minor changes in leg length could interact with pre-existing adaptations in my pelvis and spine. Over time, my body has adjusted to uneven loading, so any alteration from surgery might feel dramatic at first, even if the actual bone difference is small.

How leg length is measured and controlled

Even with minimally invasive techniques like SUPERPATH, surgeons use careful methods to check leg length. These include:

• Measuring distances between fixed points on the pelvis and femur before and after trial implants.
• Moving the leg through a range of positions to ensure the hip is stable and doesn’t feel like it might dislocate.
• Using X-ray or fluoroscopy in the operating room to verify the placement of the cup and stem and compare leg lengths while the patient is still on the table.

The SUPERPATH approach is appealing because it avoids cutting major muscles and allows for a smaller incision. The limited view can make it more challenging to judge leg length by eye alone, which is why imaging is crucial. Standing X-rays before surgery also help surgeons plan, showing the shape of the pelvis, how much bone to remove, and how to align the implants.

From what I’ve read online, patient forums often describe cases where leg length was slightly longer for stability, but the difference wasn’t communicated beforehand. People report discomfort, back pain, and difficulty adapting. Some use shoe lifts or orthotic adjustments, but for people with very large feet, these solutions can be hard to implement.

My history with footwear

In my case, I haven’t been able to wear any shoe with a heel for well over a decade. Even a tiny lift causes sharp thigh pain after walking short distances. That pain comes from the necrosis and the way my old joint has collapsed over the years. I’ve been limited to flip-flops because they are the only footwear I can find in my large size with no heel.

The problem is that if my new hip ends up slightly longer or shorter, I won’t be able to use traditional shoe inserts to correct the difference. Most commercially available trainers or shoes simply don’t exist in my size. This has been a persistent source of anxiety because it affects my mobility and comfort daily.

What I’ll wear after surgery

Flip-flops are not ideal immediately after surgery. They don’t stay on unless you grip with your toes, and the soft, thin sole provides almost no protection if I trip or twist my new hip. Going barefoot indoors is slightly better but still risky — one stubbed toe or an uneven floor could cause a sudden shift in weight that the hip isn’t ready to handle.

I’m planning to order sports sandals or rafting-style shoes with straps over the top and around the heel. A flat, cushioned slip-on could also work, provided it holds the heel firmly. For the first six to twelve weeks, the priorities are simple:

• Protect the foot from knocks and slips.
• Keep the sole flat and level to avoid exacerbating the un-operated hip.
• Ensure the shoe stays securely on my foot without forcing my toes to grip.

Once I’m walking steadily and the scar has fully healed, I expect I’ll be able to wear flip-flops indoors for short periods or even go barefoot on clean, level floors. This staged approach balances safety and comfort, especially given my long-term difficulties with heels.

Recovery, rehabilitation, and adaptation

After surgery, even if leg lengths are technically equal, the body can perceive a difference due to muscle tightness or pelvic tilting. Physiotherapy (if I could afford it) would be critical to retrain my gait and strengthen the muscles around the hip. Some days my pelvis may feel uneven, and the “long leg” sensation may come and go. Over weeks to months, the tissues adapt, and the feeling usually diminishes.

Forums and patient stories highlight the importance of patience: even small discrepancies can be frustrating, but targeted exercises, posture awareness, and careful monitoring by a physiotherapist make adaptation possible. Tracking progress in the first weeks — how far I can walk, how my back feels, and whether my old hip complains — will help me spot any persistent problems.

Practical tips from what I’ve learned

From my research and conversations online:

• Ask surgeons if small leg length changes are intentional for stability.
• Ensure intra-operative imaging is used to verify positioning.
• Plan footwear carefully, especially if you have large or unusual shoe sizes.
• Prepare for rehabilitation exercises to retrain muscles and balance.
• Track perceived differences, even if X-rays show symmetry, because muscle adaptation can take time.

In my case, understanding all these factors — the potential for slight leg length changes, the limitations of my shoes, and the role of imaging during SUPERPATH — is completely overwhelming. No one I speaks to at the hospital even mentions this or cares; I can be certain they’ll wash their hands of me or milk me dry if anything goes wrong.