You had a hip replacement surgery, and you are having different kinds of pain in the thigh, groin, buttock, lower back and knee.
As a diagnostic radiographer I have worked alongside surgeons during hip replacement surgeries. I will answer the most frequent question I hear patients and internet users ask about pain.
I will also rely on scientific studies on the subject, all references at the end of the article.
Happy reading!😀and feel free to ask questions in the comments or share your own experience.🙏
Last updated: May, 2025. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: Amazon affiliate links,full disclosure in the legal section.
Summary: with any kind of surgery, you will experience postoperative pain, and that’s not different with a hip replacement, there is normal pain and abnormal pain after a hip surgery.
But most pains after a hip replacement are normal and they may last for days, weeks or 6 months which is normally not a sign of complications.
▶️What are some of the hip pains people always complain about after a hip replacement?
Here are the most described sensations by people who are curious about pain after a hip replacement.
⏩Most frequently reported pain after hip replacement.
Where did I get this information? I simply looked at the most used keywords on the internet related to pain after hip replacement.
| Type of pain | Explanation |
| Pain in the mid-thigh | Can feel like a dull ache, a sharp pain, or even numbness and tingling. It can be in the mid-front of the thigh, or it might radiate from the hip or knee. 🟣Some people experience pain when starting to move, during movement, or at the end of movement. |
| Groin pain | Can be dull ache to sharp stabbing pain. Some people say it feels like a deep-seated pain, a pulling or tearing sensation, or a burning sensation. 🟣The pain may worsen with specific movements, like getting out of bed, bending, or squatting. |
| Buttock pain | Can feel like a dull ache, sharp pain, burning sensation, or even numbness or tingling. 🟣The pain can be present at rest or worsen with certain movements, especially sitting or transferring weight. |
| Lower back pain | Can feel like a dull ache, stiffness, or even sharp pain. 🟣It can be a symptom of the body adjusting to the changes in posture and gait after surgery. |
| Knee pain | Can manifest as a dull, aching feeling, particularly when the knee is not bearing weight. 🟣The pain may intensify during activities like walking, squatting, or kneeling, where pressure is applied to the knee. 🟣It can also feel like tingling, numbness, or radiating pain from the hip down to the leg |
A table explaining some of the pain people complain about after hip replacement.
Before we go into detail of these types of pain, we should know some of the reasons why we experience these kinds of pain after a hip replacement.
1️⃣Pre-existing pain before surgery
Remember you underwent a hip replacement for a specific reason such as a fracture, arthritis or a rare pathology
Regardless of the reason, you already have a source of pain.
2️⃣Consequences related to the hip replacement procedure
During a hip surgery, I have seen the surgeon install a hip replacement which looks very traumatising.
He usually goes through different layers through the skin, bone, muscle, ligaments and blood vessels.
This alone can cause you pain as the tissues take time to heal and recover.
▶️What do scientific medical research studies say about these kinds of pain after hip replacement?
To summarise here are research studies that synthesized knowledge about these different types of pain after hip replacement.
Why do we experience pain after a hip replacement in all these areas? Causes
Aching thigh pain:
This comes and goes in the mid front of the thigh is a symptom, not a disease.
Thigh pain after a hip replacement (thigh femoral stem pain) has been related to some of these possible causes (Pierannunzii,2008)
🔴Muscle strain: During the procedure your muscles are strained, and inflammation occurs, this can cause pain in the thigh.
🔴Nerve irritation: A hip surgery is a not a simple procedure, some nerves around the thigh will be stressed during the operation and this can cause pain, tingling or numbness in the thigh.
🔴Implant issues which are very rare, these are
⏯️Loose implant: sometimes the bone may not adequately grow into the new implant causing movement and pain
⏯️Stem pressure coming from the stiff stem of the hip replacement which presses against the bone causing pain in thigh.
⏯️Periprosthetic stress fracture: sometimes the excessive stress at the femoral stem tip can lead to another fracture around the implant causing thigh pain.
(Pierannunzii,2008)
Having pain in the thigh after a hip replacement operation can be normal because of the many tissues that may be traumatized during the procedure.
However, if you are concerned that your pain may indicate a complication always consult your doctor.
Pain worse at night
After most surgeries or injuries pain normally worsens at night because your body is going through a healing process. This can be very normal.
Here is an article why pain is more at night with any injury.
🔴However, some studies state that this can also be a sign of infection.
A study done by Wang 2023 had an observation on patients who had hip replacement complaining of pain worsening at night.
For example, pain that is present at the beginning of an activity that decreases when activity continues or improves with rest should raise suspicion of prosthetic aseptic loosening.
whereas pain not relieved with rest but continuing through the night is suggestive of infection.
Anterior Knee pain after hip replacement
There was very little research to determine if total hip replacement can lead to anterior knee pain.
But clinical observation of anterior knee pain after total hip replacement done by some researchers which included 6 men, and 7 women who were assessed before and after six weeks after hip replacement.
Results:
🔴8 of 13 subjects had anterior knee pain at six weeks post-operation. Active knee flexion was reduced postoperative
🔴Their proximal, mid- and distal thigh circumferences were increased.
🔴11 of 13 subjects demonstrated leg lengthening and 10/11 subjects demonstrated a reduction in passive knee flexion.
The results of the present study cannot be compared to other studies, as there are no previous studies on anterior knee pain after total hip replacement.
Orthopaedic surgeons and physiotherapists need to be aware if this is a possible complication of total hip replacement, and hence further research is required to test external validity
Robertson,2007
Some patients have claimed pain eventually disappearing without anyone being able to explain.
Buttock pain after hip replacement
Patients I have seen claim of buttock pain after a hip replacement, this is a very common issue, you are not alone.
The possible causes of pain and discomfort in the buttock are stated in medical studies as:
🔴Related to gluteal tendinopathy wear and tear on the gluteal tendons which are crucial for hip stability (Rosinsky,2020)
🔴Your body may be adjusting to the new joint.
🔴Muscle spasms in the buttock muscles can also lead to pain especially when you are sitting down for so long.
🔴Bursitis which is inflammation of the bursae (fluid filled sacs that cushion the joints) can cause pain.
But still all these causes may be independent of the operation, pain may be coming from other causes not a hip surgery.
Press on those spots, if they are tender, get an MRI scan to check if you have gluteal tendinopathy
This kind of pain is generally mild and usually resolves within a few weeks but if pain persists and is very uncomfortable, always consult your doctor.
Lower back pain after hip replacements
Lower back pain after hip replacement can stem from various factors:
🔴 For example, if you had problems with your spine or lower back before surgery, you may experience new or worsening back pain after surgery.
🔴While hip replacement often improves or eliminates back pain associated with hip arthritis or generative disc problems, some individuals may experience new or worsening back pain after surgery.
🔴Sometimes having a hip surgery can weaken core muscle especially those supporting the lower back causing pain.
🔴After a hip replacement some people get improper posture because of trying to compensate for the hip putting an extra pressure on the lower back.
🔴Referred pain usually originating from pain in the hip joint it can sometimes be felt in the lower back.
Groin pain after a hip replacement
If you are experiencing pain in the groin area after undergoing a hip replacement surgery, you need to ask yourself if the pain you are feeling is normal or if it is a sign of postoperative complications.
The best person to confirm or refute your concerns is your surgeon.
There are various studies that look at groin pain after a hip replacement and these are some of the possible causes.
🔴Iliopsoas tendonitis which may rub against the implant can sometimes cause you pain especially if there is inflammation or irritation of the tendon.
🔴Impingement of the femoral neck can rub against the implant causing pain in the groin (Bardakos,2015)
🔴Infection around the implant when it is not seated in the bone joint, this can cause pain.
🔴Other soft tissue issues such as bursitis or nerve irritation can contribute to the groin pain.
▶️Can pain be a sign of a complication
Pain after a hip replacement surgery is common and rarely indicates a complication.
Having complications after a hip replacement is relatively rare, and when they occur, pain is not the main specific symptom.
The three frequent complications that I see after a hip replacement are
⏭️Vein Deep thrombosis is a condition where a blood clot forms in a deep vein causing blockage of blood (Zeng,2024)
⏩Infection is also very rare, less than 1%, symptoms may be pain, redness, swelling, and warmth.
⏭️Hip dislocation is where the ball of the new hip implant comes out of the socket, which is also very rare though it can happen. I have seen a few of them.
As you can see pain is not the defining characteristic of these complications.
▶️How long will the pain last after hip replacement surgery?
Typically, after hip replacement surgery, the pain gradually decreases over the days and weeks that follow the operation.
There may be days when the pain increases again, although it continues to decrease overall.
A study done investigating pain of 103 patients immediately after hip replacement especially of osteoarthritis had these results (Greimel 2018)
🟠Patients had decreases pain during the first week of pot-surgery.
🟠And pain slightly increased between days 9 and 12.
🟠Then it continues to decrease in the following days and weeks.
And another study done by Ninomiya 2020, which investigated longer term pain progression of over 3000 hip replacements patients, six months after surgery.
🟠1 in 3 people experienced no pain at all.
🟠1 in 2 people had only mild pain.
🟠Some people claim pain is higher at 6 months after the surgery.
Another study by Ninomiya 2020
🟠1 in 5 patients still had moderate pain
🟠1 in 25 had severe pain.
🟠1 in 200 had extreme pain
Ninomiya 2020
Pain that lasts so long after trauma of surgery can be difficult to explain and treat. Always consult your doctor if pain persists it could be chronic pain that will need more investigations.
Other causes of pain discussed above, how long they last can depend on what caused your pain.
For example if your pain is caused by prosthetic aseptic loosening, your doctor will request an x-ray or CT scan to detect loosening, stem subsidence or pedestal formation and stem malalignment (wang 2023)
And if your doctor confirms that the cause of your pain is caused by prosthetic stem tip, and you have persistent, debilitating thigh pain.
He may warrant surgical intervention, such as cortical augmentation of the femur at the level of the prosthetic stem tip or revision of the femoral component (Brown,2002).
Here is an example of an x-ray of a patient who went through cortical strut grafting and thigh pain resolved completely by 6 weeks postoperatively.
A 66-year-old man had debilitating thigh pain for 1 year after cementless THA. Because the stem appeared to be radiographically stable, grafting was done without exposure of the hip joint.
Thigh pain resolved completely by 6 weeks postoperatively. This anteroposterior radiograph 6 months after cortical strut grafting shows progressive graft incorporation (Brown,2002).
Revision of the hip is normally done only when nonsurgical management fails, and you continue to experience severe and disabling pain.
What does this mean? It’s normal for pain to persist for several months without indicating a complication. Pain is most intense during the first week and around day 10 post operation.
And if pain persists, consult your doctor for further investigations and proper treatment.
▶️What helps with hip replacement pain after surgery? Tips to relieve pain:
Usually after surgery you will be given pain control medication and rehabilitation tips to help you deal with the pain.
While at home you can:
Apply ice to the hip:
🟣You can purchase cold packs to place in the freezer or use a bag of frozen peas wrapped in a cloth to avoid direct contact to the skin and apply to your hip
🟣You can use it as often as you like, even continuously, as long as your skin reacts well.
Message your thigh or other sore areas of the leg
🟣When you massage the thigh or other sore parts of your leg, you will immediately feel relief, however not everyone responds to it.
The truth is there is no correct technique, the goal is to find a touch that eases your pain.
Wearing compression stockings
🟣Compression stockings have been used to help with swelling and improving circulation in the legs.
Pain medications after surgery.
🟣After your surgery you are always given a prescription for painkillers for you to take for at least 2 weeks to a month, if pain persists, consult your doctor to modify your medication plan.
However, it is always important to consult and discuss any concerns with your clinical team that is looking after your case. Do not suffer with pain, always something can be done.
▶️How to wipe your bottom after hip replacement?
I have had people who have had a hip replacement finding it hard to use the toilet especially wiping their bottom after a hip replacement.
The truth is wiping your bottom while using the toilet can be challenging due to the limitations in movement and range of motion.
Here is a breakdown of how you can approach it.
1️⃣Choose the right method and position
You should avoid bending and twisting at the hip beyond 90%, use you non -operated side, arm and leg to help maintain stability, lean forward slightly on the non-operated side to make wiping easier.
2️⃣Safety of the toilet
Make sure the toilet you are using is safe, you can install long handled toilet aid to help your grip on to avoid putting pressure on the operated hip.
A raised toilet seat can help reduce the amount of bending required when sitting and standing.
3️⃣Keep practicing, it might take your time to get comfortable with using your method.
You can also seek help if you are finding it difficult to manage. Do not hesitate to ask a caregiver for assistance or ask your physical therapist for specific advice tailored to your individual needs.
We have come to the end of this article; any experience please leave a comment. Wishing you a quick recovery!🙋
Here are other articles that may interest you:
🟣Hip fracture: treatment and recovery options
🟣How long does it take to walk properly after a hip surgery?
🟣How soon can you drive after a hip replacement
📚Sources:
Pierannunzii LM. Thigh pain after total hip replacement: a pathophysiological review and a comprehensive classification. Orthopedics. 2008 Jul;31(7):691-9; quiz 700-1. doi: 10.3928/01477447-20110505-05. PMID: 18705563.
Greimel F, Dittrich G, Schwarz T, Kaiser M, Krieg B, Zeman F, Grifka J, Benditz A. Course of pain after total hip arthroplasty within a standardized pain management concept: a prospective study examining influence, correlation, and outcome of postoperative pain on 103 consecutive patients. Arch Orthop Trauma Surg. 2018 Dec;138(12):1639-1645. doi: 10.1007/s00402-018-3014-x. Epub 2018 Jul 31. PMID: 30066029.
Wang XQ, Ren XQ, Qin DA. Thigh pain after total hip arthroplasty. Int J Surg. 2023 Oct 1;109(10):3236-3237. doi: 10.1097/JS9.0000000000000544. PMID: 37410027; PMCID: PMC10583958.
Brown TE, Larson B, Shen F, Moskal JT. Thigh pain after cementless total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2002 Nov-Dec;10(6):385-92. doi: 10.5435/00124635-200211000-00002. PMID: 12470040.
Robertson C, Coutts F, Bell J. Investigation of anterior knee pain after total hip replacement: a pilot study. Physiother Res Int. 2007 Mar;12(1):25-8. doi: 10.1002/pri.350. PMID: 17432391.
Zeng Q, Li Z, Gui S, Wu J, Liu C, Wang T, Peng D, Zeng G. Prediction models for deep vein thrombosis after knee/hip arthroplasty: A systematic review and network meta-analysis. J Orthop Surg (Hong Kong). 2024 May-Aug;32(2):10225536241249591. doi: 10.1177/10225536241249591. PMID: 38706263.
Bardakos NV. Hip impingement: beyond femoroacetabular. J Hip Preserv Surg. 2015 Jul 16;2(3):206-23. doi: 10.1093/jhps/hnv049. PMID: 27011843; PMCID: PMC4765300.
Rosinsky PJ, Bheem R, Meghpara MB, Haden M, Shapira J, Maldonado DR, Lall AC, Domb BG. Asymptomatic Gluteal Tendinopathies Negatively Impact Outcomes of Total Hip Arthroplasty: A Propensity Score-Matched Study. J Arthroplasty. 2021 Jan;36(1):242-249. doi: 10.1016/j.arth.2020.07.063. Epub 2020 Jul 29. PMID: 32828621.
Ninomiya, K., Takahira, N., Ochiai, S., Ikeda, T., Suzuki, K., Sato, R., Ike, H., & Hirakawa, K. (2020). Incidence of postoperative complications and non- periprosthetic fractures after total hip arthroplasty: A more than 10-year follow-up retrospective cohort study. Physical therapy research, 24(1), 77–83.