Have you just had a hip replacement and you are grappling with numerous questions about how long you will be pain free.
However, you may not have been adequately informed about this being a common occurrence among patients who have had a hip replacement.
For this article I rely on my own experience as a diagnostic radiographer and of Course I have also consulted medical scientific publications on the subject.
Happy reading😀! Feel free to leave a comment or question.
Last updated: Aug 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
▶️What really causes pain after hip replacement?
Most people do experience pain after a hip replacement and this pain normally ranges from mild to moderate.
It may be radiating to the thigh down to the leg, typically it appears in the anterior thigh, this kind of pain in medical terms is described as thigh femoral stem pain and it is very common
Thigh pain after hip replacement reportedly occurs in approximately 3%-25% of cases (Barrack.2000).
So, you are not alone.
There two reasons why you may have hip/thigh pain after hip replacement are:
1️⃣Intrinsic cause: This is Pain coming from inside of the hip joint.
The surgery procedure itself can contribute to the pain you will experience after the operation.
🟣Ligaments, blood vessels, bone and skin are usually severely traumatised during the operation.
🟣If after the replacement the bone cannot grow into the implant, this can cause small amounts of movement causing you pain.
🟣The implant may be forced to painfully press into the cortical bone if the bone is more flexible than the stiff stem.
🟣Meralgia paraesthetica which describes severe pain in the outside of the thigh due to side femoral cutaneous nerve damage
2️⃣Extrinsic cause: This is Pain coming from outside of the hip
🟣If you had pre-existing pain or other health problems with your hip before surgery.
🟣Other hip associated fractures
These fractures come on due to a change in weight-bearing status and activity level that is too much for the new implant bone.
Without warning, you can begin to notice pain in the hip, thigh, or pelvis ramus
🟣Arthritis can lead to spine dysfunction causing you pain.
🟣Trochanteric pain syndrome-The tightness of your buttock muscles can cause constant pressure to the outside of the hip, leading to pain and inflammation.
When you walk, sit, and lay down on your hip, this can cause continued stress and pain.
🟣Spinal pathology caused by degeneration of the spine can mimic pain at the hip.
🟣Hip pathology or abnormality for example we all have physical differences in bone, and this can play causing you pain.
▶️Can pain be a sign of a complication?
Having pain after a hip replacement is very common in patients I see in x-ray, and it is not normally a sign of hip complications.
Complications are relatively rare and when they occur pain is not the main cause or symptom you may have.
What you should know, it takes time for the bone to attach to a cementless hip joint.
So, avoid returning to your normal activities too quickly because this may increase pain and can lead to the joint to loosen causing thigh pain.
▶️How do you know the pain you are having after hip replacement might be a sign of complications?
After your hip replacement leading to weeks of your recovery, if your pain is not improving after 6 months of your operation and you have other symptoms accompanying the pain.
♦️Infection which will cause swelling, redness, skin discoloration, high fever.
♦️Infection causing pus coming from the wound or joint
However, these kinds of infections are relatively very low, less than 1%.
♦️Pain that worsens with activity or rest.
♦️Loosening and instability of the new hip, in some cases the cup of the replacement may become loose, can occur shortly after the surgery or even years later
When you are worried of hip pain after replacement, seek medical help.
You can assess your pain using the pain scale below.
| 10 | Worse pain you can imagine |
| 7- 9 | Severe pain Pain keeps you from doing your regular activities 🟣 9-Pain is so bad that you cannot sleep or talk 🟣8-Pain is intense that you have trouble talking. 🟣7- Pain distracts you and limits your sleep. |
| 4-6 | Moderate pain Interfere with your regular activities 🟣6- pain makes it hard to concentrate. 🟣 5-You cannot ignore the pain. 🟣 4- You can ignore the pain at times |
| 1-3 | Mild Pain 🟣3-You may notice the pain, but you can tolerate it 🟣 2- You may feel some twinges of pain 🟣1- You may barely notice the pain. |
| 0 | No Pain at all. |
Tell your health term how you feel on the scale of 10 to 0, this will help them provide you the best care to ease your pain.
▶️How long does normal pain typically last after a hip replacement?
Individuals who have undergone a hip replacement usually have mild to moderate pain which is usually in the mid-front of the thigh, some people say it feels like an ache that comes and goes.
🟠Pain usually decreases daily during the first week of post-surgery.
🟠On day 9 to day 12, it slightly increases.
🟠Then it continues to decrease in the following days and weeks.
Six months after surgery usually:
🟠1 in 3 people who have had a hip replacement experience no pain at all.
🟠1 in 2 people may have only mild pain.
What does this mean? It is normal for pain to persist for several months without indicating a complication from your hip surgery.
What you should know is that pain is more intense in the first week and around 12 days after your surgery.
Most people go back to the normal activities slowly, using a walker or crutches following the operation.
However, many can walk independently 2 to 3 weeks after the operation, and most will fully recover in 3 to 4 months with no pain.
▶️How to manage your pain after a hip replacement?
To help reduce pain:
1️⃣Resting your body after surgery is very important. But spending too much time lying down or sitting in one position can cause pain, muscle cramps or fatigue.
So, walking short walks from the kitchen to the sitting room can help to ease pain and muscle cramps.
2️⃣Cold therapy reduces discomfort and swelling (inflammation) by numbing nerve endings. It can help ease pain after surgery.
Ice the hip leg and the incision site with a bag of frozen peas or cold packs wrapped in a small towel. Do not place the ice pack directly on your skin. Even continuously until you feel better.
3️⃣Massage helps to reduce pain, anxiety, muscle tension and stress.
4️⃣Taking a warm shower can reduce pain, ease sore muscles and help you relax.
5️⃣Take anti-inflammatory medications, after consulting with your doctor, to help with these symptoms.
6️⃣Changing your sleeping position every 2 hours can help reduce pain and discomfort. Making sure your hips, back and head are in proper alignment can be a great way to prevent muscle strains, joint or back pain.
7️⃣Compression stockings can help with swelling and improve circulation.
▶️Is it normal to have hip pain years after hip replacement?
Having researched a lot of medical studies, it was a bit challenging finding a particular cause of long-term pain after hip replacement.
To summarise, some of the research that synthesised knowledge about long time hip pain after a replacement.
Modern hip replacement joints are designed to last for at least 15 years. But they can get worn over time causing pain or swelling.
The presence of abnormal signs and pain 5 years after hip replacement was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years
Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years.
Could be caused by presence of stem movement or osteolysis and to a lesser degree.
Or presence of pain was associated with the risk of revision of cemented stems for aseptic loosening over the next 2 decades, especially in the young patient.
This highlights the usefulness of early regular x-ray assessment of cemented hip stems as part of the follow-up for both new and established implants.
The performance of this or other types of imaging in predicting failure of hip prostheses made of newer materials demands further studies (Lubbeka 2024)
x-ray example of osteolysis around the femoral stem and hip loosening out of the joint.
If your replacement hip dislocates or wears out, you may need another surgery to fix it.
Sometimes, it’s an obvious cause such as a dislocation or a fracture around the implant from a trauma or fall,
Or recurring tendonitis, bursitis and low back pain, or a pinched nerve
All these need to be ruled out by the physician before any imaging or testing is performed.
We have come to the end of this article, wish you a quick recovery.🙋
📚Sources.
Barrack RL, Paprosky W, Butler RA, Palafox A, Szuszczewicz E, Myers L. Patients’ perception of pain after total hip arthroplasty. J Arthroplasty. 2000;15:590–6. [PubMed] [Google Scholar] [Ref list]
Pryymachenko Y, Wilson RA, Abbott JH, Dowsey MM, Choong PFM. Risk Factors for Chronic Opioid Use Following Hip and Knee Arthroplasty: Evidence from New Zealand Population Data. J Arthroplasty. 2020 Nov;35(11):3099-3107.e14. doi: 10.1016/j.arth.2020.06.040. Epub 2020 Jun 27. PMID: 32684397.
Lübbeke A, Barea C, Zingg M, Lauper N, Hannouche D, Garavaglia G. Radiographic signs and hip pain 5 years after THA with a cemented stem predict future revision for aseptic loosening: a prospective cohort study. Acta Orthop. 2024 Jan 29;95:32-38. doi: 10.2340/17453674.2023.26190. PMID: 38284749; PMCID: PMC10823869.