Thigh Pain after Hip Replacement: Why? Treatment? How Long Does it Last?

You just have a hip replacement surgery and you have pain in your thigh? You still feel pain in other places following the operation and these worry you?

This blog post was written for you: may your reading be good and informative 🙂.

Physiotherapist, I answer the most frequent questions of my patients during the rehabilitation of a hip replacement, or at a distance of the operation.

At the end of the article, you will find numerous references to scientific studies that support what I say.

What kind of pain can you experience after a hip replacement?

Any orthopedic surgery carries risks of postoperative pain. This is also true for hip replacement surgery. These pains can be classified into two categories:

• “normal” pain
• “abnormal” pain.

Pain after hip replacement surgery: what is normal? 👍

When a surgeon installs a hip replacement, several types of tissues are necessarily traumatized (these are called operative traumas):

• Skin
• Bone
• Muscle
• Ligaments
• Blood vessels

These different traumas inevitably result in a certain level of pain🌡️. It is unavoidable (at present), but partially controllable through:

• Painkillers that are prescribed to be taken immediately after the operation
• Early and progressive return to basic activities such as walking. The rapid and controlled resumption of movement has positive effects on the control of postoperative pain. See this article on walking after a hip replacement surgery.

What is abnormal pain after hip replacement surgery? 👎

It is normal to experience pain immediately after having a hip replacement surgery. However, one may wonder if it is normal for the pain to:

• be so intense?
• last for a long time?
• be located in an area far from the site of the surgery (such as the thigh, back, knee, etc.)?
• occur during certain movements and not others?
• change in shape or location? Etc.

In other words, one may question the “normality” (or abnormality) of their pain.

In these circumstances, it is essential to consider whether the suspected “abnormal” pain may indicate a postoperative complication.

After hip replacement surgery, several complications associated with increased pain may occur, such as:

• infection of the prosthesis;
• deep vein thrombosis (or thromboembolic disease) [1];
• dislocation or instability of the replacement (or loosening of the prosthesis);
• the consequences of a nerve injury that occurred during the surgery [2]; Etc. [3]

Although these complications are rare, it is crucial to detect them in a timely manner if they occur. Therefore, if you have any doubts, consult your surgeon or a general practitioner.

In the absence of complications and after a certain time (see next section), it is also possible that some pain may persist. If this is the case, it can become very difficult to explain why and to know what to do to resolve the problem. This then leads to a process of managing chronic pain (blog post to come).

Pain after hip replacement: How long?

Typically, after hip replacement surgery, the pain gradually decreases over the days and weeks that follow the operation. This evolution can happen in a “sawtooth” pattern: there may be days when the pain increases again, although it continues to decrease overall.

The pain can even continue to improve in the months following the operation.

In an Australian study [4], 3,215 patients who had undergone hip replacement surgery (for osteoarthritis) were asked to evaluate their pain six months after the surgery:

• 1 in 3 had no pain at all;
• 1 in 2 had only slight pain.

However, although less frequently, the level of pain at 6 months can be higher 😞. In the same Australian study mentioned earlier, it was learned that six months after the surgery:

• 1 in 5 patients still had moderate pain;
• 1 in 25 had severe pain;
• 1 in 200 had extreme pain.

Pain that lasts so long after trauma or surgery can be difficult to explain and treat.

Thigh pain after hip replacement

Having pain after a hip replacement operation is normal. During the surgery, the surgeon will indeed traumatize many tissues (including the skin, which they must incise). This is not surprising.

In practice, what often worries patients is that their pain is in a different location than where the surgery took place. After a hip prosthesis surgery, one naturally expects to have pain in the hip area, and not elsewhere… For example, not in the thigh!

Is it normal to have pain in the thigh after a hip replacement? This question leads to the more general question of normal and abnormal pain after hip prosthesis placement.

I address this topic specifically in the first part of this blog post: “What is normal pain after a hip replacement?“.

What to remember regarding the presence of thigh pain after a hip replacement:

If you are concerned that this pain may indicate a complication of your surgery, consult a general practitioner or your surgeon!

Thigh pain is actually the type of pain that generates the most questions on the internet after hip replacement surgery. Look: every month, thousands of people wonder about thigh pain after a hip replacement:

Muscle pain after hip replacement

Regardless of the technique used by your surgeon, several muscles in your hip will be damaged during the operation [5]. In this sense, it is therefore quite normal for some of your postoperative pain to result from these muscle injuries.

Are you still worried about these pains? Then read the very first section of this article: “What is normal pain after a hip prosthesis?“.

Knee pain after total hip replacement

If you experience knee pain after undergoing a hip replacement surgery, there are two possibilities:

1. This pain is related to the surgery. In this case, it is necessary to identify if it is a sign of a postoperative complication. If you have any concerns, consult your surgeon or a general practitioner to be sure. If it is not a postoperative complication, there are two possible options:

• This pain will eventually disappear without anyone being able to explain clearly why it appeared or why it disappeared (but it doesn’t matter, the most important thing is that it has disappeared!).
• This pain will persist without anyone being able to explain clearly why, or offer a satisfactory therapeutic solution. This then becomes a problem of managing chronic knee pain.

2. This pain is independent of the operation. Indeed, having a hip prosthesis does not in any way prevent the risk of developing knee pain completely independently (unfortunately!).

Back & buttock pain after hip replacement

Any suspicious pain that occurs after a hip replacement surgery should be approached in the same way, including back pain.

In this regard, I invite you to read the very first section of this article: “What pains to expect after a hip replacement?“.

Iliopsoas tendonitis and pain after hip replacement

Most of the time, we feel pain in a more or less well-defined area of the body (the back, neck, shoulder, etc.) 🎯.

Incorrectly, we may tend to declare that we have pain in a specific muscle, rather than in the region where that muscle is located. For example, someone who has pain in the biceps region may falsely say that they have “biceps pain” 💪🏼.

Why is this incorrect? Because there is no guarantee that the pain felt in the biceps region is caused by a problem in the biceps itself. Unfortunately, the functioning of pain is more complex than that.

To illustrate this complexity, the most striking type of case is probably that of an amputee. Sometimes, they still feel pain in their missing limb! These are called phantom limb pains 👻.

⚠️ It is therefore possible to feel pain in a body region that no longer exists. It is not surprising, then, that one may have the impression that a pain comes from a specific muscle without this actually being the case.

This is why speaking of “psoas pain” is incorrect. Rather, one may feel pain in the region of the psoas muscle, which corresponds more or less to the groin area. This is why if you have the impression of having “psoas pain”, I invite you to refer to the following section!

Groin pain after hip replacement

Are you experiencing pain in the groin area after undergoing a hip replacement surgery? Here’s the question you need to ask yourself:

• Is my pain part of the normal postoperative course,
• or is it a sign of a postoperative complication? 🤔

If you’re here reading these lines, it’s probably because you have doubts that this pain is “normal.” The person best placed to confirm or refute your concerns is your surgeon, or failing that, a general practitioner ⚕️.

If you have already seen your surgeon or a general practitioner, there are 3 possibilities:

• The professional confirmed that your pain was a specific postoperative complication and proposed an appropriate treatment 👍🏼.
• The professional believes that your pain is part of the normal postoperative course and recommends that you wait a little longer 👍🏼. Everything should return to normal with:
  • adequate pain management (possibly to be modified);
  • the continuation of a gradual resumption of your daily activities (or even the implementation of regular and adapted physical activities);
  • a dose of patience.
• The professional believes that your pain is neither a complication of the replacement nor a normal sequel. They think it’s something else… 🛸 Naturally, the course of action to follow from there depends on:
  • the nature of this other thing;
  • how confident the professional is in their diagnosis (if there is a real diagnosis);
  • the treatments available for this other thing;
  • how certain the professional is that these treatments work. But all of this is a story specific to the thing in question, and would require a dedicated article!

Sciatic pain after hip replacement

The term “sciatic pain” is often used to describe pain that travels down the back of the thigh, or even the entire lower leg 🦵🏻. However, anatomically speaking, the term “sciatic” refers to the sciatic nerve, which does indeed pass behind the thigh.

Thus, it is common for someone who claims to suffer from “sciatic pain” to think that they have a problem with their “sciatic nerve”. ⚠️ However, this conclusion is often abusive [6,7]. Most of the time, it is unfortunately very difficult to determine precisely what is causing the pain.

The only certain thing is that you have pain behind your thigh or leg! From there, here’s the first question to ask yourself if you’ve just had hip replacement surgery:

Is my pain part of the normal postoperative course, or is it a sign of a postoperative complication? 🤔

Click on the question to read more! You may also be interested in this article on the duration of sciatic pain (coming soon in English.

Lower leg pain after hip replacement

Lower leg pain after hip replacement is similar to the sciatic pain after hip replacement.

Soft tissue pain after hip replacement

We can have the same reasoning for a soft tissue pain after hip replacement as for a iliopsoas pain.

Incorrectly, we may tend to declare that we have pain in a specific muscle or tissue, rather than in the region where that muscle or tissue is located.

Femoral stem pain after hip replacement

Femoral stem pain after hip replacement is similar to tigh pain.