Pain After Hip Replacement (Should I Be Worried?!)

How Painful Is a Hip Replacement? —

You knew there would be some pain after your hip replacement surgery, right?  Sure, but everyone said that getting their hip replaced was SO EASY and there was barely any pain.

I’m here as a PT to tell you that you will be having pain after your hip replacement, trust me.  How much pain is where the question comes in for you.

Hip replacements in general are less painful than knee replacements for my patients.  However, each person’s body is different so you may have some pain issues.  There is no one size fits all answer to the question of ‘How Painful is a Hip Replacement?’

As discussed in our previous article ‘What I Wish I Knew Before Hip Replacement Surgery’, there is 1 guarantee regrading pain after hip replacement.  That guarantee is that your old hip pain will be gone immediately.  

The new pain you have will be pain from the surgery procedure itself and incision area.  This pain after hip replacement is normal.

Once you begin your recovery and rehab at home, you will start to notice some new pains.  Starting physical therapy will force your hip through motions causing irritation and possible pain.  

Let’s discuss some potential pain locations after your hip replacement and if you should have any concerns.

What Causes Stabbing Pain in the Thigh After Hip Replacement?

thigh pain after hip replacement

Hip replacement surgery involves two parts, one piece inserted into your femur bone and the other piece the socket in your pelvis.  Generally both parts are easily fitted by the surgeon and should allow you to put weight through it immediately after surgery.

Stabbing mid thigh pain after hip replacement is something you can expect to feel in the first few weeks after surgery.  This area of your leg has major muscle, blood supply and nerve supply running through it.  Because of this involvement, effects from the hip surgery can cause it to be very sensitive and cause pain.

Because the replacement post is inserted lengthwise into your femur bone, there is a good chance that you will have some femoral stem pain in your thigh for 4-6 weeks after surgery.  Don’t forget, bone takes 6 weeks to heal.  By placing the post into the bone you are doing some minor injury to the area which takes time to heal.

If this stabbing pain in the thigh continues beyond a year after surgery you will want to get reevaluated. This type of pain can last up to 6 months however when continued beyond a year after surgery would be abnormal.

If you feel any excess movement in the mid thigh along with your stabbing pain please contact your surgeon. Excess movement or any movement of any kind can be signs of non-healing of the femoral stem and need to be x-rayed.

What Causes Thigh and Knee Pain After Hip Replacement?

Yes, the pain from your hip replacement can extend beyond the mid thigh into the knee itself.  If you also have knee arthritis it can be tough to distinguish between pain from the hip surgery vs. your current knee pain.

knee and shin pain hip replacement

Most of my patients will say that the knee pain from the hip surgery feels different than their knee arthritis pain.  While it is difficult for me to distinguish pain vs pain, I would tell you that knee pain caused from the hip should increase with specific hip movements.

Pain in your knee after hip replacement can be referred pain from the hip itself.  More than likely though it is caused from the replacement stem/post in the femur shooting pain into the knee.

Femoral Stem Pain After Hip Replacement

Stabbing mid thigh or femoral stem pain after hip replacement can also be affected by physical therapy.   You will begin doing many exercises to regain strength and range of motion.  This type of of pain is normal and expected in the first 4-6 weeks after surgery.

Exercises that can causes some increased thigh pain include quad sets, heel slides, hip flexion and squats.  These exercises should be part of your daily PT regimen for the first month after surgery.

Use your physical therapist as a resource and discuss any and all pains that you are experiencing.  If the pain is severe (ie. > 7/10 pain scale rating) and does not decrease with rest, pain meds and ice I would suggest an X-ray to ensure no issues.  Call your surgeon’s office to discuss.

Again, mid thigh pain after hip replacement is the most likely type of pain you should expect to have.  Irritation from the surgery and PT cause swelling which causes pain.

If you notice sharp pain in combination with severe swelling (ie. more than double the size of your normal leg), have your physical therapist evaluate it.  If they believe there could be potential blood clot issues you will need seen immediately.

Buttock Pain After Hip Replacement

If you had a posterior hip replacement your surgeon may or may not have cut through the gluteus maximus muscle to access the hip.  The gluteus maximus is also known as the buttock or bum cheek.  Note that the major muscle belly portion of the buttock is left untouched and only the area near the incision is affected.

buttock pain after hip replacement

If your surgeon did indeed cut through the muscle then you will have some pain from the healing in this region.  Even if they did not cut the muscle directly, by moving tendons and muscle around during surgery the area will be irritated causing pain.

The pain in your buttock can also be attributed to the long incision itself directly or possible referred pain from the incision into the buttock.  Referred pains are pains that are not actually caused by the area of pain itself but from another area.

You can also get pain in your bum cheek after hip replacement by simply walking and standing after surgery.  You should be full weight bearing on your new hip and be able to walk using a cane or walker.  Simply putting body weight on your hip can cause bum cheek or buttock pain after surgery.

Finally, starting your physical therapy exercises after hip replacement can cause buttock pain.   Doing proper squats and balance activities prescribed by your physical therapist will force your hip to be used.  This in turn will likely cause some pain and should be expected.

Shin Pain After Hip Replacement

Occasionally you can experience pain into your shin region after your hip replacement.  Yes, all the way down into the shin.  So how is this possible?

shin pain after hip replacement

For most, this pain is actually from the placement of the leg itself during the surgery.  Your surgeon needs to put your leg in a rotated position which can leave your shin or lower leg area in a compromised spot.  Being in this position for over an hour can cause some continued pain for a week or longer after your surgery date.

Another simple but possible explanation for your new shin pain is that your walking pattern is different.  Your old hip likely caused your walking to be different and use certain muscles more than others.  Now your front shin muscles might be used more causing an increase in pain.

Final Thoughts Regarding Pain After Hip Replacement

  • Mid Thigh Pain After Hip Replacement Can Be Caused by the Procedure Itself, Femoral Stem Implant or Physical Therapy Regimen
  • Buttock Pain After Hip Replacement Can Be Caused by the Incision, Cut Gluteus Muscle, Physical Therapy or Increased Weight Bearing
  • Shin Pain After Hip Replacement Can Be Caused by a New Walking Pattern or Placement During the Procedure
About Jeffrey Roth MPT

Owner and operator of Roth Therapy Services in Pittsburgh, PA focusing on in home rehabilitation physical therapy services.


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