After hip replacement surgery, your hip joints are generally held in place with metal screws or other metal hardware for stability. But if your hip is still hurting six months or more after the operation, your surgeon may have removed the screws too soon.
Removing the screws too early can lead to pain and inflammation in the hip joint, known as dislocation. In some cases, your surgeon may have placed the screws too far into the joint. This can lead to hip impingement, in which the protective covering around the hip joint is compressed against the bone.
To help relieve hip pain and reduce the risk of dislocation, your surgeon may have instructed you to keep your feet elevated and to use a cane or walker during the first few weeks after surgery. This helps to reduce the risk of blood pooling and nerve irritation in the lower leg. While it’s not necessary to keep your foot elevated for the rest of your hip recovery, this can continue for some people after six months.
For example, if you are still experiencing pain in your hip joint and walking is difficult for you, your surgeon may keep you on a walker or cane for another six months. To ensure the long-term health of your hip joint, you should also continue to perform gentle home exercises and mobility exercises after your hip replacement to keep your hip joint healthy.
The most common symptom of lower-leg pain after hip replacement is pain around the hip joint. It may begin suddenly, or it may come on gradually over time. The pain may occur in the hip joint itself, in the groin or in the thigh. It can be very intense, and it can be accompanied by redness, swelling and hot sensations. Symptoms may include:
- Bladder or bowel problems that do not respond to medication
- Swelling in the leg, foot or ankle
- Sleeplessness or fatigue
- Numbness or tingling in the leg
- The pain may be mild, moderate or severe. It may come and go, or it may be constant. It can be located below the knee, or it can be in the buttock or back.
People usually experience lower-leg pain after a hip replacement for two primary reasons: the original hip problem (proximal femoral necrosis, or PFN) and the new hip joint. The PFN usually results from a bone-on-bone contact; the bone around the hip joint, the acetabulum, is usually intact, but there is a hole in the outer part of the bone (the femoral head).
The pain can be so great that you need to take opioid painkillers to get through the day. The cause of the new hip joint pain is due to the irritation of the soft tissues of the leg (including the muscles, the skin and the nerves). The usual treatment for the PFN is painkillers and, if necessary, an opioid blocker such as a nonsteroidal anti-inflammatory drug (NSAID) such as metamucil or phenylephrine.
The new joint pain is usually treated with over-the-counter painkillers and with anti-inflammatory medications that are either NSAIDs or steroids. Sometimes, cortisone shots are given into the joint space to reduce inflammation.
Causes of Lower Leg Pain After Hip Replacement
The most common cause of lower-leg pain after hip replacement is nerve irritation at the new joint. The pain usually occurs at the bottom of the leg, but it can also occur in the groin and even in the knee. The reasons for this are unclear, but one theory is that the nerves that run through the outer part of the joint get pinched when the new implant presses against them.
There can be a number of causes of lower-leg pain after hip replacement, but here are some of the most common.
Arthritis: In about one-third of cases, advanced arthritis is to blame. This is a condition in which the hip joint becomes completely worn out and damaged. It is more common in people over 65, and it is often accompanied by other conditions, such as high blood pressure and heart disease. Hip replacement Surgery may slow or stop the progression of arthritis, but arthritis itself cannot be cured.
Trauma: Trauma can include a fall, a heavy blow to the hip or an injury that breaks the skin. Trauma can also include activities that increase the risk of trauma, such as hiking or biking with poor posture. In some cases, the leg may swell after trauma.
Infection: Sometimes bacteria or fungi get into the blood stream or into the joint and cause infection. Most commonly, this occurs in the groin or thigh.
Osteoarthritis: In about 25% of cases, the cause of lower-leg pain is osteoarthritis. This is a condition in which the cartilage in the joint has become worn out and damaged. The condition is commonly caused by aging, but it can also develop due to injury, disease or genetics.
Other causes of lower-leg pain after hip replacement include: abnormal positioning of the new implant. The implant could be sitting too deep in the socket, causing the head of the bone to rub against the inside of the pelvis, irritating the soft tissues of the leg. If the implant is sitting too high in the socket, the upper part of the thigh bone may rub on the underside of the buttocks. The implant could also be sitting too far forward, pressing against the front of the thigh bone and the inside of the upper leg.
Diagnosis of Lower Leg Pain After Hip Replacement
The best way to diagnose the cause of your lower-leg pain is to take a detailed medical history, including a description of your symptoms and when they began. Your doctor will ask about your pain, your mobility and your ability to walk and stand. The doctor may also do a physical examination to rule out conditions that can cause similar symptoms, such as septic arthritis or a bone spur in the hip. X-rays can be used to rule out damage to the hip joint. Ultrasound imaging can be used to look inside the hip joint and see if the head of the femur is sitting in the right position.
There is no specific treatment for lower-leg pain after hip replacement. The goal is to reduce the inflammation andpain and get you back to your normal routine as quickly as possible.
1. Proper Posture After Hip Replacement
After hip replacement surgery, you should maintain the same posture that you had before the operation. This means keeping your head and shoulders up and back, and avoiding hunching over or sitting with your shoulders rounded forward. If you slouch or slump, your hip joint will be subjected to increased stress, which could lead to dislocation or long-term pain and inflammation.
2. Avoid Activities That Cause Hip Bends
If you have a habit of bending your knees while sitting to other activities that put pressure on your joint, your surgeon may recommend that you avoid these activities for the first few weeks after surgery. This is because bending your knees can cause your hip to “bend” inward rather than outward, which can lead to impingement and increased risk of dislocation.
3. Strengthen Your Core and Back
Strengthening your abdominal and back muscles can reduce the stress on your new hip joint, helping to reduce the risk of impingement and dislocation.
4. Avoid Using Your New Hip for the First Few Weeks
Your surgeon may have advised you to avoid using your new joint for the first few weeks after surgery. By keeping your weight on your feet, you reduce the risk of blood pooling and nerve irritation in the hip joint. By taking it easy and avoiding sudden movements, you also give your pelvic and abdominal muscles time to strengthen.
5. Avoid Jumping and Pushing Up After Your Hip Surgery
While it’s important to begin walking once you are able, your surgeon may have advised against jumping and jumping-related activities like push-ups and squatting until at least six months after surgery. These activities put extra force on the hip joint, causing it to dislocate more frequently.
6. Don’t Walk on Tiptoe
Your surgeon may have advised against walking on tiptoe for the first month after surgery to avoid stressing your new joint. Instead, walk at a normal pace, with your weight evenly distributed on both feet.
7. Gentle Home Exercises
As part of your home exercise program, your surgeon may have recommended performing gentle ankle dorsiflexions (raising your ankle) and plantarflexions (rolling your foot), along with spinal flexions (bends) and abdominal crunches. Performing these exercises can help to strengthen your hip stabilizing muscles, reduce your risk of falls and improve your posture.
8. Mobility Exercises
Your surgeon may have advised against performing certain types of movements after hip surgery, but they are often necessary to maintain good joint health. For example, he or she may have discouraged you from performing incline sit-ups, but they are part of a healthy exercise program.
Hip pain after hip replacement can be a common but serious side effect of the procedure. It is important to follow your surgeon’s post-operative instructions and maintain good physical and postural habits to reduce the risk of dislocation and long-term pain and inflammation.