- Hip replacement is generally highly successful, but in a minority of cases problems develop that cause ongoing pain, stiffness, limping, or instability.
- Possible causes include wear, loosening, infection, fractures, soft-tissue irritation, and muscle dysfunction, including gluteal tendon tears.
- Thorough investigation, such as X-rays, blood tests, and MRI, is essential before treatment, since operating without a clear diagnosis tends to give poorer results.
- Treatment ranges from non-surgical options like physiotherapy and injections through to revision hip surgery, depending entirely on the cause identified.
- Painful and problematic hip replacements are a particular area of interest and expertise for Dr Slattery.
Hip replacement is generally a highly successful operation that provides excellent pain relief and restored function for most people. In a minority of cases, however, problems can develop that cause ongoing pain, stiffness, limping, or a feeling of instability. When this happens, careful assessment to identify the exact cause is essential, because the right treatment depends entirely on what is driving the pain.
Pain After a Total Hip Replacement
If you have a hip replacement and are experiencing pain, stiffness, limping, dislocation, or instability, it is advisable to be assessed by an orthopaedic surgeon with a specific interest in hip replacement surgery. There is a wide range of possible causes, and thorough investigation before starting treatment is important: operating or intervening without a clear diagnosis tends to give poorer results than treatment directed at a specific, identified problem.
Possible Causes of a Painful Hip Replacement
Pain from a total hip replacement can arise from a number of causes, including:
- Wear of the bearing surfaces (plastic, metal, or ceramic)
- Loosening of one or more components
- Infection
- Fractures of the bone around the implant
- Soft-tissue irritation, for example psoas tendinitis or iliotibial band irritation
- Muscle dysfunction or fatigue, such as abductor muscle overload, or gluteal tendon tears
Pain can also sometimes be referred from elsewhere, such as the spine, which is another reason a careful assessment matters.
Investigating the Cause
Identifying the cause usually involves a combination of assessment and tests, which may include:
- X-rays
- Blood tests (including to screen for infection)
- CT scans
- Bone scans
- MRI scans
The specific investigations used depend on what is suspected after your history and examination.
Treatment Options
Because treatment is directed at the underlying cause, it varies widely, from simple, non-surgical measures through to revision (exchange) of the hip replacement.
| Approach | Examples |
|---|---|
| Non-surgical treatment | Physiotherapy and muscle retraining or strengthening; injections (such as corticosteroid or platelet-rich plasma) where appropriate; activity modification. |
| Surgical treatment | Arthroscopic assessment of the joint; arthroscopic psoas lengthening; tendon repairs (open or arthroscopic); bursectomy (removal of inflamed soft tissue); partial or total revision of the hip replacement. |
Which of these is appropriate depends entirely on the cause identified, and will be discussed with you once your hip has been thoroughly assessed. Where investigations point to a mechanical problem with the implant itself, this may involve hip arthroscopy or, in more significant cases, revision hip replacement. National joint replacement registry data helps track how implants perform over the longer term, including revision rates.
Specialist Experience with Problematic Hip Replacements
Painful and problematic hip replacements are a particular area of interest and expertise for Dr Slattery. He has extensive experience assessing and treating problems arising from hip implants, both operatively and non-operatively, gained over many years in Australia and overseas, and is skilled in both advanced minimally invasive arthroscopic techniques and open surgery, including complex revision cases. If you have concerns about a hip replacement, arrange an assessment.
Frequently Asked Questions
Is some pain normal after a hip replacement?
Some discomfort is expected in the weeks and months after surgery, improving over time. Pain that is severe, persistent beyond the expected recovery period, or that develops after an initially good result should be assessed, as it may indicate an identifiable and treatable problem.
Why is finding the cause so important before treatment?
The right treatment depends entirely on the underlying cause: wear, loosening, infection, fracture, and soft-tissue problems each require a different approach. Treatment directed at a clearly identified problem gives better results than intervening without a firm diagnosis, which is why thorough investigation comes first.
Will I need revision surgery?
Not necessarily. Many causes of a painful hip replacement can be managed without major surgery, for example with physiotherapy, injections, or smaller procedures. Whether revision surgery is needed depends on the cause identified during assessment.
Medical Disclaimer: The information on this page is intended as general patient education and does not constitute medical advice. A painful hip replacement can have many causes, and treatment must be based on an individual assessment and appropriate investigation. If you have concerns about a hip replacement, please arrange a consultation for a thorough assessment.
