Hip Replacement Back Pain? How Many Hips that Don’t Hurt Get Replaced?

Is hip replacement back pain a thing? Hip replacement rates are sky rocketing this past 10 years. We’ve seen many patients who have gotten their hip replaced and still have hip pain. How is that possible? The orthopedic surgeon never checked the low back as a possible cause of hip pain. A recent study shows what we’ve seen in clinic, many patients with hip pain have low back problems and that replacing the hip joint in those patients is not going to help as much.

It’s often hard for patients to comprehend that if they feel pain in the hip joint it may be coming from their low back. They will swear that it feels like the hip joint hurts and that their low back doesn’t bother them very much. These same patients are frequently amazed when an injection in the low back makes the hip pain go away! How is this possible? The Sacroiliac (SI) joint in the low back can become injured or arthritic and that pain is felt in the back of the hip. The upper low back nerves can be pinched and refer pain to the hip. In addition, any number of other painful structures such as facet joints and discs can refer pain to the hip.

Medical illustration showing sacroiliac joint inflammation


The study was small and looked at patients undergoing hip replacement surgery who either had low back problems on imaging and exam or who didn’t. Multiple different pain and function questionnaires showed that patients without low back issues consistently did better with the hip replacement surgery than those who didn’t have the surgery. The study recommends that surgeons look at the low back!

The upshot? It’s no surprise, based on this study, that we see patients who have their hip replaced that don’t do well with hip replacement surgery because much of their hip pain was really coming from the low back. Maybe this new study will be start to prompt surgeons to examine more than just the hip!

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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