If You Need a Hip Replacement, Get Your Low Back Fixed First!

By Chris Centeno, MD /

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low back and hip pain

It’s always great to see enlightened physicians tying together how one part of the body impacts the other. We’ve done a great disservice to patients by educating them that their knee, hip, and spine are separate instead of all one big machine. Now a recent study shows us yet another connection between the low back and hip replacement complications.

First, when I tell patients that problems in their hip or knee or ankle may have originated in their low back, they look at me like I just told them that there’s an alien living inside them. The idea that their body is one connected machine is that foreign. How did we get here and what evidence is there that different parts of the system impact each other?

It’s All Connected

We’ve done a great disservice to patients by orthopedic hyper-specialization. The messaging to patients has been that since there are hip specialists and a spine experts, then the hip and the spine are two different machines. Yet, in fact, the literature continues to show that the spine and leg are one machine designed to transfer force. While that machine has specialized areas called the hip and the spine, they are intimately interconnected.

Research supports these hip and knee connections. For example, one study found that in female runners with kneecap pain, the stress on the knee was caused by weak gluteal muscles that weren’t contracting appropriately to keep the hip in proper position. Another recent investigation demonstrated that the position of the femur, which is controlled at the hip, could lead to poor tracking of the kneecap, which can lead to arthritis and cartilage injuries.

Taking this a step further, the hip and knee and even the ankle and foot are all supplied and controlled by spinal nerves in your low back.

Low Back and Hip Replacement: The New Research

The latest study on this topic looked the connection between low back and hip replacement by looking at patients who had various low back conditions at the time of their hip replacement surgery. This spanned everything from a herniated disc to degenerative disc disease with arthritis. Interestingly, in patients with a low back diagnosis, they were up to twice as likely to experience complications from a total hip replacement surgery. In this case that the device would dislocate. This makes sense as abnormal motion in the low back likely places abnormal pressure on the new hip device. In addition, other complications were more likely and these included the need for revision surgery, fracture around the new device, and infection.

The upshot? If you need a hip replacement, make sure you get your back fixed before surgery! This can often be accomplished without the need for back surgery. In addition, all the parts of your body are connected, so don’t believe for a second that what happens in your hips isn’t impacted by what happens in your back!

Category: Hip, Latest News

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28 thoughts on “If You Need a Hip Replacement, Get Your Low Back Fixed First!

  1. Fred R Schneider

    This sounds interesting. I have an absolutely terrible left hip that is so full of arthritis my doctor said I can’t wait much longer before it might fuse together. I had the left knee replaced a few years ago and I have stenosis that is pretty bad at the L4 and L5 per my great spine doctor Larry Tice in Fruita, CO. I am a 72+ year old Vietnam Veteran and the VA has been very good to me these past 15 years, but they are very slow and have too many patients so you don’t get any really super, personal follow-up but I have a terrific Ortho Doctor in Dr. Patrick Sillix who did my left knee. The Laser Spine Institute in Scottsdale, AZ has looked at my MRI the VA sent to them and says they can help me but I have to use Medicare and then pay the balance which there is no way I can do right now. Anyway, this is the first time I have seen someone say do the back first. There are LOTS of opinions out there!! Dr. Sillix wanted to hear from the SI first to see what they thought, but they did not commit to which should be done first, but seemed to intimate the back first. Thanks for your information and Semper Fi

    1. Regenexx Team Post author

      Thank you Fred. Thanks for your service! We would definitely recommend sorting your back first.

  2. Robert reily

    Am I correct in assuming that a sore knee can often cause a sore lower back?

    1. Regenexx Team Post author

      It can, in that a sore knee often changes your gait which can cause biomechanical changes which impact your back. But the often overlooked issue is low back nerve irritation without back symptoms, which causes knee or hip problems.

  3. Robin Harville

    I have both lower Back pain and am in need of a hip replacement. I did send my MRI into the Boneti spine Institute for review. How can I find more info about Regenexx?

    1. Regenexx Team Post author

      Our website is the best source: http://www.regenexx.com. Please also see: https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/ There is a white rectangle into which you can put your email adress for additional spine treatment information, and as you scroll down the page you’ll find videos of actual treatments. You can also call and speak to one of the members of our education team at 888 525 3005.

  4. Judah McKee

    Yes, I am glad that the medical field is finally realizing the facts stated in this article. I don’t understand why this is such a shocking discovery to people. I have lower back issues including the disc on L1 is completely nonexistent. Bulging discs all the way up and down my spine with problems that causes the Big nerve in the back to be inflamed keeping my hips, legs, knees and feet in pain. Doctors have already told me I’m a candidate for hip and knee replacements. When I tried to get my back fixed first the insurance companies refused to approve the procedure and doctors all thought I was crazy. Still looking for my miracle because I refuse to be cut on but I was much more prone to agree to the new laser surgery until I heard about regeneration techniques using an individual’s own healthy stem cells.

    1. Regenexx Team Post author

      Matt Chan said something similar, and can’t agree more with both of you! Please see: https://regenexx.com/blog/crossfit-injury-recovery/

  5. daniel Aleliunas

    I have a torn meniscus / confirmed MRI and need whatever information yo might have regarding how to get my knee back to the condition it once was in.

    1. Regenexx Team Post author

      The most important thing is to avoid meniscus surgery and steroid shots! Please see: https://regenexx.com/blog/should-i-get-meniscus-surgery/ and https://regenexx.com/blog/steroid-injection-risks/ Here is how we treat Meniscus tears: https://regenexx.com/meniscus-tears/ But there is alot of other valuable knee information here, including a free download of the Knee Owner’s Manual: https://regenexx.com/the-regenexx-procedures/knee-surgery-alternative/ If you’d like to see if you’d be a candidate for Regenexx Procedure, please submit the candidate form.

  6. Barbara Cooper

    This is very interesting. I have had knee pain for quite a while… have had cortisone and synvix in the past with little more than short-term relief. Have had prp and uflexxa at Greenwhich with no relief. Recently tried synvix again with no relief.
    The knees are mostly arthritis. My really annoying problem is pain in shins and calves, mostly during night, sometimes as soon as I lie down and other times starting later. Motrin may help but not always. Pillow under legs, same story.
    Do you think the leg pain could be from spine? I generally have no back problems except for an occasional low-back pain that does not last.
    Incidentally, I walk about 45-60 minutes a day and most days do not have a problem. Getting up from sitting is difficult, mostly due to stiffness, and going downstairs is painful.

    1. Regenexx Team Post author

      It’s certainly possible. The S1 nerve in your low back supplies your calf muscle. Please see: https://regenexx.com/blog/calf-muscle-tear/ Importantly, Steroid shots escalate the problem and Motrin can make arthritis worse. Please see: https://regenexx.com/blog/can-nsaids-make-arthritis-worse/ and https://regenexx.com/blog/steroid-injection-risks/ If you’d like to see if you’d be a Candidate for a Regenexx procedure and speak to one of our Physicians about your particular case, please submit the Candidate form

  7. Judy

    5 years ago a spine specialist told me that there is nothing they can do to ‘fix’ my degenerative disc disease. I am now scheduled for a hip replacement- the hip is bone on bone and affecting my ability to walk without a limp – which is now effecting my knee & ankle. I am an active person able to do yoga, pilates, water aerobics etc. to maintain overall health. I eat a healthy mostly Paleo diet. So I am curious how I can ‘fix’ my spine? My orthopedic actually recommended the opposite. He feels that my low back symptoms will subside with a new hip. The research does seem to indicate a higher likelihood for hip dislocation with spinal degeneration – I appreciate the heads up. By the way I underwent stem cell therapy for both hips and my lumbar spine last October – less than stellar results. Hence the now scheduled hip replacement.

    1. Regenexx Team Post author

      Spine specialists and Orthopedic Doctors generally have very little understanding of Regenerative medicine,as it is a totally different paradigm. Who treated your hips and lumbar spine?

  8. Pam Sinclair

    What type of treatment for the back do you suggest. Would chiropractic treatment be of any use.?

    1. Regenexx Team Post author

      A skilled Chiropractor can be great, but the need ongoing for chiropractic adjustments usually signals a problem that needs treatment. Please see: https://regenexx.com/blog/how-to-read-a-low-back-mri-report/

  9. Ellen

    What exactly is the treatment for the lower back prior to hip surgery.

    1. Regenexx Team Post author

      It depends what the back issue is. Most can be handled regeneratively with precise image guided injections of your own stem cells and platelets. Please see: https://regenexx.com/blog/how-to-read-a-low-back-mri-report/

  10. Jay

    I am getting my right hip replaced in a few months. I walk with a gait now. I wanted to know if I should see a chiropractor before my surgery to help me with my gait.

    1. Regenexx Team Post author

      The important thing to do before hip replacement surgery is to rule out a low back issue as the cause of your hip issue given the relationship between the two. These Physicians can do that type of exam: https://regenexx.com/find-a-physician/ Not sure what you meant by “walk with a gait now”, however, that is an additional reason to be evaluated before surgery. Here is additional info about hip replacement: https://regenexx.com/blog/hip-replacement-after-lumbar-fusion/

  11. Todd C Pittman

    My wife has had long term knee issues with injections of sinvix? to help her get through until needing the knee replacement and now she is told that she needs a hip replacement on the opposite side immediately because of a cyst and bone spurs causing her the most pain in her hip. She has been out of alignment for a long time and now just diagnosed with a mild spondylolysthesis? at L4/L5 that is causing her some back pain and discomfort. One doctor is pushing for getting the hip replaced and another doctor is telling her the back needs to be addressed first. What does addressing the back actually mean when it is this condition? Just treatment to remove the pain or surgery to fuse the spine into place?

    1. Regenexx Team Post author

      Studies show it’s important to diagnose and treat the low back issue before hip replacement. We don’t know what the Dr. meant by “addressing” the low back issue. If your wife’s particular issues are found to be Candidates for these procedures, we treat Spondylolythesis and hip bone cysts without surgery. Please see: https://regenexx.com/blog/a-hip-stem-cell-treatment-in-an-akido-master/ and https://regenexx.com/blog/hip-arthritis-getting-worse-new-research-says-bone/ and https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/ and https://regenexx.com/the-regenexx-procedures/hip-surgery/

  12. Paul Pirrung

    My wife had a total hip replacement in Oct 2014 than in March 2017 and lumbar fusion,,L4,L5 ever since then she has really bad hip problems with her hip replacement. We were told the back surgery caused her hip to rotate an the hip hardware moved causing the screws to come out she had to have a hip revision which she dislocated 2 weeks later now 6 months later she was told the muscles in her hip has complete atrophy and they cannot do anything more for is this common? She is in pain all the time.

    1. Chris Centeno Post author

      Paul, stuff like this certainly happens. I’m sorry it happened to your wife.

  13. Michael Hartzsch

    Are you or can you recommend somebody in Australia?

    1. Regenexx Team

      Hi Michael,
      Yes, we have a Regenexx Provider in Australia. Please see: https://regenexx.com/providers/regenexx-australia/

  14. peggy

    I have a bulging disk and now by hip went out suppose to have hip replacement will my back be better?

    1. Regenexx Team

      Hi Peggy,
      Generally, it’s important to address the back issue first. But to determine what’s needed in your particular case, we’d need to examine you. To set that up, please give us a call at 855 622 7838.

Chris Centeno, MD

Regenexx Founder

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.
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