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Buttock Pain After Hip Replacement? It Could Be Your Tendons

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If you’re planning a hip replacement or have already had one, a new study could mean you should be looking at the health of your tendons. Why would your tendons matter if you have arthritis of the joint? Is there a way to avoid or fix continued pain after hip replacement? Let’s dig in.

Why Gluteal Tendinopathy Is a Pain in the Butt

There are muscles that protect the hip joint and surround it. They are the “butt” muscles like the gluteus maximus, medius, and minimums. These muscles have tendons that can become beat up with wear and tear. When that happens, it’s called gluteal tendinopathy.
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Hip Replacement With Gluteal Tendinopathy

Researchers followed 50 patients with gluteal tendinopathy that could be seen on MRI, but was otherwise asymptomatic, underwent hip replacement (1). They also tracked 50 patients who didn’t have any evidence of gluteal tendinopathy on MRI and who also had their hip replaced. The patients that had the beat-up gluteal tendons had worse outcomes on a functional hip questionnaire, worse pain, and poorer patient satisfaction.
Basically, these patients had pain after hip replacement. The pain experienced by the hip replacement patients with gluteal tendinopathy was toward the outside of the hip and twice as many patients needed revision hip replacement surgery in this group. So while their hip joint may have felt better, they still had problems related to these damaged tendons.

How to Avoid Butt Pain After Hip Replacement

How can you avoid pain after hip replacement? Many times these tendon issues will be talked about on your MRI report. So look for terms like “tendinopathy,” “tendinosis,” or “tendon tear” in muscles like:

  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • TFL (tensor fascia lata)

If you don’t have an MRI, take some time to press on these spots:

Back view of the muscular system from the waist to the bottom of the thigh. Areas mentioned in the text are circled.

Matis75/Shutterstock

If they’re tender, get an MRI to check if you have gluteal tendinopathy.

How to Treat Pain After Hip Replacement

If you have these gluteal tendon issues, first trying to figure out why is a good idea. For example, irritated nerves in the back can cause this problem. That doesn’t have to be full-on sciatica, it can just be low-level irritated nerves with or without back pain. Since the nerves tell the muscles what to do, bad nerve signals can cause these muscles to misfire and the tendons to get ripped up.

Second, treating the tendons before or after hip replacement is a good idea. The most common way to treat beat up tendons these days is using your own concentrated blood platelets (called platelet-rich plasma or PRP). In this case, ultrasound guidance would be used to guide the needle to the bad parts of the tendon and then relief can be achieved in weeks to months as the growth factors from the platelets stimulate healing and growth of the tendon cells. However, note that if the bad tendons were in fact caused by irritated nerves in your back, the back will need to be treated as well.

Other Causes of Pain After Hip Replacement

First, watch my video above for some causes of butt pain after hip replacement. Then, please read this extensive review of hip replacement materials and sizing and other things that can go wrong. Here’s the abbreviated list of other things that you should consider if you’ve already had a hip replacement and still have pain:

  • An allergy to the hip replacement materials (2). The cement used or the nickel and/or cobalt used to make the device are common allergies.
  • A prosthesis that is too short or long. This will cause a leg length discrepancy.
  • Hip pain that was from elsewhere, other than your arthritic hip. That means that the hip pain could have always been referred from the low back or from the SI joint (see video above). Hence, replacing the hip joint never treated the original pain generator.
  • A pseudotumor (3). This is a growth caused by irritation of the local tissues due to the hip replacement device.
  • Wear particles from a metal-on-metal or minimally invasive anterior hip replacement (Birmingham hip or “Hip Resurfacing”). This is wear debris that then irritates the tissues and causes pain.

What We Know About Hip Replacement

Is hip replacement a panacea? Meaning, does it always work? Most people think that getting a hip replacement is like getting a new part installed in your car, but it’s really not. In fact, it’s a big surgery that involves amputating the hip joint and then installing a prosthesis. This is why so many still have pain after hip replacement.
These tendon findings aren’t all that surprising given that we know that things like a back fusion can make hip replacement outcomes worse (5). We also know that a hip replacement won’t improve your activity level, which is generally the opposite of what patients think (6). We also know that younger hip replacement patients fare more poorly than their older and less active counterparts (7).
The upshot? Pain after hip replacement is surprisingly common and can be due to beat-up butt muscle tendons. A little detective work may help you avoid problems or provide a way to fix them.

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References

(1) Rosinsky PJ, Bheem R, Meghpara MB, et al. Asymptomatic Gluteal Tendinopathies Negatively Impact Outcomes of Total Hip Arthroplasty: A Propensity Score-Matched Study. J Arthroplasty. 2021;36(1):242-249. doi:10.1016/j.arth.2020.07.063

(2) van der Merwe, JM. Metal Hypersensitivity in Joint Arthroplasty. JAAOS. March 2021;5(3). doi:10.5435/JAAOSGlobal-D-20-00200

(3) Bosker BH, Ettema HB, van Rossum M, et al. Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg. 2015;135(3):417-425. doi:10.1007/s00402-015-2165-2

(4) Gofton W, Beaule PE. Serum Metal Ions with a Titanium Modular Neck Total Hip Replacement System. J Arthroplasty. 2015;30(10):1781-1786. doi:10.1016/j.arth.2015.04.040

(5) Blizzard DJ, Sheets CZ, Seyler TM, et al. The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes. Orthopedics. 2017;40(3):e520-e525. doi:10.3928/01477447-20170327-03

(6) Harding P, Holland AE, Delany C, Hinman RS. Do activity levels increase after total hip and knee arthroplasty?. Clin Orthop Relat Res. 2014;472(5):1502-1511. doi:10.1007/s11999-013-3427-3

(7) Haynes J, Sassoon A, Nam D, Schultz L, Keeney J. Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty. Knee. 2017;24(3):663-669. doi:10.1016/j.knee.2016.11.004

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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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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