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Pain after Hip Replacement? Is It Your Tendons?

pain after hip replacement

If you’re planning a hip replacement or have already had one,
could a new study 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.

The Gluteal Tendons

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

The New Research

Researchers followed 50 patients with gluteal tendinopathy
that could be seen on MRI, but was otherwise asymptomatic,
underwent hip replacement. 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 Can You Avoid Being This Patient?

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:

pain after hip replacement

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

What Could You Do to Make Yourself a Better Candidate?

How could you avoid or fix 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.

Also, please
read this extensive review of hip replacement materials and sizing
and other things that can go wrong.

Here’s the 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
    . 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 hip
    replacement caused pseudotumor
    . 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 Resurfacingâ€). 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. 
We also know that a hip replacement won’t improve your
activity level
, which is generally the opposite of what
patients think. We also know that younger hip replacement patients fare
more poorly 
than their older and less active
counterparts.
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.

pain after hip replacement

If you’re planning a hip replacement or have already had one,
could a new study 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.

The Gluteal Tendons

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

The New Research

Researchers followed 50 patients with gluteal tendinopathy
that could be seen on MRI, but was otherwise asymptomatic,
underwent hip replacement. 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 Can You Avoid Being This Patient?

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:

pain after hip replacement

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

What Could You Do to Make Yourself a Better Candidate?

How could you avoid or fix 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.

Also, please
read this extensive review of hip replacement materials and sizing
and other things that can go wrong.

Here’s the 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
    . 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 hip
    replacement caused pseudotumor
    . 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 Resurfacingâ€). 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. 
We also know that a hip replacement won’t improve your
activity level
, which is generally the opposite of what
patients think. We also know that younger hip replacement patients fare
more poorly 
than their older and less active
counterparts.
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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