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Sports Medicine

Hip pain after knee replacement

06/20/2007

Question:

i had a right biomet vanguard knee replacement in dec. 2003 and have since been experiencing throbbing pain in my right hip just below the hip bone. At times I feel the right hip and knee would `give out` when I stand. I have actively participated in prescribed physical therapy as well as several courses of antiinflammatory meds. I was informaed that the artificial knee was `loose`. I have sought the opinion of 2 other orthopedic surgeons as well as having MRIs and bone scans - we are all perplexed. Do you have any information that may help my situation?

Answer:

Although it's not clear your question is sports-related, and although your questions are most appropriately directed to an orthopedic surgeon subspecialized in knee joint replacement surgery, hopefully the following will be of some use to you:

Although loosening of a knee replacement could account for your feeling that your leg could give out while weightbearing, this would not typically cause pain in the hip. Also, since your throbbing hip pain has been present ever since the knee replacement - but loosening of the knee replacement would not have been present immediately after it was performed - this would again suggest a loose knee replacement would not be the direct cause for your hip pain.

If the reason you underwent knee replacement was due to arthritis in your knee, it would not be unusual for arthritis to also be present in one or both hip joints, in your sacroiliac joint(s) (within the pelvis), and/or in your lumbar spine (lower back), any or all of which could cause pain in the hip area. Another possible cause for pain in the hip area is hip bursitis. A physical exam, along with possibly imaging studies of your pelvis/hip joints and/or lower back, are usually sufficient to determine the source(s) for such pain. Sometimes, selective injections (with anesthetic and cortisone) will both diagnose and treat such pain problems; for example, if your hip bursa was injected and your pain significantly improved, this would then indicate that hip bursitis was the main culprit.

Since loosening of an artificial joint doesn't normally occur so soon after surgery (the vast majority of knee replacements do well 10 years or more following surgery), hopefully your doctors can explain why loosening may have occurred in your case... potential causes include specifics pertaining to the surgical technique used(alignment of the prosthetic components, soft tissue balancing, etc.), and also engaging in activities (particularly high impact and quick stop-and-start) which aren't usually recommended following knee replacement surgery. Although revision surgery (replacing the replacement) is an option, usually this is an option of last resort, with outcomes less predictable and less favorable compared to the initial joint replacement.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University