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Hip

The Cause of Buttock Pain After Hip Replacement

Hip replacement surgery can be a very safe and successful procedure to repair serious damage to the hips and joints. With a success rate of over 90%, it is considered one of the best performed procedures in modern medicine and leads in terms of positive outcomes. However, even the most successful hip replacement is not immune to postoperative aches and pains, the most common of which being pains in or around the buttocks.

The pain does not render you immobile and does indicate an unsuccessful surgery as it is entirely normal following a hip replacement. But what exactly causes it? Since the procedure is meant to repair that region or part in particular, why do the surrounding areas ache afterwards? It may not be an indicator of other complications (it is actually the opposite), but it is nonetheless uncomfortable and may create some complications along the recovery process.

With that in mind, we can examine exactly what these pains are and how to relieve them to make your 2-3 month recovery as smooth as possible.

The Connection of Hips to Buttocks

Anatomically, the buttocks and hips are interconnected through the pelvis and a series of muscles. One muscle in particular, the piriformis muscle, is a muscle in the buttocks that connects to just above the hip joint. So, when the hip undergoes surgery, we feel it in those surrounding areas.

The perfect example would be in the actual gluteal muscles. Your maximus, minimus and medius also act as the protectors of the hip joints, so they are directly connected when you get the hip replacement. The hip joint may have been improved but it can leave the issue of affecting these gluteal muscles and causing gluteal tendinopathy. Platelet-rich plasma or PRP therapy is the most common way to treat tendon issues, but an MRI scan will pinpoint exactly where you have these issues as well as their level of potential damage.

Common Post-Hip Replacement Pains

Common Post-Hip Replacement Pains

Again, the pelvis and surrounding regions of the hip are affected in the surgery, which makes it completely normal to experience discomfort in the buttocks, as well as in the groin and thighs. This does not create a number of complications, and most likely do not need surgery, but it is beneficial how they affect you and how they can be treated.

Hematoma

Hematoma is most common after a THR (or a total hip replacement) or hip arthroplasty (THA), despite only being reported in about 2% of patients. This is when a blood vessel, basically internal bleeding, is broken during surgery and is left to pool around that area. What hematoma creates is similar to a bruise from the blood pooling under the skin, making that area slightly discolored and lumpy. 

During the surgery, there is a chance that a blood vessel in the gluteal muscles could have been damaged along the way, resulting in a mild soreness when sitting down or sleeping on that side.

Since it is merely blood pooling to one spot, this will is usually resolved by letting the excess blood spread out evenly and smooth out naturally: A process that usually takes no longer than 1 to 4 weeks following the surgery. The only time a hematoma is of concern for further attention is when it grows overtime instead of receding, or if it is clearly visible after 4 weeks to 2 months

Bone-Prosthesis Micromotion

For your surgery to be successful and for your new implant to stay in place so it can function properly, the implant needs to be stable and cemented. However, brand new implants tend to move ever so slightly during that small window of time where they have not completely fused with the pelvic bone or surrounding joints.

If you have ever experienced degenerative discs joints, the bones in your spine start to rub together when they are not supposed to, leading to great discomfort. Following a hip replacement, you may feel a similar pain in the thigh and buttocks in the first few weeks of your recovery. 2 weeks of this is normal but it can lead to implant failure if it is not properly treated.

Swelling and Inflammation

Much like the hematoma, it is perfectly normal to experience inflammation and swelling in or around the surgical wound, buttocks or the areas that are applied the most pressure. Specifically, the ischial bursae in your buttocks may be inflamed from this kind of pressure, irritating the nerves and sending those pain signals throughout the area.

Quite possibly the easiest of these pains to treat, a semi-regular dose of ibuprofen or other anti-inflammatory medications should do just the trick. After a hip replacement, too much mobility may seem like it would be harmful (which it definitely is), but controlled stretches for only a few minutes will also ease the pain and strengthen the muscles and tendons, while a simple ice pack can still accelerate the healing from inflammation.

Mobility Pain

Lastly, as much as it is necessary to take care of your joints and muscles by keeping them active, this understandably becomes difficult for about one month post-operation. The connective muscles and tissues to the hip and buttocks will likely feel irritated sitting for a while or excessively stretching the gluteal muscles.

Your body is still adjusting itself to work with the implant, so those first few weeks is when the pain is most noticeable. But all is not lost: Resting your body is still a viable option when you are not in your physical therapy and you can return to doing what you love early in the recovery.

Is Buttock Pain Normal After Hip Surgery?

As mentioned earlier, your gluteal muscles protecting the hip joints are in the direct path of your hip replacement surgery, so it is entirely normal for them to feel tender or sore following the operation. In fact, it is considered part of the healing process, typically lasting about 3 months. If your operation was not for both hips, then the side opposite of your incisions will not feel nearly as sore, but it can feel like an inconvenience to have one side more sore than the other. 

When Should I Go Back to the Doctor?

Leading up to your hip replacement, you were likely aware of what kind of complications you had in that area as well as the severity of the pain. You will know that if pain in the buttocks or the pelvic region is worse than that of a sprain, then it would be an ideal time to take medications. Should it be worse than that (hopefully not), then it is time to visit the doctor again.

What Relieves The Pain?

It may sound difficult at first, but keep moving to relieve the pain. A walk around the block a couple of times a day for a few weeks followed by an ice pack on the inflamed areas will keep those muscles strong, stress-free and active, which subdues the pain.

Dr. Matthew HC Otten

Director of Regenerative Orthopedic and Sports Medicine
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan State University Alumni

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