Hip replacement surgery (total hip arthroplasty) is one of the most successful orthopedic operations, often providing patients with significant pain relief and improved mobility. Nevertheless, postoperative pain can occur even after hip replacement, posing challenges for both patients and physicians. This comprehensive article explores the potential causes of pain following hip replacement and presents effective treatment options. The goal is to help those affected better manage their situation and initiate the appropriate treatment steps.

Why does pain occur after hip surgery?

Postoperative pain can occur for various reasons, ranging from normal healing processes to serious complications. It can be divided into acute and chronic pain.

1. Acute pain

• Surgical trauma: Cutting through tissue and muscle inevitably causes pain, which subsides as part of the healing process.
• Inflammatory response: The body's natural reaction to surgery.
• Swelling: Tissue edema in the area surrounding the surgery.

2. Chronic pain

• Misposition of the prosthesis: Incorrectly placed implants can cause abnormal stress.
• Scar tissue: Adhesions or thickenings can irritate nerves.
• Loosening of the prosthesis: Mechanical instability leads to recurring pain.
• Infections: An infected prosthesis is a serious complication.

Typical causes of postoperative pain after hip replacement

1. Wound healing pain

These pains are common and represent a natural reaction to the procedure.

Therapy:

• Rest the affected leg.
• Use of ice packs to reduce swelling.
• Painkillers such as ibuprofen or paracetamol.

2. Muscle weakness and muscle imbalance

The muscle is cut during the operation and needs time to regenerate.

Therapy:

• Physiotherapy to strengthen the muscles.
• Regular, joint-friendly exercise such as swimming.

3. Incorrect loading of the joint

Incorrect gait or leg length discrepancies can disrupt balance and cause pain.

Therapy:

• Gait training with a physiotherapist.
• Orthopedic insoles or adjustments by an orthopedist.

4. Infections

Infections around the implant can cause acute pain and restricted mobility.

Therapy:

• Antibiotic treatment.
• In severe cases, the prosthesis is surgically removed.

5. Nerve irritation or injury

Damage to nerve structures can cause severe pain or numbness.

Therapy:

• Corticosteroid injections to reduce pain.
• Specialized pain therapy for neuropathies.

Diagnosis of pain after hip surgery

A correct diagnosis is crucial to identify the cause of the pain and treat it effectively.

1. Clinical examination

The doctor checks the mobility of the joint, locates painful areas, and analyzes the gait.

2. Imaging techniques

• X-ray: Assessment of the prosthesis position.
• MRI or CT: Analysis of soft tissue damage and loosening.
• Scintigraphy: Localization of infections or inflammations.

3. Blood tests

Elevated inflammatory markers such as CRP or leukocyte count indicate an infection.

Acute pain after surgery – immediate help

1. Pain management

• Use of analgesics, tailored to the intensity of the pain.
• Local cooling.

2. Movement and Rehabilitation

• Early mobilization under physiotherapy guidance to prevent stiffness.

3. Pain-relieving aids

• Assistance for relief.
• Compression stockings to reduce edema.

Chronic pain after hip replacement and its treatment options

1. Revision surgeries

In cases of serious complications such as loosening of the prosthesis, a further procedure may be necessary.

Indication:

• Persistent pain despite conservative therapy.
• Mechanical instability or inflammation.

2. Special pain therapy

Chronic pain often requires multidisciplinary treatment.

Possibilities:

• Medications for pain modulation (e.g., gabapentin).
• Local anesthetics or nerve blocks.

3. Physical therapy and occupational therapy

Non-invasive methods to improve mobility and quality of life:

• Water therapy.
• Electrotherapy for muscle stimulation.

Prevention of pain after hip surgery

1. Optimizing surgical preparation

• Physiotherapy to strengthen the muscles before the procedure.
• Dietary changes to promote healing.

2. Postoperative measures

• Regularly providing information about realistic healing processes.
• Early movement under professional guidance.

3. Regular follow-up care

Routine check-ups by the treating orthopedist help to identify problems early.

Summary and Conclusion

Postoperative pain after hip replacement surgery (total hip arthroplasty) is treatable in most cases and often part of the healing process. A systematic diagnosis and tailored treatment options are crucial for long-term success. Patients should openly communicate their symptoms and work closely with their doctors and therapists. With the right measures, a pain-free life and unrestricted mobility can be achieved. Only rarely is further surgery necessary.