Pain after hip replacement is normal for the first several weeks and usually fades steadily over about 3 months. Pain that persists, returns after a good recovery or worsens may come from tendon irritation, loosening, infection, instability, a leg length difference or the lower back. A hip specialist can find the cause with an exam, X-rays and blood tests.
Most people are thrilled with their new hip, so it is discouraging when pain lingers or comes back. Some soreness is part of normal healing, and many causes of ongoing pain are very fixable. Dr. Stride sees patients for second opinions on painful replacements, including surgeries done elsewhere, and works carefully to find the specific cause before recommending any treatment.
Written and medically reviewed by Dr. Stride, MD, board-certified orthopedic surgeonSoreness, swelling and bruising are expected in the first few weeks. Thigh and outer hip aching often continues as muscles regain strength. Most patients see steady improvement week by week, with continued gains for up to a year.
The clue: Pain that is a little better each week, without fever or wound problems, is usually normal recovery.
Greater trochanteric pain syndrome is one of the most common causes of lasting pain after hip replacement. The iliopsoas tendon can also rub on the edge of the socket, causing groin pain with lifting the leg. Both usually respond to therapy or an injection.
The clue: Outer hip pain with lying on the side, or groin pain with leg lifts, suggests a tendon problem.
Over time the bond between implant and bone can weaken, or the bearing surface can wear. This causes pain, often in the groin or thigh. X-rays compared over time usually show the change.
The clue: Thigh or groin pain with the first steps after sitting, called start-up pain, suggests loosening.
An infection around the implant can occur soon after surgery or later, from bacteria spreading through the blood. It may cause wound drainage, fever or simply persistent pain. Blood tests and a joint aspiration help diagnose it.
The clue: Pain that never settled after surgery, or new pain with fever or wound drainage, needs an infection workup.
The ball can slip partly or fully out of the socket. A full dislocation is very painful and obvious. Repeated partial slips may feel like clunking or the hip giving way.
The clue: A clunk with the hip feeling like it is coming out, especially with certain positions, suggests instability.
Pain from the lower back can continue after the hip is replaced, sometimes revealing a spine problem that was there all along. A small leg length difference is common and often improves as the muscles adjust, though larger differences may need a shoe lift.
The clue: Buttock or leg pain below the knee with numbness after surgery suggests the spine.
Dr. Stride starts with a detailed history, including when the pain began, whether the hip ever felt good and what the original surgery involved, so bring your operative report and old X-rays if you have them. He checks the incision, watches you walk, measures leg lengths and tests hip strength. He presses on the greater trochanter and tests resisted leg lifts for the iliopsoas, and examines the lower back. X-rays are compared to earlier films to look for loosening, wear or position problems. Blood tests for inflammation (ESR and CRP) screen for infection, and a joint aspiration is performed when infection is possible. CT or an MRI with metal reduction sequences can show soft tissue and implant position in more detail.
“Bring your outside X-rays and MRI. I’ll go through them with you, but how your hip moves on the exam table tells me just as much as the pictures.”
Dr. Stride, MD
In the first 3 months, steady walking, therapy and strengthening resolve most soreness. Our team checks that you are on track.
An ultrasound-guided injection for trochanteric bursitis or iliopsoas irritation often relieves pain and confirms the source.
A short course of an anti-inflammatory, when safe, can calm tendon irritation.
When the back is the source, our team coordinates care with a spine specialist rather than operating on the hip again.
Loosening, wear, recurrent instability and infection usually need revision hip replacement, where some or all of the implant is replaced.
Most patients have the most soreness in the first 2 weeks and steady improvement over about 3 months. Mild aching with activity can continue for up to a year as muscles strengthen. Pain that is worsening rather than improving should be checked.
Groin pain after a replacement can come from iliopsoas tendon irritation, loosening of the socket, infection or the lower back. Pain when lifting the leg suggests the tendon. X-rays and blood tests help sort out the cause.
Yes, Dr. Stride provides second opinions for painful hip replacements done elsewhere. Bring your operative report, implant information and prior X-rays if available. The Saturday Hip Pain Clinic is a convenient option.
Not usually. Many causes, such as tendon irritation and bursitis, respond to therapy and injections. Revision surgery is recommended for specific problems like loosening, infection or recurrent dislocation.
Revision hip replacement is a surgery that removes and replaces some or all parts of a previous hip replacement.
Read more →InjectionsA trochanteric bursa injection places cortisone and numbing medicine over the bony point on the outside of the hip to calm hip bursitis and gluteal tendon pain.
Read more →DiagnosisHip X-rays and MRI answer different questions.
Read more →Non-surgicalPhysical therapy helps many types of hip pain, including arthritis, gluteal tendinopathy, hip impingement and many labral tears.
Read more →Front of hip and groin pain usually comes from inside the hip joint itself.
Causes & treatment →Hip pain · Outside of hipPain on the outside of the hip is most often greater trochanteric pain syndrome, an irritation of the gluteus medius and minimus tendons and the bursa over the bony point of the hip.
Causes & treatment →Hip pain · Back of hipPain in the back of the hip and buttock most often comes from the lower back, such as a pinched nerve or sciatica, or from the sacroiliac joint.
Causes & treatment →Hip pain · symptomHip joint pain is usually felt in the groin or front of the thigh and flares with putting on socks or getting out of a car.
Causes & treatment →
Some people do run after a hip replacement, but it is a personal decision to make with your surgeon.
Trouble lifting your leg into a car usually means the hip cannot bend far enough or the muscles that lift the thigh are painful or weak.
Most people walk with a walker before leaving the hospital or surgery center, stop needing it within 2 to 4 weeks, and return to light daily activities in 3 to 6 weeks.
Medically reviewed by Dr. Stride, MD against current guidance from these sources. Last reviewed October 2026. How we write and review content
