Knee pain after hip replacement: causes and treatments

Hip replacement surgery is a big step toward improving comfort, movement, and overall quality of life if you’ve been dealing with chronic hip pain. But as with any procedure, it’s normal to experience some temporary discomfort afterward. Along with pain at the surgical site, some people may also notice knee pain after hip replacement.

Because your body is adapting to changes around the hip, it’s common for nearby areas, like the knee, to feel different for a while. “As your body adjusts after a hip replacement, it’s normal for some muscles to take a break while others temporarily work a bit harder, which can show up as knee discomfort,” says Aashini Govani, PT, DPT, a Hinge Health physical therapist. Conservative strategies during your surgery recovery, such as targeted exercises and stretches can help alleviate hip and knee pain.

Here, learn about knee discomfort after hip replacement, along with how to treat it — especially with exercises recommended by our Hinge Health physical therapists. 

Causes of knee pain after hip replacement surgery

After hip replacement surgery, it’s common to notice new sensations in other parts of your body — your knees included. This doesn’t mean there’s anything wrong; your body is adjusting as you recover. One study found that about 7% of people experience knee pain after hip replacement. Potential causes of knee pain include:

• Changes in strength. “Without as much support from the hip, the muscle area around your knees works harder,” says Dr. Govani. “If these muscles aren’t used to that extra pressure, you may feel pain.”

• Sensation of change in leg length after a hip replacement. In some cases, this can alter gait and increase stress on the knee, leading to pain.

• Changes in how you move. Some patients experience pain in the knee opposite to the operated hip due to compensatory changes in walking patterns.

• Referred pain. Post-surgery inflammation or swelling at the hip can sometimes lead to discomfort that is perceived elsewhere, including the knee — a phenomenon known as referred pain.

• Pre-existing knee issues. Osteoarthritis, muscle imbalances, and altered biomechanics also contribute.

• Surgical complications. After any surgery, there’s some risk of adverse outcomes that may cause new or worse knee pain, including infections and blood clots.  

The key to alleviating knee discomfort after a hip replacement? Strengthening the muscles in your legs that support your knees. When these muscles are strong, they can take some of the load off of your joint. Performing movements that improve leg mobility is also key. Strengthening your core muscles can also help your whole body feel more supported during movement, which may contribute to comfort in your knees as well.

Movement after a hip replacement

After hip replacement surgery, many people work with a physical therapist in person who can help guide their recovery and suggest appropriate exercises. 

If you start to experience knee pain during your recovery, it’s important to talk to your physical therapist. They can help you understand why you’re having knee pain and can suggest changes to your exercise routine or recommend new exercises to help relieve the pain. Your PT can also guide you on when to start additional exercises for your knee and make sure they’re appropriate for your stage of recovery.

Below are examples of the types of knee exercises that may be recommended and that you can do at home. These exercises can help build strength, mobility, and confidence in movement, even well after the initial hip replacement surgery recovery phase. Double-check with your surgeon and care team before doing these movements.

These gentle, targeted exercises can make a big difference in your recovery and mobility. “A physical therapist can help you identify other types of movements that can help you build strength without interfering with healing,” says Dr. Govani. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for knee pain after hip replacement

There are many ways to manage knee discomfort after hip surgery, and caring for your knee can also support your overall recovery. Some treatments help ease pain and swelling, while others focus on building strength and movement. Working with your care team can help you find the best approach for a smoother recovery. Treatments include: 

• Try physical therapy and targeted exercises. Targeted exercises can help strengthen muscles around your knee, easing pressure on the joint. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Even if it’s uncomfortable to move, physical activity is key in alleviating pain after a hip replacement. Strengthening moves, in particular, play an important role. “Movements that activate your hip and surrounding muscles can support your mobility and ease discomfort,” says Dr. Govani. Low-impact cardio like walking can help increase blood flow and promote healing after surgery. Talk to your physical therapist about the best activities and routine for your needs.

• Dial back on intensity at first. Focus on gentle activities that don’t make your pain significantly worse. Some pain or soreness is normal as you get moving after hip surgery, but that doesn’t mean you should avoid activity altogether. Work with your physical therapist to find your movement "sweet spot" — the right balance where you’re staying active without pushing too hard. Listen to your body and adjust the intensity or duration of your exercises or everyday movements as needed.

• Take breaks and make modifications. You may need to rest after usual activities that may feel more challenging during recovery, such as going up the stairs, or make modifications to your exercise therapy movements. A physical therapist can recommend movement modifications so you can continue to build strength while also promoting healing.

• Apply ice and heat. Both ice and heat therapy can help relieve knee discomfort after hip replacement surgery, says Dr. Govani. Ice helps tame inflammation and swelling in and around the knee and heat promotes blood flow to tense muscles and other soft tissues like tendons and ligaments. “Just be sure to not apply heat therapy directly over the surgical site on your hip,” Dr. Govani says. This can help reduce the risk of infection at your incision.

• Wear a knee brace or use athletic tape. Wearing a brace or applying elastic athletic tape (like kinesiology tape) around your knee can help provide compression to the area, which may help reduce discomfort as you perform your targeted exercises.

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for knee pain.  However, your surgeon or doctor may have prescribed other medications for you after surgery, so it’s important to follow their recommended treatment plan. Always check with your healthcare provider to make sure it’s safe for you to take these medications based on your medical history and any other medicines you are currently using.

• TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle electrical impulses to interact with your nervous system and help reduce knee pain after a hip replacement. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable. Note: Enso has to be placed at least three inches away from the surgical incision and the metal implant in your hip. However, Enso is fine to use near your knee after a hip replacement. 

• Complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for knee and hip pain relief, such as massage, acupuncture, or chiropractic care.

Other areas you may feel pain after hip replacement

It’s normal for your body to feel different after a hip replacement. As your body adapts to new movement patterns and routines, you might notice temporary discomfort in areas beyond your hip — and knee. 

“Recovery can be more than just healing the surgical site — your whole body adjusts and finds its rhythm again,” says Dr. Govani. “During this time, it’s common to experience new or different sensations in other places.”

Some of the most common areas where people might notice discomfort during hip replacement recovery include the various joints and muscle groups in your lower body, such as:

• Lower back 

• SI joint

• Ankle

• Foot

When to see a doctor

‌If your knee pain after ‌hip replacement surgery doesn’t improve on its own with the above conservative treatments, or the pain becomes worse, that’s a sign it’s time to talk to your healthcare provider. It’s also a good idea to get care if you have:

• Muscle weakness or significant numbness  

• Inability to bear weight on your knee or unstable leg

• Safety concerns with doing regular daily activities 

Surgery may worsen pain, sometimes due to infections or blood clots, like deep vein thrombosis (DVT), so it’s vital that you seek medical attention if you notice any of the following symptoms:

• Worsening swelling

• Pain or tenderness that’s not improving with time

• Fever, redness, warmth, or drainage

• Shortness of breath, chest pain, or heart symptoms

PT tip: Strength train before hip surgery

If you’re planning to have hip replacement surgery, performing strengthening and flexibility exercises consistently beforehand can support your recovery after the procedure. “Building strength in your hips, knees, and whole body before surgery can help you feel better as you heal,” says Dr. Govani. Research shows that following a pre-surgery exercise program can help reduce pain and improve function and quality of life within the first two to five months after hip surgery. 

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Tokuhara, Y., Kadoya, Y., Kim, M., Shoundou, M., Kanno, T., & Masuda, T. (2011). Anterior Knee Pain After Total Hip Arthroplasty in Developmental Dysplasia. The Journal of Arthroplasty, 26(6), 955–960. doi:10.1016/j.arth.2010.07.007

3. Jones, B. Q., Covey, C. J., & Marvin H. Sineath, J. (2015). Nonsurgical Management of Knee Pain in Adults. American Family Physician, 92(10), 875–883. https://www.aafp.org/pubs/afp/issues/2015/1115/p875.html 

4. Kemp, J. L., Mosler, A. B., Hart, H., Bizzini, M., Chang, S., Scholes, M. J., Semciw, A. I., & Crossley, K. M. (2020). Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain. British Journal of Sports Medicine, 54(23), 1382–1394. doi:10.1136/bjsports-2019-101690

5. Baldania, S. (2024). Investigating the Impact of Pre-Operative Physical Fitness on PostOperative Rehabilitation in Total Hip Replacement: A Literature Synthesis. Journal of Physical Medicine Rehabilitation Studies & Reports, 1–7. doi:10.47363/jpmrs/2024(6)195

6. CDC. (2024, May 22). Understanding Your Risk for Healthcare-Associated VTE (Blood Clots). Venous Thromboembolism (Blood Clots). https://www.cdc.gov/blood-clots/risk-factors/ha-vte.html