Texas Joint Institute - November 27, 2023
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Knee Pain After Hip Replacement: Exercises and Guidelines

Are you experiencing knee pain after hip replacement surgery? Many individuals who undergo this procedure may encounter discomfort in their knees during the recovery process. 

In this comprehensive guide, we'll discuss the causes of knee pain after hip replacement and provide a series of exercises and guidelines to help alleviate it. We'll also discuss when contacting your surgeon is crucial for further evaluation and care.

Is it normal to have knee pain after hip replacement?

Before diving into the specifics of knee pain after hip replacement, distinguishing between normal discomfort and concerning pain is essential. When you undergo hip replacement surgery, it's normal to experience some discomfort and stiffness in your hip and surrounding areas. This discomfort usually stems from the surgical incisions, soft tissue manipulation, and the adjustment period your body needs to adapt to the new hip joint. However, persistent or worsening knee pain can be a cause for concern.

What causes knee pain after hip replacement surgery?

Several factors can contribute to knee pain after hip replacement surgery. Understanding these factors can help you and your healthcare team address the issue effectively:

Implant positioning

The positioning of the hip implant is critical to ensure proper alignment and function. If the implant is not placed correctly, it can lead to abnormal forces on the knee joint, resulting in pain.

Hip implant size and design

The choice of hip implant size and design can impact how the forces are distributed within the joint. Incompatibility between the implant and your natural hip mechanics can lead to knee discomfort.

Soft tissue and ligament changes

During surgery, soft tissues and ligaments surrounding the hip joint may be altered. These changes can affect the stability of the entire joint complex and indirectly lead to knee pain.

Muscle weakness and imbalance

Weakness or imbalance in the muscles supporting the hip and knee joints can result from the surgery itself or prolonged immobility during recovery, contributing to knee pain.

Nerve irritation or compression

Nerves in the hip area can become irritated or compressed during the surgical procedure, causing radiating pain into the knee.

Inflammation and scar tissue

Inflammatory responses and the formation of scar tissue are natural parts of the healing process after surgery. However, excessive inflammation or scar tissue development near the knee can lead to pain and stiffness.

Pre-existing knee issues

If you had pre-existing knee problems before hip replacement surgery, they may become more noticeable or exacerbated during the recovery process, contributing to knee discomfort.

Importance of post-hip replacement exercises

Now that we've explored the potential causes of knee pain after hip replacement let's discuss the importance of postoperative exercises. A structured exercise program can significantly improve your overall recovery experience and minimize knee pain. These exercises not only help you regain strength and mobility but also ensure a smoother transition to your daily activities.

Early Postoperative Exercises

Ankle pumps

Ankle pumps are one of the earliest exercises you can perform post-hip replacement surgery. While lying down, gently flex and point your ankles. This exercise promotes blood circulation, reduces swelling, and helps prevent blood clots.

Quadriceps sets

To perform quadriceps sets, sit or lie down with your legs extended. Tighten your thigh muscles, pushing the back of your knee down towards the floor. Hold for a few seconds and release. This exercise strengthens the quadriceps and supports knee stability.

Straight leg raises

While lying on your back, bend one knee and keep the other leg straight. Lift the straight leg a few inches off the ground, then lower it slowly. Straight leg raises target the hip and thigh muscles while also promoting knee joint flexibility.

Gluteal sets:

Gluteal sets involve squeezing your buttocks together while sitting or lying down. This exercise activates the gluteal muscles, which play a crucial role in hip stability and function.

Passive range of motion (PROM) exercises:

PROM exercises involve gently moving your hip and knee joints through their range of motion with the assistance of a therapist or a passive motion machine. These exercises help maintain joint flexibility while avoiding excessive strain.

Advanced Exercises and Activities

As you progress in your recovery, it's essential to continue with more advanced exercises to further strengthen the hip and surrounding muscles and reduce knee pain.

Standing hip abduction

While holding onto a stable surface, such as a chair or countertop, lift your operated leg sideways while keeping it straight. This exercise targets the hip abductors and improves hip joint stability.

Hip flexion exercises

Gently lift your operated leg towards your chest while standing or lying down. This exercise strengthens the hip flexor muscles, enhancing your ability to walk and perform daily activities.


Using a step or stair, practice stepping up and down with your operated leg. Step-ups help improve leg strength, balance, and coordination.

Balance and proprioception training

Balance exercises help enhance proprioception (awareness of your body's position in space) and stability. Improved balance can prevent knee pain associated with falls or missteps.

Low-impact cardio activities

Engaging in low-impact cardio exercises like stationary cycling or swimming can promote overall cardiovascular fitness without putting excessive stress on the hip and knee joints. Cardiovascular health is crucial for your overall well-being during recovery.

When to Contact the Surgeon

While postoperative exercises and a structured rehabilitation program can alleviate knee pain for many individuals, it's important for you to be aware of warning signs that may require immediate attention from your surgeon:

Sudden and severe knee pain

If you experience intense and persistent knee pain that is not improving with rest and pain medication, contact your surgeon promptly.

Swelling and warmth

Excessive swelling or warmth around the knee joint may indicate an underlying issue that requires evaluation.

Loss of motion

See medical attention if you notice a significant decrease in knee joint range of motion or the inability to bear weight on your operated leg.

Fever or signs of infection

Fever, redness, increased pain, or drainage from the surgical site can be signs of infection and should be reported to your surgeon immediately.

Partner with Texas Joint Institute in your hip replacement journey!

Experiencing knee pain after hip replacement surgery can be distressing, but it's essential to understand that this discomfort is not uncommon. By identifying the potential causes of knee pain and engaging in a structured exercise program, you can significantly improve your recovery and regain your mobility. Always stay vigilant for warning signs and maintain open communication with your surgeon to ensure a smooth and successful recovery process. With the right guidance and dedication to your rehabilitation, you can minimize knee pain and look forward to an active lifestyle post-hip replacement surgery.


Ready to say goodbye to knee pain and embrace a life of mobility after hip replacement surgery? Let Texas Joint Institute be your trusted partner in this journey to a pain-free future. Contact us today for personalized guidance and expert care.