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Hip-replacement rates have been sky-rocketing in the past 10 years. Many patients who have gotten their hip replaced still have hip pain. How is that possible? The orthopedic surgeon never checked the lower back as a possible cause of hip pain. Now a new study reported August 20, 2015, by the Journal of Orthopaedic Science shows that many patients with hip pain have lower back problems, and that replacing the hip joint in those patients is not going to do much to ease the patient’s pain.

It’s often hard for patients to comprehend that if they feel pain in the hip joint it may be coming from their lower back. They will swear that it feels like the hip joint hurts and that their lower back doesn’t bother them very much. These same patients are frequently amazed when an injection in the lower back makes the hip pain go away. The sacroiliac joint in the lower back can become injured or arthritic and that pain is felt in the back of the hip. The upper low back nerves can be pinched and refer pain to the hip. In addition, any number of other painful structures such as facet joints and discs can refer pain to the hip.

In the small newly reported study, researchers looked at patients undergoing hip-replacement surgery who either had lower back problems on imaging and exam or who didn’t. Multiple different pain and function questionnaires showed that patients without lower back issues consistently did better with the hip-replacement surgery than those who didn’t have the surgery. The study recommends that surgeons look at the lower back.

It’s no surprise, based on this study, that many patients don’t do well with hip-replacement surgery because much of their hip pain was really coming from the lower back.

“Hip Replacement Back Pain” first appeared as a post on the Regenexx blog.