Causes of Buttock Pain After Hip Replacement

You're a few weeks (or months) into your hip replacement recovery, and something doesn't feel right. Instead of the groin pain you had before surgery, you've got this nagging ache in your buttock. 

You're wondering: Is this normal? Should I be worried?

Buttock pain after hip replacement catches many patients off guard. Your new hip joint might be functioning perfectly, yet you're dealing with discomfort in an area you didn't expect. The good news? You're not alone, and there are usually clear explanations for what's happening.

Around 95% of hip replacement patients experience significant pain relief. But that remaining 5% – and others who develop new pain patterns – often deal with buttock discomfort that needs proper diagnosis and treatment.

Quick Answer

Common causes of buttock pain after hip replacement:

• Gluteal tendon problems (inflammation or tears)

• Sciatic nerve irritation during the procedure

• Muscle healing and scar tissue formation

• Referred pain from your lower back or SI joint

• Less common: implant issues or infection

What is normal pain after hip replacement surgery? Mild buttock soreness for 2-3 months is typical as muscles heal. Sharp, worsening, or persistent pain beyond 3 months needs investigation.

Why Your Buttocks Hurt After Hip Surgery

The hip and buttocks share a complicated relationship. Your gluteal muscles (the maximus, medius and minimus) wrap around the hip joint and protect it. When a surgeon operates on your hip, these muscles and their tendons can be affected, even with the most careful surgical technique.

Gluteal Tendon Issues

This is the most common cause behind buttock pain after hip replacement. Your gluteal tendons attach muscle to bone at the top of your thigh. During surgery, , these tendons can be stretched or irritated. Most patients already have worn tendons before surgery (gluteal tendinopathy), and these can take time to heal and strengthen after joint reconstruction.

Research shows that patients with pre-existing gluteal tendon damage visible on MRI scans before surgery tend to have worse outcomes, more pain and lower satisfaction after hip replacement. The tendon issue doesn't magically fix itself just because the hip joint is replaced, however some of these concerns do improve over time.

You'll typically feel this pain on the side of your hip or deep in your buttock, especially when lying on that side or climbing stairs.

Nerve Irritation

The lateral femoral cutaneous nerve nerve runs directly through the surgical field in anterior hip replacement surgery. During surgery, especially with an anterior approach hip replacement, the nerve can be stretched or develop scar tissue around it, causing numbness or thigh pain after hip replacement, in up to 30% of patients. It might feel like burning, tingling or sharp jabs rather than a dull ache. The risk of nerve injury and chronic thigh pain is drastically reduced utilising the posterior approach to hip replacement  . 

The good news? Most nerve irritation resolves within a few months as inflammation subsides and tissues heal. Severe or worsening nerve symptoms require prompt assessment to rule out compression that may necessitate treatment.

Muscle Healing and Scar Tissue

Surgery disrupts soft tissues. Your body responds with inflammation and the formation of scar tissue as part of the normal healing process. This can cause temporary buttock pain and stiffness, particularly in the first 8-12 weeks.

For patients at 8 weeks post hip replacement, aches and pains are common in the buttock region as muscles rebuild strength and scar tissue matures. This typically improves with physiotherapy and gentle movement.

However, excessive scar tissue can trap the sciatic nerve or pull on the gluteal tendons, leading to persistent discomfort that may require physiotherapy or, in very rare  cases, surgical release.

Pain That's Not Actually From Your Hip

Here's where it gets tricky: your buttock pain might have nothing to do with your new hip. Lower back problems (like disc bulges or spinal stenosis) and sacroiliac joint dysfunction both cause buttock pain. Research indicates that about 71% of patients report buttock pain and 22% have pain radiating below the knee after hip surgery – some of this is referred pain from other structures.

When Should You Worry?

Some buttock discomfort is expected. But certain signs warrant immediate attention:

• Severe pain that's getting worse, not better

• Fever, chills or wound drainage (possible infection)

• Sudden sharp pain with a popping sensation (possible dislocation)

• Weakness in your leg or foot drop

• Numbness spreading down your leg

• Pain that prevents you from sleeping or doing basic activities

For the question "why is my hip replacement hurting after 5 years": Pain that develops years after surgery could indicate implant wear, loosening, infection or an unrelated problem like tendon degeneration. This isn't normal and needs investigation with imaging and possibly blood tests.

Learn more about the expected timeline for hip recovery and the lifespan of hip implants.

How to Address Buttock Pain After Hip Replacement

Treatment depends on the underlying cause, but most buttock pain responds well to conservative management.

Physiotherapy is the foundation of treatment. A skilled physio can strengthen your gluteal muscles, release tight areas and improve your walking pattern. If you've developed muscle imbalances or poor movement habits during recovery, these need to be corrected.

Advanced treatments, such as platelet-rich plasma (PRP) therapy, can help heal damaged gluteal tendons by stimulating your body's natural repair processes. For severe tendon tears, surgical reconstruction might be necessary.

For comprehensive guidance on recovery, read our tips for smoother recovery.

The Bottom Line? Trust Your Gut

Buttock pain after a partial or total hip replacement in Melbourne is common and usually treatable. Most cases stem from gluteal tendon issues, muscle healing or nerve irritation - all of which improve with time and appropriate treatment.

The key is accurate diagnosis. Don't assume all post-surgical pain is "normal." If something doesn't feel right, speak up. Your surgical team would rather investigate early than deal with a chronic problem later.
With proper management and an expert Melbourne hip surgeon like Dr. David Sime, most patients return to comfortable, pain-free movement within a few months.

FAQs – Causes of Buttock Pain After Hip Replacement

What are the main causes of buttock pain after hip replacement?

The most common causes are gluteal tendon damage or inflammation, sciatic nerve irritation during surgery, normal muscle healing and scar tissue formation, and referred pain from the lower back or SI joint. Less commonly, implant issues or infection can cause buttock pain.

What is normal pain after hip replacement surgery?

Mild to moderate buttock soreness that gradually improves over 8-12 weeks is normal. Pain should respond to rest, ice and prescribed medication, and you should see noticeable improvement week by week. Severe pain, pain that worsens, or pain lasting beyond 3 months needs medical review.

Why is my hip replacement hurting after 5 years?

Pain developing years after surgery isn't normal recovery. Possible causes include implant loosening or wear, late-developing infection, gluteal tendon degeneration, or new problems unrelated to the replacement (like arthritis in the spine or SI joint). This requires thorough investigation with imaging and potentially blood tests.

Is buttock pain at 8 weeks post-hip replacement normal?

Yes, 8 weeks post hip replacement, aches and pains in the buttocks are common as muscles continue healing and building strength. However, the pain should be gradually improving, not worsening. 

If pain is severe, interfering with sleep, or not responding to physiotherapy and medication, it needs assessment.