{"id":4989,"date":"2025-12-03T08:54:06","date_gmt":"2025-12-03T08:54:06","guid":{"rendered":"https:\/\/www.chirurgiedelahanche.com\/blog\/douleurs-trochanteriennes-apres-prothese-de-hanche\/"},"modified":"2025-12-03T09:12:22","modified_gmt":"2025-12-03T09:12:22","slug":"trochanteric-pain-after-total-hip-replacement","status":"publish","type":"post","link":"https:\/\/www.chirurgiedelahanche.com\/en\/blog\/hip-surgery\/trochanteric-pain-after-total-hip-replacement\/","title":{"rendered":"Trochanteric pain after total hip replacement"},"content":{"rendered":"<p><img decoding=\"async\" class=\"aligncenter wp-image-4991 size-full\" src=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-scaled.jpg\" alt=\"Trochanteric pain\n\" width=\"2560\" height=\"1977\" srcset=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-scaled.jpg 2560w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-300x232.jpg 300w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-1024x791.jpg 1024w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-768x593.jpg 768w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-1536x1186.jpg 1536w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-2048x1581.jpg 2048w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/cover-trochanteric-pain-after-total-hip-replacement-inside-the-hip-300x232@2x.jpg 600w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/p>\n<h2>What is the trochanteric region ?<\/h2>\n<p>The trochanteric region is the prominent area on the lateral side of the hip, slightly below the pelvis and toward the upper thigh. It corresponds to the <strong>greater trochanter<\/strong>, where the gluteal tendons insert &#8211; particularly the <strong>gluteus medius<\/strong>, one of the most important tendons of the hip. This muscle stabilizes the pelvis during single-leg stance and walking.<\/p>\n<p>A bursa lies over the greater trochanter, normally painless.<\/p>\n<h2>Common causes of trochanteric pain after hip replacement<\/h2>\n<p>A frequent cause of post-replacement trochanteric pain is <strong>gluteus medius tendinopathy<\/strong>, sometimes associated with <strong>trochanteric bursitis<\/strong>. Gluteus medius tendinopathy commonly affects women over 60, especially in cases of excess weight. Tendon degeneration may already exist before the hip replacement and persist after surgery.<\/p>\n<p>Diagnosis relies on <strong>ultrasound<\/strong>, which shows tendon insertion changes on the bone, sometimes associated with inflammation of the trochanteric bursa. Treatment includes structured <strong>physiotherapy<\/strong> and possibly <strong>ultrasound-guided corticosteroid injections<\/strong>. In some cases, <strong>surgical tendon repair<\/strong> may be considered.<\/p>\n<h2>The influence of the surgical approach<\/h2>\n<p>Some surgeons still use the <strong>transgluteal Hardinge approach <\/strong> to implant total hip prosthesis, which is detrimental because it requires detaching the anterior portion of the gluteal tendons from their bony insertion. These tendons sometimes fail to heal after hip replacement, resulting in <strong>chronic trochanteric pain and limping<\/strong>. Patients may also notice their foot turning outward due to the weakening of the internal rotator muscles cut during surgery.<\/p>\n<p>Diagnosis relies on:<\/p>\n<ul>\n<li>Reviewing the operative report<\/li>\n<li>Clinical examination, locating tenderness near the incision area<\/li>\n<li><strong>Ultrasound<\/strong>, confirming tendon rupture<\/li>\n<li><strong>MRI with metal-artifact-reduction protocol<\/strong>, assessing tendon integrity and muscle degeneration<\/li>\n<\/ul>\n<p>We frequently perform <strong>gluteal tendon repair<\/strong> in patients operated via the transgluteal Hardinge approach.<\/p>\n<h2>Pain related to incorrect muscle tension adjustment<\/h2>\n<p>In some situations, trochanteric pain may result from improper muscle tension adjustment during prosthesis implantation. If the <strong>medio-lateral femoral offset<\/strong> is not properly restored, excessive muscle tension may occur, leading to increased traction forces on the trochanteric region. Patients may notice that the lateral hip area appears wider and that their clothing feels tighter.<\/p>\n<p>Diagnosis relies on:<\/p>\n<ul>\n<li>Clinical examination<\/li>\n<li>Comparison of pre- and postoperative radiographs<\/li>\n<li>Ideally, a <strong>3D CT scan<\/strong> to precisely measure femoral offset<\/li>\n<\/ul>\n<p>When the offset is increased by more than 30%, this can lead to significant painful complications and contribute to an <strong>unhappy hip replacement<\/strong> .<\/p>\n<h2>Trochanteric pain of spinal or neurological origin<\/h2>\n<p>Sometimes the pain does not originate from the hip but is <strong>referred from the lumbar spine<\/strong>, caused by nerve compression or radicular involvement.<\/p>\n<p>In such cases, it is essential to :<\/p>\n<ul>\n<li>Perform a complete neurological examination<\/li>\n<li>Look for sensory-motor deficits<\/li>\n<li>Examine the lumbar spine<\/li>\n<li>Order appropriate imaging (lumbar radiographs, EOS scan, CT or MRI, electromyography)<\/li>\n<\/ul>\n<p>These investigations help rule out neurological conditions that may coexist with hip pain.<\/p>\n<h2>The importance of accurate diagnosis and appropriate imaging<\/h2>\n<p>Trochanteric pain after total hip replacement must always be thoroughly evaluated with targeted imaging studies to precisely determine the cause and recommend the appropriate medical or surgical management.<\/p>\n<h2>How to prevent trochanteric pain ?<\/h2>\n<p>Prevention relies on several essential principles:<\/p>\n<ul>\n<li><strong><strong>Using a direct anterior approach<\/strong><\/strong>, which preserves the gluteal tendons and surrounding musculature<\/li>\n<li><strong>Performing preoperative <\/strong><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/treatments\/custom-made-hip-prosthesis\/3d-scanner\/\"><strong>3D CT planning<\/strong><\/a>, crucial for accurately measuring the hip anatomy and medio-lateral offset<\/li>\n<li><strong>Implanting a custom-made prosthesis<\/strong>, ensuring precise adjustment of muscle balance and avoiding painful tension<\/li>\n<\/ul>\n<p>As part of the preoperative evaluation, it may also be necessary to examine the lumbar spine to avoid overlooking associated neuropathic pain.<\/p>\n<p>In older women, the presence of <strong>gluteus medius tendinopathy<\/strong> combined with osteoarthritis must be identified and treated simultaneously to prevent residual pain after surgery.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>After a <strong><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/treatments\/custom-made-hip-prosthesis\/\"> total hip replacement<\/a><\/strong>, the joint is expected to become mobile, stable, and pain-free within a few weeks or months. However, some patients develop <strong>trochanteric pain<\/strong>, located on the outer side of the hip, which can impair walking and quality of life. At <i> Inside the Hip <\/i> , a highly specialized center in Lyon and Paris, such postoperative pain is assessed rigorously to identify its origin (muscular, mechanical, or neurological) and to propose an appropriate treatment. This type of persistent lateral hip pain is also one of the frequent causes of what is commonly referred to as an <strong>unhappy hip replacement<\/strong>.<\/p>\n","protected":false},"author":35,"featured_media":4993,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[],"class_list":["post-4989","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hip-surgery"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trochanteric pain after total hip replacement | Paris and Lyon | Inside the Hip<\/title>\n<meta name=\"description\" content=\"After total hip replacement, some patients experience a feeling that one leg is longer or shorter than the other. 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