If You Need a Hip Replacement, Get Your Low Back Fixed First!

low back and hip pain

It’s always great to see enlightened physicians tying together how one part of the body impacts the other. We’ve done a great disservice to patients by educating them that their knee, hip, and spine are separate instead of all one big machine. Now a recent study shows us yet another connection between the low back and hip replacement complications.

First, when I tell patients that problems in their hip or knee or ankle may have originated in their low back, they look at me like I just told them that there’s an alien living inside them. The idea that their body is one connected machine is that foreign. How did we get here and what evidence is there that different parts of the system impact each other?

It’s All Connected

We’ve done a great disservice to patients by orthopedic hyper-specialization. The messaging to patients has been that since there are hip specialists and a spine experts, then the hip and the spine are two different machines. Yet, in fact, the literature continues to show that the spine and leg are one machine designed to transfer force. While that machine has specialized areas called the hip and the spine, they are intimately interconnected.

Research supports these hip and knee connections. For example, one study found that in female runners with kneecap pain, the stress on the knee was caused by weak gluteal muscles that weren’t contracting appropriately to keep the hip in proper position. Another recent investigation demonstrated that the position of the femur, which is controlled at the hip, could lead to poor tracking of the kneecap, which can lead to arthritis and cartilage injuries.

Taking this a step further, the hip and knee and even the ankle and foot are all supplied and controlled by spinal nerves in your low back.

Low Back and Hip Replacement: The New Research

The latest study on this topic looked the connection between low back and hip replacement by looking at patients who had various low back conditions at the time of their hip replacement surgery. This spanned everything from a herniated disc to degenerative disc disease with arthritis. Interestingly, in patients with a low back diagnosis, they were up to twice as likely to experience complications from a total hip replacement surgery. In this case that the device would dislocate. This makes sense as abnormal motion in the low back likely places abnormal pressure on the new hip device. In addition, other complications were more likely and these included the need for revision surgery, fracture around the new device, and infection.

The upshot? If you need a hip replacement, make sure you get your back fixed before surgery! This can often be accomplished without the need for back surgery. In addition, all the parts of your body are connected, so don’t believe for a second that what happens in your hips isn’t impacted by what happens in your back!

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Read 18 Comments
  1. This sounds interesting. I have an absolutely terrible left hip that is so full of arthritis my doctor said I can’t wait much longer before it might fuse together. I had the left knee replaced a few years ago and I have stenosis that is pretty bad at the L4 and L5 per my great spine doctor Larry Tice in Fruita, CO. I am a 72+ year old Vietnam Veteran and the VA has been very good to me these past 15 years, but they are very slow and have too many patients so you don’t get any really super, personal follow-up but I have a terrific Ortho Doctor in Dr. Patrick Sillix who did my left knee. The Laser Spine Institute in Scottsdale, AZ has looked at my MRI the VA sent to them and says they can help me but I have to use Medicare and then pay the balance which there is no way I can do right now. Anyway, this is the first time I have seen someone say do the back first. There are LOTS of opinions out there!! Dr. Sillix wanted to hear from the SI first to see what they thought, but they did not commit to which should be done first, but seemed to intimate the back first. Thanks for your information and Semper Fi

    1. Robert,
      It can, in that a sore knee often changes your gait which can cause biomechanical changes which impact your back. But the often overlooked issue is low back nerve irritation without back symptoms, which causes knee or hip problems.

  2. I have both lower Back pain and am in need of a hip replacement. I did send my MRI into the Boneti spine Institute for review. How can I find more info about Regenexx?
    Thanks!
    Robin

  3. Yes, I am glad that the medical field is finally realizing the facts stated in this article. I don’t understand why this is such a shocking discovery to people. I have lower back issues including the disc on L1 is completely nonexistent. Bulging discs all the way up and down my spine with problems that causes the Big nerve in the back to be inflamed keeping my hips, legs, knees and feet in pain. Doctors have already told me I’m a candidate for hip and knee replacements. When I tried to get my back fixed first the insurance companies refused to approve the procedure and doctors all thought I was crazy. Still looking for my miracle because I refuse to be cut on but I was much more prone to agree to the new laser surgery until I heard about regeneration techniques using an individual’s own healthy stem cells.

  4. I have a torn meniscus / confirmed MRI and need whatever information yo might have regarding how to get my knee back to the condition it once was in.

    1. Daniel,
      The most important thing is to avoid meniscus surgery and steroid shots! Please see: https://www.regenexx.com/the-end-meniscus-surgery/ and https://www.regenexx.com/steroid-injection-risks/ Here is how we treat Meniscus tears: https://www.regenexx.com/meniscus-tears/ But there is alot of other valuable knee information here, including a free download of the Knee Owner’s Manual: https://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/ If you’d like to see if you’d be a candidate for Regenexx Procedure, please submit the candidate form.

  5. This is very interesting. I have had knee pain for quite a while… have had cortisone and synvix in the past with little more than short-term relief. Have had prp and uflexxa at Greenwhich with no relief. Recently tried synvix again with no relief.
    The knees are mostly arthritis. My really annoying problem is pain in shins and calves, mostly during night, sometimes as soon as I lie down and other times starting later. Motrin may help but not always. Pillow under legs, same story.
    Do you think the leg pain could be from spine? I generally have no back problems except for an occasional low-back pain that does not last.
    Incidentally, I walk about 45-60 minutes a day and most days do not have a problem. Getting up from sitting is difficult, mostly due to stiffness, and going downstairs is painful.

    1. Barbara,
      It’s certainly possible. The S1 nerve in your low back supplies your calf muscle. Please see: https://www.regenexx.com/calf-muscle-tear/ Importantly, Steroid shots escalate the problem and Motrin can make arthritis worse. Please see: https://www.regenexx.com/can-nsaids-make-arthritis-worse/ and https://www.regenexx.com/steroid-injection-risks/ If you’d like to see if you’d be a Candidate for a Regenexx procedure and speak to one of our Physicians about your particular case, please submit the Candidate form

  6. 5 years ago a spine specialist told me that there is nothing they can do to ‘fix’ my degenerative disc disease. I am now scheduled for a hip replacement- the hip is bone on bone and affecting my ability to walk without a limp – which is now effecting my knee & ankle. I am an active person able to do yoga, pilates, water aerobics etc. to maintain overall health. I eat a healthy mostly Paleo diet. So I am curious how I can ‘fix’ my spine? My orthopedic actually recommended the opposite. He feels that my low back symptoms will subside with a new hip. The research does seem to indicate a higher likelihood for hip dislocation with spinal degeneration – I appreciate the heads up. By the way I underwent stem cell therapy for both hips and my lumbar spine last October – less than stellar results. Hence the now scheduled hip replacement.

    1. Judy,
      Spine specialists and Orthopedic Doctors generally have very little understanding of Regenerative medicine,as it is a totally different paradigm. Who treated your hips and lumbar spine?

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