Hip replacement warning signs are the handful of symptoms I never want a patient to wait out. The phone call I get most often after a hip replacement is a fever of 99.5, and it is almost never a problem. The symptom that worries me is the one patients try to tough out for a week or longer, when I needed to hear about it the same day.
After more than twenty years and 700+ hip and knee replacements a year, I can tell you which calls turn out to be nothing and which calls I am glad came in. This article is the difference.
Which pain after hip replacement is normal?
Most pain in the first weeks after hip replacement is normal. Healing is sore, and soreness has a schedule: a rough first few days, a small bump around days three to five, then gradual improvement week over week. I walk through that timeline in my article on how painful hip replacement surgery is.
You might think any pain after surgery means something is wrong. It does not. What matters is whether the pain is controllable and whether it lets you do your walking.
Pain you cannot control, or pain that stops your recovery, gets evaluated. Full stop.
Why does the side of my hip hurt after an anterior hip replacement?
Side-of-hip pain after an anterior hip replacement is usually swollen, irritated muscle, and it is the pain that fools almost everyone. I do nearly all of my hip replacements through the front, using the anterior approach. The incision sits about where your front pocket would be, so patients expect front soreness. Then the outside of the hip starts aching, nowhere near the incision, and the worry starts.
Some people call it bursitis (irritation of the small fluid-filled cushion over the bone). In practice it is swelling in muscles you did not know were involved. It can flare when you sleep on that side, which I allow right away; the position is safe, the muscle is just sore. More on that in sleep after hip replacement.
That side soreness is normal unless it is uncontrollable or interfering with your recovery. Then it gets looked at.
What are the six hip replacement warning signs that mean you should call?
The six hip replacement warning signs are a fever over 101.5 or a sustained fever over 100.4; redness that spreads, darkens, or hurts with light touch; drainage that soaks the dressing; calf pain and swelling that elevation does not fix; a sudden change in your leg; and pain that trends worse after it had been improving. Any one of them means pick up the phone. Here is what I tell my patients about each.
Sign 1: What fever after hip replacement means you should call?
A fever over 101.5, or a temperature over 100.4 that keeps coming back, means call. A low-grade fever early on is very common after surgery. Your body is revved up, healing a wound around the clock, and that work can nudge your temperature up.
A 99.5 is the body doing its job. A 101.5, or a temperature over 100 that keeps returning, is a different conversation completely. I want that call.
Sign 2: Is redness around the hip incision normal?
Some pinkness around the incision is normal; redness that expands day over day, turns dark, or hurts with a light touch is not. Pinkness comes and goes with swelling, and even the ice you use on the skin can make it red for a while.
What I care about is the change. Mark the edge of the redness with a pen if you need to. If it spreads past the line, darkens, or hurts when the bedsheet brushes it, call.
Sign 3: What if drainage soaks the dressing?
Significant blood or drainage of any color that soaks through the dressing needs to be seen in person the same day. You will likely go home with a waterproof bandage, and you probably will not see the incision itself for about two weeks. Your job is the bandage.
A little staining early can happen. Soaking through is different, and I want to look at it myself.
Sign 4: When is calf pain and swelling a blood clot warning sign?
Deep calf pain with swelling into the calf, foot, or ankle that does not improve with elevation, and keeps getting worse, is a blood clot warning sign. Blood clots are the reason you go home on a blood thinner. For most of my patients that is just aspirin; some need a stronger anticoagulant (a prescription blood thinner) based on their risk.
Here is the test I give patients. Swelling that improves when you put your leg up is probably gravity and normal after surgery. Swelling that ignores elevation is a phone call.
Sign 5: What does a sudden change in your leg mean?
A sudden inability to bear weight, or a leg that is suddenly a different length than it was that morning, means something mechanical has changed. That can mean a fracture around the hip or a dislocation (the ball coming out of the socket). Call right away.
I will be straight with you. A dislocation is not subtle. It is profoundly painful, and it is usually not a call-the-office situation; it is a call for an ambulance. It is rare, but you should know it exists.
Sign 6: Why does the trend matter more than any single day?
Pain that gets progressively worse over several days, after it had been improving, is a warning sign even when nothing else is wrong. This is the quiet one, and it may matter most. Recovery should improve week over week, not necessarily every single day.
Sore muscles can spasm. It is fine to try the simple things first: rest, ice, gentle stretching. Give it a day. But a trend heading the wrong direction is not a toughness test. It is a sign to call.
What is the most common false alarm after hip replacement?
The most common false alarm is the 99.5 fever. I get that call every week, and somewhere in it the patient usually confides, “I typically run low.” I understand the worry. But that low-grade temperature is the post-operative period: a charged-up body trying to heal.
Here is the thing. I would rather get that call than not get it.
Should I compare my recovery to other patients?
No. Measure yourself against your own last week, not against someone else’s recovery. I have patients a month out taking nothing but acetaminophen (Tylenol), and I celebrate with them. But that is not your assignment.
If you are a month out and need more than Tylenol, that can be completely normal. Every hip walks in with its own history.
What is the one rule that beats the whole list of hip replacement warning signs?
If you are concerned, I am concerned. That is the whole policy. I would rather you call too often than have us miss something important, and I would much rather tell you everything is okay than find an infection or a problem with the parts later, when we could have stepped in earlier.
You will never bother us by calling. Keep the list, watch the trend, and use the phone.
Where can patients in Franklin, Nashville, and Columbia get evaluated?
My patients are seen at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067, minutes from Nashville and Brentwood off Interstate 65 and a short drive from Columbia and Spring Hill. If you are my patient and notice one of these hip replacement warning signs, call (615) 791-2630. If you cannot bear weight or your leg has suddenly changed, call 911.
If you are still deciding on surgery, the free Hip Replacement Recovery Guide walks through the whole timeline, and you can schedule a consultation online. Patients from across Middle Tennessee see me for total hip replacement, and every one of them leaves with this list.
Watch: Is your hip healing correctly? The 6 signs it’s time to call
Prefer to hear it from me directly? In this video I walk through the side-of-hip pain that fools almost everyone, each of the six hip replacement warning signs, the most common false alarm, and the one rule that beats the whole list.
Want Dr. Calendine’s articles to stand out in your Google and AI search results? Add him as a preferred source (one tap).
This article is for educational purposes only and does not replace the instructions you received from your own surgeon. If you have had hip replacement surgery and are worried about a symptom, call your surgeon’s office. For a medical emergency, call 911. Individual recovery varies; the thresholds above reflect Dr. Calendine’s orthopaedic practice and may differ from your surgeon’s instructions.
References
- Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med. 2018;378(8):699-707. doi.org/10.1056/NEJMoa1712746
- Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet. 2016;387(10016):386-394. doi.org/10.1016/S0140-6736(14)61798-0
- Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309-1314.e2. doi.org/10.1016/j.arth.2018.02.078
- Kunutsor SK, Barrett MC, Beswick AD, et al. Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements. Lancet Rheumatol. 2019;1(2):e111-e121. doi.org/10.1016/S2665-9913(19)30045-1
