Knee is finally behaving but now my HIP and lower back ache every evening. Did fixing one joint set another one off?

Nine months out from my second knee and the knees themselves are the least of my problems, which I never thought I'd type. What's got me now is the hip on the side of the first surgery and a band across my lower back that shows up around six in the evening, every single day, worse if I've been on my feet.

Here's what's bugging me. I did not have hip pain before any of this. I had bad knees and a back that behaved. Now I've got two decent knees and a hip that grumbles and a back that seizes up while I'm making supper. It feels like I traded one problem for another, or like something's off in how I'm standing now. I've also got a feeling the operated leg is LONGER, which my husband says is nonsense but I swear I can feel it walking on the sidewalk.

Anyone else find that sorting the knees moved the pain somewhere else? And is this something to bring to the surgeon or to a physical therapist or to my regular doctor, because I genuinely don't know whose department this is.

Not the hip for me, but yes to the back. Around month four I started getting a low back ache in the evenings that I'd never had. My PT said it was because I'd spent about three years walking like a woman protecting a sore knee and my back had built its own way of doing things around that, and now the knee was fine but the habit wasn't. Six weeks of hip and core work and it settled a lot. Not gone, but I stopped noticing it most days.

The longer leg feeling: I had exactly that and it drove me batty for about five months. Mine turned out to be nothing measurable at all. The PT put me against a wall with a tape measure and blocks and the legs were the same, and what I was feeling was the operated knee finally being able to straighten out properly after years of never quite going flat. A straight leg genuinely feels longer than a bent one.

Doesn't mean yours is the same, but it might spare you a few nights of worrying.

pattyo64 said:

It feels like I traded one problem for another, or like something's off in how I'm standing now.

New hip or low back pain in the year after a knee replacement is common enough that it has a straightforward explanation in most cases, and it is usually not a sign that the implant is wrong. Before surgery, a painful knee changes everything above it: you walk with a slightly bent, stiff knee, your stride shortens, you push off less on that side, and the hip abductors (the gluteal muscles on the outer hip that keep your pelvis level) do less work and weaken. After surgery the knee straightens, your stride lengthens, and you suddenly ask a deconditioned hip and a back that has been compensating for years to work in a new alignment. The tissue that complains is usually the one that has been idle, and evening pain that builds with time on your feet is the classic pattern for muscular and postural fatigue rather than for a problem with the joint itself.

The perceived leg length difference is worth taking seriously without assuming the worst. Carol has described the most common cause precisely: a knee held in a few degrees of flexion for years feels short, and restoring full extension makes that leg feel longer, even when measured lengths are identical. There can also be a genuine small change in limb length after replacement, and pelvic tilt from tight or weak muscles produces the same sensation. It is measurable, and measuring it is the first step rather than guessing.

Two things earn a prompt call rather than a wait. Hip or thigh pain that is severe, night-time, or clearly worsening rather than fatigue-related, and any back pain with numbness, weakness, or changes in bladder or bowel function. Also, hip osteoarthritis genuinely can coexist and can announce itself once the knee stops shouting louder; groin pain and pain putting on socks and shoes are more typical of hip arthritis than of the muscular pattern above, and our note on telling hip and knee arthritis apart covers the distinction.

On whose department this is: a physical therapist assessing your gait, hip strength, and leg length is a very reasonable first stop, and your surgeon's team should know about it at your next review either way. Which of them you see first is a decision for you and the clinician who knows your history, and the answer often depends on how quickly you can be seen.

Adding one small practical thing that helped my evening back more than any exercise did: I stopped standing still at the counter. Chopping, dishes, the stove, all of it done standing dead still for forty minutes. A low stool to put one foot up on, alternating, and a stool to actually sit on for the chopping. Sounds like nothing. It cut my evening ache in half.

The exercises did the rest, but the standing habit was the free part.

Partial update. Saw a PT, who measured my legs three ways and told me they're within a whisker of each other, so Carol was right and my husband was right, which I'll never hear the end of. Outer hip on that side is genuinely weak though, she showed me on a single leg test that I couldn't hold the position for anything.

Doing the hip work now, four weeks in, and the hip is noticeably better in the evenings. The back is not, really. Still there at six o'clock, still worse on days I'm on my feet, and Sue's stool trick helps more than anything else has. PT says give it another couple of months and if the back hasn't moved she wants my regular doctor to have a look at it rather than us assuming it's all gait.

So: hip explained, back not explained. I'll take one out of two for now.