Is It Your Hip or Your Knee? The Hidden Connection and How to Fix the Problem
I see many patients who come in with knee pain, assuming arthritis or another knee issue is to blame. But sometimes, the real problem isn’t the knee at all—it’s the hip.
Just like a heart attack can cause pain that radiates down the arm, hip problems can send pain down to the knee. In fact, I’ve seen a handful of patients with debilitating knee pain (and no pain in the hip), only to discover that the pain was coming from their hip all along.
In those cases, simple hip treatments—like injections or hip replacement—completely relieved their knee pain, without ever needing knee surgery. This phenomenon is well-documented in orthopedics and happens because the hip and knee share nerve pathways, particularly through the obturator nerve, which supplies sensation to both joints. This nerve crosstalk can cause pain from the hip to be felt in the knee, making it easy to misdiagnose the true source of pain.
So if you’re dealing with knee pain—or hip pain—how do you know which joint is really causing the problem? And if you need joint replacement, which one should come first? Let’s break it down.
How Hip and Knee Arthritis Affect Each Other
The hip and knee work as a team. When one joint starts breaking down, the other often suffers. Here’s why:
- Altered Walking Mechanics: If your hip is stiff or painful, you’ll compensate by changing how you walk, which puts extra stress on the knee.
- Referred Pain from the Hip: Hip pain often masquerades as knee pain due to shared nerve pathways.
- Muscle Imbalances: Weakness in the hip muscles can cause instability in the knee, increasing strain and accelerating joint wear.
- Alignment Issues: Hip arthritis can subtly change leg alignment, affecting knee mechanics and worsening knee arthritis.
Which Joint Should Be Replaced First?
If both your hip and knee have arthritis and you’re considering joint replacement, the order matters. In most cases, hip replacement should be done first. Here’s why:
- Hip Pain Can Disguise Itself as Knee Pain: If your knee pain is actually referred pain from the hip, replacing the hip may completely eliminate knee pain—potentially avoiding knee surgery altogether.
- The Hip Controls Leg Alignment and Stability: The hip plays a key role in posture and movement. If you replace the knee first while the hip is still arthritic, it may throw off your gait and put extra stress on the new knee implant.
- Easier and More Effective Knee Recovery: A strong, stable hip is crucial for knee rehabilitation. If the hip is still painful or stiff, knee recovery can be significantly harder.
Self-Check: Is Your Knee Pain Really a Hip Problem?
Not sure if your knee pain is really coming from your knee? Try this:
- Does your knee hurt more when you twist your hip?
- Is your knee pain worse when you’ve been sitting for a while but improves after moving?
- Have treatments for knee arthritis (like injections) failed to provide relief?
If you answered yes to any of these, your hip might be the true culprit. A proper evaluation can help pinpoint the real source of your pain.
Next Steps: Get an Expert Evaluation
You don’t have to keep guessing what’s causing your pain. Let’s get to the root of the problem and create a plan to get you moving again—without unnecessary procedures.