Sports and Total Hip Surgery

Can I continue with Sports after total hip surgery?

“Many of us young people have been told that a total hip surgery is the end of life as we know it. Well, if your life has been pain and disability as mine, it is! And what is wrong with that?

This last Monday, I had my follow-up visit with the surgeon and get a clean bill of health for my new total hip. I can now drive and I don’t have to keep a pillow between my legs when in bed. I know that there are lots of sports I can never be able to do again. But I for one enjoy every moment of my new life without pain. And I already started hitting golf balls and soon I will be playing tennis again. “

The question as whether you should participate in sports after total hip replacement is up to you. Ask always your surgeon and his staff to discuss with you the benefits and the risks of resuming sports after total hip surgery.

• The most important risk is the wear of the new joint surface by increased use,
• risk of a dislocation of the ball component or fracture through the skeleton around the new hip with fall
• and risk of earlier loosening of the implant by more stresses laid on the total hip.

This last risk is somehow controversial. Much will depend on your previous experience, training, and physical condition after your total hip surgery.
The reports about failures of total hip prostheses in more active patients are controversial. Some studies maintain that the deleterious effect of the increased sports activity on total hip prosthesis will be apparent first 10+ years after the surgery, (Kilgus, 1991), other studies maintain that the athletically active patients have had less failures of their total hips than the inactive patients.

Several studies showed that patients who resumed their athletic activity after total hip replacement experienced improved fitness of their heart and lung system.

Individual sports

Skiing: cross country skiing and downhill skiing on flat slopes load your new total hip with about 4 times your body weight, slightly less than speedy walking. Downhill skiing on steep hills overloads your new hip with up to 8 times your body weight. One X-ray study revealed that skiers had twice as great wear of their polyethylene cups compared with non-skiers, but only half so many prosthetic failures than their less active co-patients.

Golf: most surgeons do not discourage their patients to play golf. Studies showed that total hip patients- golfers played golf at least 3 times a week, improved their handicap after the total hip surgery with 1,1 strokes and their drive length with 3 meters. All these patients noted mild hip ache after playing. One short term study showed that non-cemented total hips have had less signs of wear on X-rays than cemented total hips. Use golf carts!

Tennis: One study showed that among the competitive tennis players with total hip replacement, only 14 % of them have had approval from their surgeon. Some of these patients also reported that return to active tennis was the main reason for their total hip surgery. The prosthesis failure rate among these patients was 8 %. Single tennis is usually considered a high impact sport which puts much load on the new hip joint. Surgeons usually do not recommend it.

Typical conclusion of one paper on this issue sounds like this:

“Until future studies are performed, the authors would recommend that physicians advise caution in tennis activities…” (Mont 1999)

Recommendations of the Hip Society

as to suitable and non-suitable sports for patients with total hip replacement are compiled in the Table. Some of the sports are recommended only to experienced patients (*). It is important to realize that you have good chance to return to the sports you practiced already before the surgery. It is, however, very improbable that after total hip replacement you will learn and practice successfully new sports (Healy 2001)

No conclusion was reached among the members of The Hip Society as to the following sports:

References:

• Healy W et al. Am J Sports Med 2001;29: 377-88.
• Kilgus: Clin Orthop, 1991; 269: 25-31
• Mont MA et al.: Am J Sports Med 1999;27: 60-4