What sports can I do after a hip replacement? Lets look at what surgeons know about Hip Replacements and Athletic Activities

Total Hip Replacement surgery is great for allowing people to return to their daily activities.  

But what about activities beyond grocery shopping, visiting friends and family and going for walks.  

Baby booms remain extremely active even into their 70s and 80s.  Many see athletic activities to be an essential part of their happiness.  Playing golf, swimming, and hiking are just a few activities that people want to return to after having a hip replacement.  

But how active can a person be after a hip replacement without risking the stability of the hip replacement?  Most people want to know the risk of various activities they want to do.  In general, low impact activities are recommended because the strengthen the muscles and bone around the hip replacement and allow patients to lead healthier lives.  However, doctors are concerned about people with a hip replacement playing high impact activities such as basketball, soccer, football and jogging.  As more and more younger people are getting hip replacements, these activity restrictions are becoming more important for doctors to explain to patients before surgery.  

Lets look at a few activities to see the specifics.

GOLF.  About 1-8% of people that get a hip replacement actively play golf.  In areas like Florida and Arizona this number is probably even higher.  Golf is considered a low impact sport on the hips and is therefore allowed after hip replacement by 99% of orthopedic surgeons. To date, there are no published reports of a hip replacement breaking (ie the hip dislocates or the prosthesis becomes loose) during golf.  X-rays of a swing in people with and without a hip replacement show very similar motion within the hip (which is great, because it means that your handicap won't change too much).

It is important to note however, that golf is a more demanding sport than many people give it credit for. The golf swing places a high torque on the lower back and hip, and some doctors remain concerned that this repetitive force, over many years, could lead to the hip replacement wearing out prematurely.  

A recent study looked at x-rays of people with hip replacements while swinging their golf club.  During a normal golf swing (these people had time to warm up, and had no complaints of pain while swing the club), over 1/3 showed signs that the ball and socket of the hip replacement were improperly bumping into each other (this is called impingement).  This has some orthopedic surgeons concerned that this could lead to premature wearing out of the replacement or it could cause a hip dislocation, although there is no evidence to date that suggests this minor bumping during activities is significant.  The impingement was seen in people where the socket was positioned in more anteversion, and the people had a swing that produced more hip external rotation.

TENNIS. High impact and therefore generally discouraged by orthopedic surgeons. Studies on hip and knee replacement in people that played competitive tennis showed significant improvement in pain relief and court mobility after the joint replacement.  So a hip or knee replacement will let you get back to playing tennis, however, there is the concern that a fall could cause significant damage to the affected joint or overuse could lead to premature failure of the joint replacement.

References.  

1. Healy WL et al.  Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90(10):2245-2252. see full article.

2. Ollivier M et al.  Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement. Bone Joint J. 2014;96(8):1041-1046. see full article.

3. Swanson EA et al. Activity recommendations after total hip and knee arthroplasty. J Arthroplasty. 2009;24(6):120-126.3. see full article. 

4. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75(2):228-232. see full article. 

5. Hara, D. et al. Dynamic Hip Kinematics During the Golf Swing After Total Hip Arthroplasty. AJSM 2016 44 1801-1809. see full article. 

6. Marchetti E et al. Component impingement in total hip arthroplasty: frequency and risk factors. A continuous retrieval analysis series of 416 cup. Orthop Traumatol Surg Res. 2011;97(2):127-133. full article. showed that in 311 cup retrevels, there was >50% that showed some contact but only 5/311 showed significant damage from impingement suggesting that some degree of contact is normal with daily living.

7. Hassim SS, Douglas SL, Haddad FS. Athletic activity after lower limb arthroplasty: a systematic review of current evidence. Bone Join J. 2014; Jul: 96-B(7): 923-27. see full article.

8. Mont MA, LaPorte DM, Mullick T, Silberstein CE, Hungerford DS. Tennis after total hip arthroplasty. Am J Sports Med. 1999;27:60-4. full article. 

9. Mont MA, Rajadhyaksha AD, Marxen JL, Silberstein CE, Hungerford DS. Tennis after total knee arthroplasty. Am J Sports Med. 2002. full article. 

10. McGrory BJ, Stuart MJ, Sim FH. Participation in sports after hip and knee arthroplasty: review of literature and survey of surgeon preferences. Mayo Clin Proc. 1995;70:342-8. 45. full article.

11. Healy WL, Iorio R, Lemos MJ. Athletic activity after joint replacement. Am J Sports Med. 2001;29:377-88. full article.

12. Mallon WJ, Callaghan JJ. Total hip arthroplasty in active golfers. J Arthroplasty. 1992;7 Suppl:339-46. 42. full article. 

13. Mallon WJ, Callaghan JJ. Total knee arthroplasty in active golfers. J Arthroplasty. 1993;8:299-306. full article.