Sport after Total Hip Replacement

In the past there have been concerns that being too active after a hip replacement may lead to early wear and failure or loosening of the replacement. In general surgeons had been rather cautious about recommending sports activity following a hip replacement. There does now seem to be a change in thought about this particularly now what we are seeing implants lasting for a much longer period of time than they used to.

At a number of recent meetings there has been quite a lot of discussion as to what sort of exercise activity surgeons are happy for their patients to get back to and there has clearly been a change in attitude around this. The benefits of sport and exercise for mental and physical health are well recognised and it is important that hip replacement surgery returns patients to an active life where they need not feel they have to restrict what they do.

Clearly the younger the individual the more likely they are to want to engage in higher levels of activity. Young patients who come to need hip replacement surgery usually do so as a result of an abnormal shape or development of the hip joint which then leads to early wear of the cartilage surface of the joint. Some of these deformities are felt to arise as a result of high levels of impact sport during adolescence when the hip is completing it’s development. Such individuals have often become very accustomed to life engaging in high levels of sports activity and for this to end after failure of the hip joint can have a major detrimental effect on quality of life and mental health.

My view is that the focus needs to be to return patients to the sports that they wish to do. There is little evidence currently that higher levels of activity result in earlier wearing out of the hip replacement. My own preference is to use a ceramic on ceramic bearing surface and this seems to withstand the high stresses for a long time and even after 20-25 years we are not seeing any detrimental effect to the hip joint. In many respects, an important aspect to protect the hip and the implant over the longterm is to maximise the strength of the bone around the replacement and this is where impact is a good thing as the bone strength responds positively to this. The ageing process itself tends to weaken bone and ultimately maybe a greater threat to the longevity of the replacement than using it vigorously.

A strong message for patients is that they need not feel that a hip replacement means the end of their days of high level activity.