Hip replacement in the athlete: is there a role?


Sport and total hip arthroplasty (THA) have been regarded by many as being mutually exclusive. The primary indication for hip arthroplasty has always been pain. With advances in the technology surrounding hip replacement surgery and increasing patient expectations of what THA can offer, there is a growing demand for hip replacement with the aim of returning to sporting activity. The aim of this review article is to report the advances in hip replacement surgery that aim to make the procedure more suitable for the sporting individual and to summarise the literature on the subject of returning to sports after THA.

Level of evidence V.

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  1. 1.

    Akutagawa S, Kojima T (2005) Trunk rotation torques through the hip joints during the one- and two-handed backhand tennis strokes. J Sports Sci 23:781–793

    PubMed  Article  Google Scholar 

  2. 2.

    Annual Report (2004) Swedish Natioanl Arthroplasty Register. http://jru.orthop.gu.se

  3. 3.

    Annual Report (2008) Swedish National Arthroplasty Register. http://www.jru.orthop.gu.se

  4. 4.

    Annual Report (2009) National Joint Registry of England and Wales. http://www.njrcentre.co.uk

  5. 5.

    Baker DA, Hastings RS, Pruitt L (1999) Study of fatigue resistance of chemical and radiation crosslinked medical grade ultrahigh molecular weight polyethylene. J Biomed Mater Res 46:573–581

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Bal BS, Khandkar A, Lakshminarayanan R, Clarke I, Hoffman AA, Rahaman MN (2009) Fabrication and testing of silicon nitride bearings in total hip arthroplasty. J Arthroplasty 24:110–116

    PubMed  Article  Google Scholar 

  7. 7.

    Banerjee M, Bouillon B, Banerjee C, Bäthis H, Lefering R, Nardini M, Schmidt J (2010) Sports activity after total hip resurfacing. Am J Sports Med 38:1229–1236

    PubMed  Article  Google Scholar 

  8. 8.

    Barrack RL, Burak C, Skinner HB (2004) Concerns about ceramics in THA. Clin Orthop Relat Res 429:73–79

    PubMed  Article  Google Scholar 

  9. 9.

    Bauman S, Williams D, Petruccelli D, Elliott W, de Beer J (2007) Physical activity after total joint replacement: a cross-sectional survey. Clin J Sport Med 17:104–108

    PubMed  Article  Google Scholar 

  10. 10.

    Beaulé PE, Harvey N, Zaragoza E, Le Duff MJ, Dorey FJ (2007) The femoral head/neck offset and hip resurfacing. J Bone Joint Surg Br 89:9–15

    PubMed  Article  Google Scholar 

  11. 11.

    Bergmann G, Graichen F, Rohlmann A (1993) Hip joint loading during walking and running, measured in two patients. J Biomech 26:969–990

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Berry DJ (2001) Unstable total hip arthroplasty: detailed overview. Instr Course Lect 50:265–274

    PubMed  CAS  Google Scholar 

  13. 13.

    Boone DC, Azen SP (1979) Normal range of motion of joints in male subjects. J Bone Joint Surg Am 6:756–759

    Google Scholar 

  14. 14.

    Bradford L, Baker DA, Graham J, Chawan A, Ries MD, Pruitt LA (2004) Wear and surface cracking in early retrieved highly cross-linked polyethylene acetabular liners. J Bone Joint Surg Am 86:1271–1282

    PubMed  Google Scholar 

  15. 15.

    Brand RA, Pedersen DR, Davy DT, Kotzar GM, Heiple KG, Goldberg VM (1994) Comparison of hip force calculations and measurements in the same patient. J Arthroplasty 9:45–51

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH (2005) Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty 20:11–19

    PubMed  Article  Google Scholar 

  17. 17.

    Calvert GT, Devane PA, Fielden J, Adams K, Horne JG (2009) A double-blind, prospective, randomized controlled trial comparing highly cross-linked and conventional polyethylene in primary total hip arthroplasty. J Arthroplasty 24:505–510.13

    PubMed  Article  Google Scholar 

  18. 18.

    Chandler DR, Glousman R, Hull D, McGuire PJ, Kim IS, Clarke IC, Sarmiento A (1982) Prosthetic hip range of motion and impingement. The effects of head and neck geometry. Clin Orthop Relat Res 166:284–291

    PubMed  Google Scholar 

  19. 19.

    Charnley J (1961) Arthroplasty of the hip. A new operation. Lancet 27:1129–1132

    Article  Google Scholar 

  20. 20.

    Charnley J (1979) Low friction arthroplasty of the hip: theory and practice. Springer-Verlag, Berlin

    Google Scholar 

  21. 21.

    Chatterji U, Ashworth MJ, Lewis PL, Dobson PJ (2004) Effect of total hip arthroplasty on recreational and sporting activity. ANZ J Surg 74:446–449

    PubMed  Article  Google Scholar 

  22. 22.

    Clifford PE, Mallon WJ (2005) Sports after total joint replacement. Clin Sports Med 24:175–186

    PubMed  Article  Google Scholar 

  23. 23.

    Cohen NP, Foster RJ, Mow VC (1998) Composition and dynamics of articular cartilage: structure, function, and maintaining healthy state. J Orthop Sports Phys Ther 28:203–215

    PubMed  CAS  Google Scholar 

  24. 24.

    Daniel J, Pynsent PB, McMinn DJ (2004) Metal-On-Metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br 86:177–184

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    J- Dorlot, Christel P, Meunier A (1989) Wear analysis of retrieved alumina heads and sockets of hip prostheses. J Biomed Mater Res 23:299–310

    Article  Google Scholar 

  26. 26.

    Dubs L, Gschwend N, Munzinger U (1983) Sport after total hip arthroplasty. Arch Orthop Trauma Surg 101:161–169

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Fisher J, Firkins P, Tipper J, Farrar R, Ingham E (2005) Wear of a novel ceramic on metal bearings for hip prosthesis. In: D’Antonio JA, Dietrich M (eds) Bioceramics and alternative bearings in joint arthroplasty. Steinkopff, pp 197–199. ISBN: 978-3-7985-1540-6. doi:10.1007/3-7985-1540-9_30

  28. 28.

    Geesink RG (2002) Osteoconductive coatings for total joint arthroplasty. Clin Orthop Relat Res 395:53–65

    PubMed  Article  Google Scholar 

  29. 29.

    Gschwend N, Frei T, Morscher E, Nigg B, Loehr J (2000) Alpine and cross-country skiing after total hip replacement: 2 cohorts of 50 patients each, one active, the other inactive in skiing, followed for 5–10 years. Acta Orthop Scand 71:243–249

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Guilak F, Jones WR, Ting-Beall HP, Lee GM (1999) The deformation behavior and mechanical properties of chondrocytes in articular cartilage. Osteoarthritis Cartilage 7:59–70

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Guilak F (2000) The deformation behavior and viscoelastic properties of chondrocytes in articular cartilage. Biorheology 37:27–44

    PubMed  CAS  Google Scholar 

  32. 32.

    Guilak F, Erickson GR, Ting-Beall HP (2002) The effects of osmotic stress on the viscoelastic and physical properties of articular chondrocytes. Biophys J 82:720–727

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    De Haan R, Campbell P, Reid S, Skipor AK, De Smet K (2007) Metal ion levels in a triathlete with a metal-on-metal resurfacing arthroplasty of the hip. J Bone Joint Surg Br 89:538–541

    PubMed  Article  Google Scholar 

  34. 34.

    Harris WH, Schiller AL, Scholler JM, Freiberg RA, Scott R (1976) Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am 58:612–618

    PubMed  CAS  Google Scholar 

  35. 35.

    Hasegawa M, Sudo A, Hirata H, Uchida A (2003) Ceramic acetabular liner fracture in total hip arthroplasty with a ceramic sandwich cup. J Arthroplasty 18:658–661

    PubMed  Article  Google Scholar 

  36. 36.

    Ha YC, Kim SY, Kim HJ, Yoo JJ, Koo KH (2007) Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res 458:106–110

    PubMed  Google Scholar 

  37. 37.

    Huch K, Müller KA, Stürmer T, Brenner H, Puhl W, Günther KP (2005) Sports activities 5 years after total knee or hip arthroplasty: The Ulm osteoarthritis study. Ann Rheum Dis 64:1715–1720

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Kilgus DJ, Dorey FJ, Finerman GA, Amstutz HC (1991) Patient activity, sports participation, and impact loading on the durability of cemented total hip replacements. Clin Orthop Relat Res 269:25–31

    PubMed  Google Scholar 

  39. 39.

    Kluess D, Zietz C, Lindner T, Mittelmeier W, Schmitz KP, Bader R (2008) Limited range of motion of hip resurfacing arthroplasty due to unfavorable ratio of prosthetic head size and femoral neck diameter. Acta Orthop 79:748–754

    PubMed  Article  Google Scholar 

  40. 40.

    Lachiewicz PF, Heckman DS, Soileau ES, Mangla J, Martell JM (2009) Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. Clin Orthop Relat Res 467:3290–3296

    PubMed  Article  Google Scholar 

  41. 41.

    Laupacis A, Bourne R, Rorabeck C, Feeny D, Wong C, Tugwell P et al (1993) The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg Am 75:1619–1626

    PubMed  CAS  Google Scholar 

  42. 42.

    Lavigne M, Masse V, Girard J, Roy AG, Vendittoli PA (2008) Return to sport after hip resurfacing or total hip arthroplasty: a randomized study. Rev Chir Orthop Reparatrice Appar Mot 94:361–367

    PubMed  CAS  Google Scholar 

  43. 43.

    Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519

    PubMed  Article  Google Scholar 

  44. 44.

    Lombardi AV, Berend KR, Seng BE, Clarke IC, Adams JB (2010) Delta ceramic-on-alumina ceramic articulation in primary THA: prospective, randomized FDA-IDE study and retrieval analysis. Clin Orthop Relat Res 468:367–374

    PubMed  Article  Google Scholar 

  45. 45.

    Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, Sculco TP (2008) Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res 466:424–431

    PubMed  Article  Google Scholar 

  46. 46.

    Mow VC, Mak AF, Lai WM, Rosenberg LC, Tang LH (1984) Viscoelastic properties of proteoglycan subunits and aggregates in varying solution concentrations. J Biomech 17:325–338

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Naal FD, Maffiuletti NA, Munzinger U, Hersche O (2007) Sports after hip resurfacing arthroplasty. Am J Sports Med 35:705–711

    PubMed  Article  Google Scholar 

  48. 48.

    Narvani AA, Tsiridis E, Nwaboku HC, Bajekal RA (2006) Sporting activity following Birmingham hip resurfacing. Int J Sports Med 27:505–507

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Ogunwale B, Clarke J, Young D, Mohammed A, Patil S, Meek RM (2009) Direct to consumer advertising via the internet, a study of hip resurfacing. Scott Med J 54:10–13

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Oldinski RA, Cranson CN, James SP (2010) Synthesis and characterization of a hyaluronanpolyethylene copolymer for biomedical applications. J Biomed Mater Res B Appl Biomater 94:441–446

    PubMed  Google Scholar 

  51. 51.

    Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL et al (2008) Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 90:847–851

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Philippot R, Adam P, Reckhaus M, Delangle F, Verdot FX, Curvale G, Farizon F (2009) Prevention of dislocation in total hip revision surgery using a dual mobility design. Orthop Traumatol Surg Res 95:407–413

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Philippot R, Camilleri JP, Boyer B, Adam P, Farizon F (2009) The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. Int Orthop 33:927–932

    PubMed  Article  Google Scholar 

  54. 54.

    Ritter MA, Thong AE (2004) The role of cemented sockets in 2004: is there one? J Arthroplasty 19:92–94

    PubMed  Article  Google Scholar 

  55. 55.

    Rydell N (1973) Biomechanics of the hip-joint. Clin Orthop Relat Res 92:6–15

    PubMed  Article  Google Scholar 

  56. 56.

    Rydell NW (1966) Forces acting on the femoral head-prosthesis. A study on strain gauge supplied prostheses in living persons. Acta Orthop Scand 37:1–132

    PubMed  Article  Google Scholar 

  57. 57.

    Simon JA, Dayan AJ, Ergas E, Stuchin SA, Di Cesare PE (1998) Catastrophic failure of the acetabular component in a ceramic-polyethylene bearing total hip arthroplasty. J Arthroplasty 13:108–113

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Skyttä ET, Eskelinen A, Paavolainen PO, Remes VM (2010) Early results of 827 trabecular metal revision shells in acetabular revision. J Arthroplasty. doi:10.1016/j.arth.2010.01.106

  59. 59.

    Stulberg SD (2010) Dual mobility for chronic hip instability: a solution option. Orthopedics 33:637

    PubMed  Google Scholar 

  60. 60.

    van den Bogert AJ, Read L, Nigg BM (1999) An analysis of hip joint loading during walking, running, and skiing. Med Sci Sports Exerc 31:131–142

    PubMed  Article  Google Scholar 

  61. 61.

    Williams S, Schepers A, Isaac G, Hardaker C, Ingham E, Jagt D et al (2007) The 2007 Otto Aufranc award: ceramic-On-Metal hip arthroplasties: a comparative in vitro and in vivo study. Clin Orthop Relat Res 465:23–32

    PubMed  Google Scholar 

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Correspondence to M. J. Wilson.

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Wilson, M.J., Villar, R.N. Hip replacement in the athlete: is there a role?. Knee Surg Sports Traumatol Arthrosc 19, 1524–1530 (2011). https://doi.org/10.1007/s00167-011-1492-2

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  • Hip replacement
  • Arthroplasty
  • Sport