German Surgeons Report on Sports Participation After Hip Resurfacing
Hip Resurfacing is a new way to manage painful joint destruction at an age too young for a total hip replacement. Active adults thinking about having this procedure done want to know -- how active can I be after recovery? Can I run? Play tennis? Join a soccer team? Go skiing?
Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients that are expected to need a second, or revision, hip replacement surgery as they grow older and wear out the original artificial hip replacement.
Special powered instruments are used to shape the bone of the femoral head so that the new metal surface will fit snugly on top of the bone. The cap is placed over the smoothed head like a tooth capped by the dentist. The cap is held in place with a small peg that fits down into the bone. The patient must have enough healthy bone to support the cap. The hip socket may remain unchanged but more often it is replaced with a thin metal cup (the acetabular component).
In theory, the level of physical and sports activity might cause the component parts to loosen or wear out. There is an additional fear of fracture or hip dislocation. But in reality, we really don't know if these problems are likely or not. Surgeons may caution patients to reduce their participation in high-level impact sports in favor of low-impact sports. Instead of playing tennis, soccer, or volleyball, they might be advised to stick with fitness and weight training or riding a bicycle. Some of the more active, athletic patients may think this is pretty boring and unacceptable.
They may be looking for solid evidence to prove these restrictions are necessary. There's really no evidence to support one approach over another (i.e., inactivity versus activity). Reports like this one from Germany will get the ball rolling and help guide future recommendations. Data was collected by surgeons who operated on active adults and then followed them after total hip resurfacing. Information was gathered information on their sports level and physical activity.
It was a short-term study (two years follow-up) with a moderate number of patients (152 hips). There is a need to continue following this group (and others) to find out how the resurfacing holds up -- especially with various low, intermediate, and high-impact activities. What do we know so far?
The patients were all diagnosed with hip osteoarthritis. There were men up to age 55 and women up to age 60 included. Everyone was tested for osteoporosis. Anyone with weak or brittle bones was excluded (left out) of the study. Everyone followed the same post-operative plan with partial weight-bearing on the leg the first two weeks. There were some motion limitations (hip flexion past 90 degrees, internal rotation, and crossing the legs were not allowed) the first six weeks after surgery.
The results were based on several things: before and after reports of activity level, range of motion, need for pain medication, and age. The participants were asked if there were any activities they had to give up after the surgery and how long it took to get back to their desired level of activities.
They found that adults under age 55 were more likely to stay active and at a higher level of activity. Men were more active before surgery but the participation level between men and women evened out after surgery. Only a small percentage (two per cent) of the people in the study gave up their sports involvement. Tennis and skiing were the two activities patients gave up most often.
The number of patients involved in high-level sports definitely decreased after the hip resurfacing procedure. Some of the changes made were based on their physician's recommendation. Some changes in behavior was attributed to their own fears and uncertainties. As far as post-operative complications go, there were few but not very many. These included hip one hip dislocation, one hip fracture, and one displaced acetabular component (cup). The most common problem after surgery was a change in the length of the leg compared to the uninvolved leg. Leg length differences were observed in almost half of the patients (42 per cent).
In summary, there are no universal or standard recommendations for activity level following a hip joint resurfacing procedure. Only a few studies have even looked at this problem. Based on the results of this study, it looks like remaining active is a possibility. The natural response is to shift from high-impact to intermediate- or low-impact activities and to participate less often. Whether or not this is entirely necessary remains an area for future research and discovery.
Marc Manerjee, MD, et al. Sports Activity After Total Hip Resurfacing. In The American Journal of Sports Medicine. June 2010. Vol. 38. No. 6. Pp. 1229-1236.