Tennis After Total Hip Arthroplasty
February 1, 2000 3 minutes read
Tennis After Total Hip Arthroplasty
ABSTRACT & COMMENTARY
Synopsis: Total hip replacement allows return to tennis; however, athletes tend to play the sport with only 14% of physicians approving the activity.
Source: Mont MA, et al. Tennis after total hip arthroplasty. Am J Sports Med 1999;27(1):60-64.
This paper is the result of a questionnaire sent to all members of the U.S. Tennis Association (USTA) to identify those members having undergone a total hip arthroplasty and investigate the resultant return to tennis. The questionnaire identified 58 members (50 males, 8 females) with 75 hip arthroplasties. Questions investigated three areas: 1) the total hip, 2) general tennis questions (national rating before and after surgery, number of times per week competing in either singles or doubles tennis) and 3) sports-specific tennis questions (scale designed to evaluate the functional level of play in an outcomes measure of each component of tennis, i.e., stroke, surface play, etc.).
The respondents in this study underwent total hip arthroplasty at an average age of 62 (range, 42-77 years). Types of hips placed included cemented (29%), uncemented (64%), and hybrid (7%). The questionnaire was completed at a mean time of eight years after the hip replacement (range, 2-22 years). Interestingly, only eight (14%) patients’ surgeons approved the activity. The surgeons of 20 (34%) respondents recommended only doubles play, and 52% of the respondents’ surgeons were completely opposed to any tennis playing.
Ninety percent of respondents took nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain while playing tennis prior to surgery, which decreased to 26% one year after arthroplasty. Interestingly, nine players (16%) complained of intermittent thigh pain responsive to NSAIDs. There was no statistical difference between type of arthroplasty, level of play, or singles vs. doubles activity with respect to degree of symptoms.
Comment by Robert C. Schenck, Jr., MD
This study is an ingenious way to evaluate functional activity (namely tennis) after a total hip arthroplasty from the viewpoint of the patient, while minimizing the bias produced when questioned by the treating physician. The study demonstrated that this select group of tennis players functioned at a higher level in every component of their game after a total hip arthroplasty. Mont and colleagues recognized the inherent bias in this study in questioning USTA members about tennis and total hip arthroplasty: questioning this group already implies the fact that the respondent can play tennis. Total hip patients unable to play tennis would probably drop their membership and would not have been questioned. This bias notwithstanding, the study allows for useful information and should be the start of future functionally based patient outcome studies for sports-specific activities. Furthermore, future studies need to evaluate an all-encompassing group of tennis players on a prospective basis.
Mont et al should be commended for such a unique and ingenious study. They recommend that physicians advise caution in tennis activities and carefully follow their patients for evidence of osteolysis. But, I wonder, will the patient listen?
Reference
1. McGrory BJ, et al. Participation in sports after hip and knee arthroplasty: Review of literature and survey of surgeon preferences. Mayo Clin Proc 1995;70:342-348.
Tennis after total hip arthroplasty is:
a. usually tolerated well with no thigh pain.
b. universally recommended by surgeons.
c. usually at a level at or below preoperative tennis.
d. usually advised against by surgeons.
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