Mount Sinai Health Tip:
Mount Sinai | April 11, 2019
Eyes were on Andy Murray at the Australian Open. Before his first-round match, the three-time Grand Slam® champion, 31, gave a tearful press conference detailing his plan to retire after this year’s The Championships, Wimbledon.
Chronic pain from an injured hip was the culprit. Murray had undergone hip surgery in January 2018, but the pain persisted, not only preventing him from playing world-class tennis but even impeding his daily activities.
The pain prompted Murray to undergo hip resurfacing after his punishing first-round loss at the 2019 Australian Open. In this Q&A, Shawn G. Anthony, MD, MBA, an orthopedic sports medicine surgeon with the Mount Sinai Health System in New York, explains the surgery, why an athlete would undergo it and what the future may hold for the former No. 1 player. ADVERTISEMENT An on-site physician at the US Open, Dr. Anthony is part of a team of Mount Sinai doctors and sports medicine experts responsible for caring for players throughout the tournament.
What is hip resurfacing?
Hip resurfacing is a procedure primarily used to treat patients with hip osteoarthritis. It is a less intensive, but certainly not less invasive, version of a total hip replacement. During hip resurfacing surgery, damaged bone or cartilage within the hip socket is removed and replaced with a metal shell. Additionally, the femoral head—the highest part of the thigh bone—is trimmed and topped with a metal covering. Following the surgery, most patients are able to get back to daily activity in four to six weeks.
What is hip osteoarthritis?
Hip osteoarthritis involves the loss of cartilage in the hip joint. A “wear and tear” condition, hip osteoarthritis causes progressively worsening pain, mostly in the groin area. As it advances, it can limit a person’s ability to engage in high-impact sports and can even limit everyday activities.
Why would an athlete choose hip resurfacing to address hip osteoarthritis?
Traditionally, hip osteoarthritis is seen in older patients, who then undergo a total hip replacement. During this surgery, all hip cartilage is removed in exchange for metal and plastic components.
The challenge is that the age of patients who have hip arthritis due to high activity levels is getting younger. A total hip replacement is not a great option for these young patients. Those looking to return to high-impact sports risk wearing the parts out too quickly as well as dislocation.
A variety of different procedures have been explored to address these young patients; hip resurfacing is one of them.
Is hip resurfacing common for tennis players?
No. For tennis players, the most common hip injury that requires surgery is a labral tear, which affects the ring of cartilage that surrounds the hip joint called the labrum. Damage to this soft tissue can occur with acute injury or through repetitive motions such as sudden pivoting or twisting. Labral tears can also be caused by chronic hip impingement, a structural disorder of the hip that interferes with the joint’s smooth motion. Labral tears are treated by minimally invasive hip arthroscopy surgery, which has an excellent return-to-sport rate.
Hip resurfacing for osteoarthritis is typically what happens later. If you have had hip impingement and labral tears, you have a greater risk of developing osteoarthritis and potentially having to undergo additional surgeries, such as resurfacing or total hip replacement.
While the procedure is not common in tennis, 40-year-old American doubles player Bob Bryan underwent hip resurfacing in August 2018 and returned to the sport in January. Several tournaments into his return, Bryan has already hoisted a trophy with twin brother Mike Bryan. Can Murray replicate this success?
Singles tennis is more demanding and more taxing on the body than doubles.
However, studies have looked at return-to-sport rates after hip resurfacing, and patients do quite well getting back to leisure sports as well as high-impact sports. That being said, the return rate is not 100 percent for high impact sports; it is closer to 50-60 percent.
Most patients who undergo hip resurfacing can return to playing tennis. It is uncharted territory whether a professional singles tennis player will get back to the same level that he had before. We would expect, though, that Murray will be able to conclude—or continue—his tennis career at Wimbledon.