Mount Sinai

Having Hip Problems?  

April 20, 2018

Having Hip Problems? 


With all its running and twisting, tennis can sometimes place great strain on the hip joints of amateurs and professionals alike. Rafael Nadal and Andy Murray are just the latest top players who have had to deal with serious hip problems.


Many players believe they may need to play through the pain of a persistent hip problem. But doctors are often recommending they consider hip surgery earlier for better recovery. When arthritis is the cause of pain and disability, a successful hip replacement can allow many to get back on the court and play with exceptional results. New surgical techniques and implants are making this process quicker, easier, and safer.


Here is a quick backgrounder from Calin Moucha, MD, Chief of Adult Reconstruction and Joint Replacement Surgery at The Mount Sinai Hospital. ADVERTISEMENT Mount Sinai Health System is the official medical services provider of the United States Tennis Association (USTA) Eastern Section and the US Open.


Why hip replacement?


The vast majority of hip replacements are done to treat arthritis, a degeneration of the cartilage that serves as a cushion between the bones that meet in the hip joint.  Wear and tear is part of the problem, but so is genetics.  Some people are predisposed to have a biochemical imbalance in the cartilage that accelerates its breakdown. Others are born with abnormal hip bony anatomy that may predispose them to arthritis.   One thing to keep in mind: You probably will feel the pain associated with hip arthritis in your groin, thigh, and knee, rather than the side where many people think their hip is located.


What if I think I’m too young for hip replacement?


Increasingly, reconstructive surgeons are finding that younger patients are electing to have hip replacement surgery so they can stay active. In my practice, I have seen a 15 percent increase of patients under the age of 60 who are having their hips or knees replaced.


Not that long ago, we would have told these patients to hold off on surgery until they were in much more pain and until their activity was much more limited. But our approach has shifted: waiting isn’t always the best thing. During that time, the arthritis progresses and muscles atrophy. As a result, patients start the rehabilitation process with a lower functional level, which makes recovery harder and longer. Together, all of those factors diminish the final outcome.


Our new attitude toward hip replacement is that if you’re an active tennis player in your mid-40s and you’re having arthritis-related symptoms, you might be better off having your hip replaced now instead of waiting until muscles atrophy and range of motion diminishes. 


Why is minimally invasive surgery so important?


At this point, hip replacement can be done with minimally invasive surgery.  The surgery entails removing the arthritic portion of the hip joint and replacing it with an implant. Most surgeons use cementless implants made of a combination of titanium, ceramic, and plastic.  Evidence suggests that this combination is the safest, most long-lasting choice. Thanks to technological and surgical advances, there is very little muscle cutting involved in hip replacement, which is crucial to the recovery process.


How soon can I get back on the courts?


I tell my patients they can be back playing singles in three months. But that depends on whether they’ve reached targeted goals throughout the recovery process. Most patients stay one or two nights in the hospital and many are ready to go home the same day – every case is different and every patient is treated with a hands-on personalized approach.   I expect my patients to be walking close to a mile a day within three weeks. Some people request regimented physical therapy, which can help, but the most important thing is really just walking.


Anything else I should know?


Hip replacement surgery is a highly successful procedure, truly one of the marvels of modern medicine. It can provide pain relief, improve functionality, and give you a long-lasting, working hip. But like any surgery, it’s not risk-free, and potential complications include infection, dislocation, fracture, leg-length discrepancy and neurovascular injury. So, while the overall complication rate is less than 1 percent, this is still a surgical procedure that shouldn’t be undertaken lightly.  I create life-long relationships with my patients as I continue to follow their progress with check-ups every 2-3 years.


If arthritis is interfering with your quality of life and you’re considering hip replacement surgery, the most important thing is to talk with an experienced surgeon. The surgeon should know how to deal with any complications, and which surgical approach is best for you. Hip replacement is life-changing surgery.  And especially for tennis players, it can allow you to continue following your passion and playing the sport you love.


Calin Moucha, MD, is a board certified, fellowship-trained hip and knee replacement surgeon and the Chief of Adult Reconstruction and Joint Replacement Surgery at The Mount Sinai Hospital. He is also an Associate Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai.


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