Running, Swimming, Skiing, Golfing: Sport after Hip Replacement

How to Determine if a Sport is Prohibited with a Hip Replacement?

I encounter at least two situations among my patients that lead them to inquire about whether a sport is restricted or not when having a hip replacement:

1. In the case of coxarthrosis (hip osteoarthritis), when seeking information to determine whether a hip replacement would be relevant. Knowing if you are allowed to engage in sports afterward can influence the decision to undergo surgery or not.
2. Once operated due to osteoarthritis or a broken femur, people often wonder what activities they can resume, when, and how.

You are probably in one of these two scenarios!

Here are three different ways to gather information about resuming sports with a hip replacement in your situation. Often, it’s a combination of these approaches that will help you reach your final decision.

1. Seek Input from People You Know Who Have Been Operated: Consult those who have undergone similar procedures for their opinions and firsthand experiences on the matter. What sports have they resumed? With what results?
   • Advantage: You’ll have concrete examples from people you trust.
   • Disadvantage: This will provide insights from a small sample, which might not represent all individuals who have had hip surgery.
2. Consult a Healthcare Professional: Seek advice from a healthcare provider such as an orthopedic surgeon, general practitioner, sports medicine physician, or physical therapist. They can offer personalized answers after conducting an assessment.
   • Advantage: You’ll receive tailored advice from someone familiar with your health condition and lifestyle.
   • Disadvantage: Sometimes, professionals have strong opinions on topics like “you must never run with a hip prosthesis,” while the evaluation of benefit versus risk is a very individual decision that only you can truly weigh.
3. Refer to Dedicated Articles or Videos: Consult materials that are specifically focused on the topic, drawing from professional experience, patient feedback, and recommendations based on scientific publications.
   • Advantage: You’ll likely access more detailed and sourced information.
   • Disadvantage: It will be your responsibility to personalize this information to your own situation.

Is There Really a Sport Restricted for All People with a Hip Replacement?

In this article, I advocate the following stance: there is no sport strictly forbidden with a hip replacement.

There are always benefits and potential risks associated with engaging in sports, whether or not one has a hip replacement.

In my opinion, it’s up to the individual engaging in the sport to decide whether the balance between benefits and risks is favorable in their case ⚖️.

As a physical therapist or physician, I believe we are here solely to assist in this decision-making process. For instance, we can explain which types of sports might potentially pose more risks than others when one has a hip replacement, why that is, and at what level of practice.

In the remainder of the article, I will provide factual elements that will enable you to make an informed choice. Particularly, I will focus on the three sports for which patients after hip arthroplasty (hip replacement) have the most questions:

• Running, light jogging and trail running
• Weight training and crossfit
• Swimming, including breaststroke

The reality of what patients achieve in terms of intensity and duration of activity often differs from what they declare and what they are advised to do (after a hip replacement).

(Meek, 2020)

What to Consider Generally Regarding Resuming Sports with a Hip Replacement?

The main factors that determine whether someone will resume sports after hip replacement surgery are:

1. Your pre-operation level of activity: Individuals who were more active before the surgery are more likely to resume sports.
2. Your body mass index (BMI): Slimmer individuals are more inclined to resume sports.
3. Your age: Younger people are more likely to resume sports.

There is no correlation between sports activity and an increased prevalence of replacement integration failure in bone. In other words, there are no more issues with hip replacement loosening or dislocations among individuals engaged in sports compared to others.

There is no evidence that replacement revision is more frequent among athletes, although individuals are generally followed up for only 10 years. Differentiating between those who engage in regular sports and those who do so occasionally is not always clear.

Here are the conclusions from a research team that recently synthesized all the studies on sports with a hip replacement:

1. Current fixations and bearings appear suitable for short and medium-term amateur sports activities.
2. There is no substantial literature indicating a link between early activity and arthroplasty complications, such as fractures or instability.
3. Recent evidence regarding early dislocation suggests that disregarding precautions and actively resuming activities may actually be beneficial.

Source: Meek, 2020

Do people often resume sports with a hip replacement?

Here are two pieces of information on this topic:

1. 91% of people who engaged in sports before hip replacement surgery resume sports.
2. The percentage of resumption is higher for low-impact activities like hiking, Nordic walking, and swimming.
3. However, a significant portion of people also resume higher-impact activities such as alpine skiing (downhill skiing).

(Meek, 2020)

And how long after the surgery?

• 94% resume sports between 6 and 12 months after the operation.
• 40% resume sports 2 to 3 months after the surgical intervention. Source: Magan 2023.

Approximately 9 out of 10 people resume sports with a hip replacement (among those who were engaged before). Some even resume sports despite having stopped.

Can You Run with a Hip Replacement 🏃‍♀️?

An increasing number of research teams are examining the resumption of running after a hip replacement. Why? For at least these three reasons:

1. The implanted devices are of better quality, less prone to wear or dislocation.
2. Individuals receiving hip prostheses are getting younger.
3. More and more people are becoming fond of running.

The majority of people who used to run before having a hip replacement resume running: 73.6%.

A greater number of individuals resume running after hip resurfacing (partial prosthesis) than after total hip replacement. The rate of resumption was also lower for the latter (hip resurfacing).

Source: Harrington, 2023

Some people even resume marathons and Ironman events with a hip replacement!

For instance, a study followed 48 individuals aged 28 to 59 who competed in Ironman events and needed a hip replacement. Within the five years following the hip replacement surgery:

• 85% resumed cycling.
• 79% resumed swimming.
• 69% resumed running.

Among those who resumed competition, their performance was not inferior after the surgery compared to before. Seven individuals returned to Ironman, and 21 to the half-Ironman distance.

Source: Girard, 2017.

Can You Run with Two Hip Replacement?

The same reasoning applies whether you have one or two hip prostheses: it is technically possible to run with two hip prostheses.

However, we still have even less experience with this type of practice!

Weight Training with a Hip Replacement: Is it Possible? 🏋️

Most individuals who have undergone hip replacement surgery engage in some form of weight training, sometimes even unknowingly. Of course, this depends on what we mean by the term.

If we consider strength training as “engaging muscles to gain more strength,” then, to varying degrees, almost everyone engages in muscle building after a hip replacement.

Why?

Because following the surgery (and in some cases, after years of deconditioning that preceded it):

• Our gluteal muscles need to heal.
• They have reduced strength.

We therefore reinvigorate these muscles even by walking, climbing stairs, or performing similar activities.

There are no restricted movements after a hip replacement. And nothing that seems truly hazardous with bodyweight exercises, as long as it’s done progressively and in tune with our bodies.

Can you engage in weightlifting, cross-fit, or activities that challenge muscles:

• With added weight?
• At high velocity: rapid, powerful movements?

Once again, there isn’t a definitive answer to this question. It depends on your own assessment of the benefit and risk.

It’s reasonable to think that over the long term, these weight training activities might lead to increased and earlier wear and tear. However, we lack empirical data on this matter. Furthermore, at the short and medium term, no sport seems to provoke such effects.

Swimming with a Hip Replacement 🏊: Is it Possible? How?

A research team in the United Kingdom specifically examined swimming after a hip replacement because:

• Swimming is often encouraged during hip replacement rehabilitation due to its low-impact nature.
• However, the breaststroke is often discouraged, as it is the most commonly practiced stroke.

This team found that:

• Out of more than 600 healthcare professionals surveyed, only 18% reported advising their patients to swim breaststroke after a hip replacement.

• No healthcare professional had witnessed a case of hip replacementdislocation after swimming the breaststroke.
• No cases of hip replacement dislocation during breaststroke swimming were reported in the literature.

Conclusion: When you feel capable (likely around 1-3 months after hip replacement surgery and when everything is well-healed), you can resume swimming, including breaststroke, with a hip prosthesis! As always, this should be done progressively (not with an intense 1-hour session right away).

Source: Singh, 2015.

Golfing After a Hip Replacement?

Among those who have undergone a hip replacement surgery, 72% resume golfing, and 84% are satisfied with their performance and capabilities.

What about skiing ⛷️?

The main risk associated with skiing after a hip replacement is the possibility of falling.

The risk of falling is higher while skiing compared to the other mentioned activities, especially in alpine skiing. A fall can lead to dislocation of the prosthesis or a femur fracture.

For cross-country skiing, there are no particular issues: in fact, there is even less impact compared to running.

If you feel the need to learn more about the recovery period after a hip replacement, I wrote this guide in eBook format:

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