Last Updated on Thursday, 25 February 2016 09:35
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question:I am a 65-year-old university professor who still enjoys playing hockey. I have hip arthritis that is becoming very painful with activity, so I am considering hip replacements. Is there any evidence concerning the impact on hip replacements of participation in “old guy” recreational ice hockey?
Answer:This is a very good question that is likely pertinent to many recreational players. It is well recognized that hockey players have a high risk of developing hip arthritis. Unfortunately, scientific research studies have not specifically investigated the issue of ice skating and hip replacements to date. Therefore, the best recommendations are found by reviewing studies that have looked at hip replacement failure rates and participation in other sports. Most evidence suggests that ice hockey after hip replacements carries a low but not insignificant risk of replacement failure. However, you can decrease the risk of implant failure by taking some simple precautions and using common sense.
Hip arthritis is a very common ailment that is strongly associated with increased age. High-impact activities that repeatedly place large and sudden stresses on the joint can lead to accelerated hip arthritis. However, ice hockey is generally considered a low-impact sport, and the high rate of hip arthritis in hockey players is thought to be due to the rather unnatural motion of skating, which can lead to the development of femoroacetabular impingement (bony overgrowth at the hip joint) and labral tears.
Hip arthritis is characterized by articular cartilage loss that lines the ball and socket bones of the hip joint. The cartilage normally provides a smooth gliding surface and shock absorption for the joint. Over time, hip arthritis usually causes loss of hip flexion, internal rotation, and abduction, which can interfere with skating. Hockey players with hip arthritis may be limited by pain in the groin area where the hip joint is actually located (not the outside of the hip).
There has been a shift towards increased participation in sports following hip replacement over the past decade. As increasing numbers of baby boomers reach the age where they are having joint replacements, pervious high activity levels and the expectation to continue these activities has resulted in more patients resuming various types of physical activity and sporting events after joint replacements than previous generations. Orthopaedic surgeons may also be less cautionary. There have been numerous short-term studies that have reported good outcomes with participation in higher impact activities following joint replacement, and some of these studies even indicate a lower rate of prosthesis loosening with increased activity due to maintaining greater bone strength. However, the Swedish hip registry has noted higher long term failure rates in males under the age of 50, possibly in part due to greater participation in higher impact activities. In 2005, the Hip Society’s expert opinion changed its stance from recommending against playing hockey after hip replacement to having no consensus opinion on this matter.
In your case, the two biggest risks of returning back to skating activities would be a dislocation of the hip prosthesis or a fracture around it. While these risks are likely low, they vary depending on the type of prosthesis implanted, the surgical approach, muscle strength, bone quality, and the physicality of your league. If you anticipate playing non-contact hockey after hip replacement, talk to your orthopaedic surgeon about the potential benefits of an increased femoral head size to increase the femoral head-neck ratio. This may help to minimize the risk of a total hip replacement dislocating out of socket. It is recommended that you participate in a hip and lower extremity strengthening program to make sure that the muscles are strong enough to hold the total hip prosthesis in place before returning to on-ice activity. In addition, using appropriately sized breezers with padding would help to minimize the risk of a fracture around the prosthesis if you had any on-ice collisions or contact against the boards. There are no specific limitations to backwards skating, crossovers, or leg extensions in abduction if you follow these recommendations. However, contact play should be strictly avoided.
To summarize, it is possible to continue your on-ice hockey activities after a total hip replacement. However, there is likely a small increased risk of prosthesis failure that increases with the amount of contact you experience in your league. Participating in a lower extremity strengthening program and wearing appropriately padded breezers will help to minimize these risks.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
