Total Hip Athroplasty (THA) is a procedure that is frequently used in orthopedic surgery to address severe osteoarthritis (OA) in the hip joint. With the burgeoning “baby boomer” generation and older athletes who desire to return to competitive levels of sports, understanding how sporting activity affects THA outcomes is becoming considerably important. The purpose of this review is to characterize the current recommendations and risks for returning to sports after THA, as well as discuss the implications of the changing demographic and level of expectation on rehabilitation paradigms. Although the actual risks associated with participating in sports after THA are unknown, there are concerns that higher levels of physical activity after THA may increase risk for fracture, dislocation and poor long-term outcomes. Evidence surrounding the specific effect of sporting activity on wear after THA is conflicting. Newer alternatives like metal-on-metal hip resurfacing are expected to provide better durability but there are concerns of systemic metal ions from mechanical wear, although the impact of these ions on patient health is not clear. Tracking outcomes in patients participating in higher level activities after THA presents a problem. Recently the High Activity Arthroplasty Score has been developed in response to the need to quantify higher level of physical activity and sports participation after joint arthroplasty. This measure has been shown to have a higher ceiling effect than other common outcome measures. The prospective evidence regarding the likelihood of poor clinical outcomes with higher level of sporting activity is lacking. There is some evidence to suggest that wear may be related to activity level, but the impact on clinical outcomes is conflicting.
When advising an athlete considering returning to sport after THA, consider their preoperative activity level, current physical fitness, and specific history including bone quality, surgical approach and type of prosthesis.