[Hip Joint Loading during Sports Activities after Hip Replacement: Is There Still Room for More? Subjective and...

Hip joint replacement with total hip arthroplasty is a frequently performed and highly successful treatment option that is increasingly being offered to younger patients. Due to their longer life expectancy, the longevity expectations for the endoprosthesis have also increased. Physical activity and sports have a positive effect on the risk of loosening. There is no scientific evidence that participation in any specific sport adversely affects the longevity of a hip endoprosthesis. Nevertheless, recommendations to patients vary widely from surgeon to surgeon, and some types of sport are still generally discouraged. This article provides an overview of both recent and older studies addressing the question "What sports are still permissible with an artificial hip?" It attempts to clarify that high joint forces are not necessarily associated with high risk of damage, as the anatomy of muscles and bones, together with muscle function, is optimised to accomodate higher loads. High forces pose a risk only if they are applied in directions not physiologically intended or if the implant is poorly anchored in the bone. The principle that only sports which can be performed with sufficient coordination should be undertaken is therefore certainly correct. Overall, patients should be encouraged to engage in activities in which they feel comfortable and are aware of their own limitations and risks. Hip resurfacing represents an option for a carefully selected patient population, potentially allowing for a return to elite sports. However, the indication requires careful consideration of the local and systemic risks associated with metal-on-metal articulations, as well as the patient's age and athletic aspirations. The extent to which new developments without a metal-on-metal articulation may allow for an expanded indication must be carefully evaluated. Clear guidance from the surgeon to the patient regarding the timeline and postoperative activity following hip replacement with an H-TEP or hip resurfacing is necessary to support patient confidence.