Return to Sports After Total Hip Arthroplasty: Patterns of Participation and Sport-Specific Outcomes

Return to sports is a concern for many patients undergoing total hip arthroplasty (THA). As younger, active patients increasingly undergo THA, identifying factors that influence athletic recovery is critical. Although prior work has reported favorable outcomes, large-scale studies comparing return rates across both surgical approaches and sport types remain limited.

We retrospectively analyzed 1,115 athletically participant THA patients and compared rates of returning to sports up to 1 year postoperatively. Survey data captured sport type, participation at four time points, frequency, exertion, and perceived recovery. Patients were stratified by surgical approach: posterior approach (PA) (n = 519), anterior approach (AA) (n = 556), and lateral approach (LA) (n = 50).

Preoperatively, 45.2% of patients were active in at least one sport versus 43.7% at one year postoperatively; 73.2% of preoperative athletes returned, and 23.3% of those previously inactive took up sports. Return-to-sport rates were 68.1, 77.0, and 81.8% for PA, AA, and LA, respectively (Chi-square = 3.42, P = 0.181). There were no significant differences between AA and PA, and the LA was not statistically comparable due to a smaller sample size. Low-impact sports had significantly higher return rates than high-impact sports (72.4 versus 50.0%; P < 0.001). At survey completion (> one year postoperatively), satisfaction rates were high across all sports, and activity restrictions were reported by about one in five patients, regardless of approach. Sport-specific outcomes showed that most patients maintained or improved performance.

Patients undergoing THA can expect high return rates and satisfaction with athletic endeavors. Surgical approach generally does not affect return-to-sport outcomes after THA. Most patients, regardless of approach, resumed or exceeded preoperative activity. In addition to high return rates among previously active patients, many previously inactive patients participated in sports after THA, highlighting the role of THA in enabling sport resumption and participation.