Andrew G Yun MD

The Arthritis Institute, Centinela Hospital, 501 East Hardy Street, Suite 306, Inglewood, CA 90301, USA

The overlying purpose of total hip replacement (THR) is to relieve hip pain. The indications for THR involve a combination of objective and subjective criteria. Although the objective factors related to examination and radiographic factors remain largely unchanged, the subjective criteria continue to evolve.

The effect on a patient's quality of life determines when to proceed with THR. It is this determination of quality of life that is currently changing. Formerly, quality of life, or lack thereof, reflected the persistence of pain with walking, rest, and sleep. Even the analysis of clinical success based on the Harris hip score measured only limited functional criteria of limp, stair climbing, need for a cane, and ability to put on shoes and socks. This relative success of THR seen in the elderly, lower-demand population has now expanded the indications to a younger, more active individual.

Today these patients expect much more than pain relief; their goals of hip replacement now extend to function. This subgroup often hopes and expects to return to an active, even athletic, lifestyle. Although most will have already self-restricted their activity before hip replacement [1], some make seek a return to sports that is unrealistic or unsafe. It is the surgeon's responsibility to preopera-tively guide these patients to distinguish between reasonable and unreasonable athletic expectations.

Few validated guidelines exist for a return to sports after THR, however. Current recommendations are based on a consensus of opinion and practice patterns. Surgeons at the Mayo Clinic in 1995 listed activities as recommended, intermediate, and not recommended based on a similar survey [2]. Members of the 1999 Hip Society who were polled to differentiate activities that were allowed, allowed with experience, or not allowed, developed a modestly conflicting list [3]. Other anecdotal reports describe a return to running, professional golf and tennis, and ballet [4]. Given recent advances in materials, fixation, and technique, each of these activities may deserve re-examination.

E-mail address: [email protected]

0278-5919/06/$ - see front matter doi:10.1016/j.csm.2006.01.002

© 2006 Elsevier Inc. All rights reserved.

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