A Tennis Champions Journey
Andy Murray, former world #1 ATP men’s singles tennis player and two-time Wimbledon champion, is one of the most prominent athletes to have undergone successful hip resurfacing surgery. Patients and sports fans are more eager to learn information about the procedure. Several patients with known hip arthritis have questions about whether they are candidates for a hip resurfacing procedure. Furthermore, people want to know the difference, risks, and benefits of hip resurfacing versus total hip replacement or hip arthroplasty (THA). They want to know how Andy Murray has been able to return to a high level of performance quickly. Here is a list of commonly asked questions.
What led Andy Murray to develop a condition that required Hip Resurfacing?
Available from interviews, information about Andy Murray’s hip condition suggests that he has dealt with his hip issue “for a very long time,” which likely indicates a structural problem within the hip joint that resulted in cartilage wear. Furthermore, tennis is a sport that involves a lot of pivoting, twisting, and repetitive sprinting, all of which involve significant use of the hip joint and place stress on the hip joint. A predisposing structural issue of the bone (femoroacetabular impingement), combined with the wear and tear of vigorous athletic activity, caused wear in the joint, leading to an arthritic condition. It is becoming increasingly common for professional athletes across different sports to experience this situation.
What is a Hip Resurfacing?
Hip resurfacing is an alternative procedure to total hip replacement (THA), creating new artificial surfaces for the ball and socket. It is an open procedure that involves reshaping the bone of the ball (femoral head) and the socket (acetabulum) to accept two new metal implants that will function as the new joint surfaces. Hip resurfacing, also known as Birmingham Hip Resurfacing (BHR), uses the implant developed in Birmingham during the 1990s.
The primary benefit of hip resurfacing, as compared to THA, is that the bone of the femur is preserved, which can be beneficial for younger patients. Another advantage of hip resurfacing is that the implanted ball size (metal cap) is larger than a THA, providing greater stability. Finally, activity choices may also be different. Studies have shown that the activity level achieved by hip resurfacing patients is higher than that of total hip replacement patients, even when matched for age and pre-arthritic activity levels.
Why was Andy Murray a good candidate for hip resurfacing versus a THA?
Due to several factors, Andy Murray is an ideal candidate for hip resurfacing compared to THA. His young age, large bone size, good bone quality (assumed from regular participation in impact sports), high activity level, and personal preference for hip resurfacing make him a prime candidate. Research studies conducted over the last 15 years indicate that men under the age of 65 years, with primary osteoarthritis of the hip and good structural integrity of the hip bones, have achieved the best results with hip resurfacing.
How did Andy Murray decide that resurfacing was his best option?
Andy Murray watched closely as another tennis player, Bob Bryan, a member of the most successful doubles team in tennis history, recovered from hip resurfacing surgery performed in August 2018. Like many athletes, Bob Bryan had a similar hip condition and was the first tennis player to recover well enough to return to professional tennis in 5 months. According to interviews, during the 2019 Australian Open, Andy Murray and Bob Bryan had many conversations about hip resurfacing as a possible treatment for Andy’s condition and particularly as a viable way to extend Andy’s tennis career.
Ultimately, like most patients, the decision to undergo a hip resurfacing operation came down to Andy’s quality of life. The severity of symptoms in his arthritic hip caused him to feel limited on a regular basis. While he always harbored a desire to return to playing competitive tennis, according to interviews, Andy would have been satisfied with the pain relief provided by hip resurfacing.
Given Andy’s young age of 31, hip resurfacing was a better option than THR because of the preservation of bone. Also, given that playing competitive tennis was a goal, hip resurfacing was the best option to allow that return to such an elite athletic level.
What are the risks of hip resurfacing compared to total hip replacement?
Hip resurfacing implants are made of cobalt-chromium metal alloy due to the shape of the implant and bone preservation. This material is very smooth and durable, but only after implantation in the human body did we realize some patients could react to the metal-on-metal articulation. Microscopic metal debris created by the ball and socket can cause an allergic reaction in some patients. Unfortunately, the only solution is to remove the implants and perform a total hip replacement using different materials. The estimated risk of this happening in a man is less than 1%.
Metal debris from a hip resurfacing surgery can dissolve into a solution and enter the bloodstream. From there, the kidneys filter it out. If the hip resurfacing is well-functioning and the kidneys are healthy, the levels of cobalt and chromium found in the bloodstream are in the single-digit parts per billion range. These levels should be monitored by an appropriate healthcare provider periodically with a blood test, but they do not appear to cause any harm to the body.
Comparatively, a total hip replacement has other materials, such as ceramic and polyethylene, that can be used and that do not pose this risk.
Could he have achieved the same level of activity with a total hip replacement?
In studies, it has been shown that hip resurfacing results in a return to a higher level of activity compared to traditional THA. Although patients with THA return to a high activity level, patients with a hip resurfacing return to even higher levels more consistently. With hip resurfacing, the femoral head or cap size is much larger, the proximal femoral bone loading is more physiologic, and a hip is more stable than a THA. For a sport like tennis, hip resurfacing is more likely to allow the quick movements and sprinting activity that is required regularly.
How did Andy Murray make such a quick return to competitive tennis?
Like most orthopedic surgeries, the recovery progresses in phases. The first phase involves gait normalization and regaining balance. Like most patients with hip arthritis, Andy Murray had a noticeable limp as he was compensating for years. The second phase involves regaining flexibility or range of motion. For years, hip arthritis has caused muscle and tissue contractures and bone spurs, which can reduce range of motion. The third phase is muscle strengthening for functional and athletic goals. For an athlete, this phase never ends. Usually, return to sport occurs at six months due to bone healing and implant purposes. Andy Murray is one of the most dedicated athletes to rehabilitation and muscle strengthening.
What is the durability of hip resurfacing?
It is impossible to predict how long an implant will last in the body, but some research suggests that hip resurfacing has a greater than 90% chance of surviving 15 years.