Last week, 31-year-old Scottish tennis star Andy Murray announced he will retire from tennis because of a right hip injury. Murray told reporters he had been experiencing chronic hip pain for years before undergoing surgery in 2017, but the pain persisted even after the procedure
Below, Dr. Anay Patel, MD, a joint replacement and hip preservation specialist at affiliate Texas Orthopedic Hospital, answers our questions about Murray’s story and what it means for those suffering from chronic hip pain.
Andy Murray said he has been struggling with hip pain for a long time, so much so that he underwent hip surgery which was unsuccessful in treating his pain. Is that common?
It depends on what kind of procedure he had. Yes, it is common for patients to continue to have pain after a hip arthroscopy. The majority do very well, but some do fail. For him, the kind of performance and level you’re trying to reach means you’re trying to clear a much higher bar than in your more day-to-day patients.
It’s important to understand how we define success. For example, if you have a 40-year-old patient who is a weekend warrior who just plays basketball with their kid, that’s one level of performance, as opposed to an international tennis player, where they need to be performing at 100 percent. So defining success always depends on what your goal is.
When is chronic pain bad enough to merit joint replacement surgery?
That’s an excellent question because some patients don’t want to wait too long, others don’t want to do it too early and some think they’re too young for a joint replacement. What I tell my patients is that age really shouldn’t play into the equation, because I’ve [performed hip surgery] on patients as young as 16, and as old as 100. So age, for me, really doesn’t play into it.
I recommend a total hip arthroplasty when it meets three conditions:
- It’s going to fix the problem the patient has.
- The patient is going to use it. (I don’t care how long they’re going to use it – if they’re going to get up and walk then the surgery can help them.)
- The risks of the surgery aren’t greater than the benefits.
When a patient comes in and says they feel some soreness in their hip when they run 5 miles but don’t have any pain when they’re walking or at work or putting on socks and shoes, that patient probably isn’t an ideal candidate for a hip replacement.
On the other hand, if you have someone who feels pain when they sleep at night, when they get up in the morning their hip is stiff, by the end of the day it’s sore, they have trouble putting on shoes and socks or using a toilet comfortably, or sex has become very painful, patients like that, where the day-to-day activities that we take for granted are limited, those are patients who should have a discussion about a hip replacement.
It really boils down to: What are you trying to get the patient back to? What kind of activity are you trying to have them do that they can’t do right now because of their arthritis? And so running 5 miles is not something I think most arthroplasty surgeons want their patients doing.
On the other hand, living your day-to-day life and going to work, being able to put on your shoes and socks, those are obviously things people need and want to do, and a hip replacement could certainly allow someone to achieve those kinds of things.
What are some of the myths about hip replacement surgery or reasons people are hesitant to get it?
Myth 1 – Only older people get hip replacements
People worry that [getting a hip replacement] is going to put them into a box of an elderly person or retired person. The myth that this is an operation for an older person is just that, it’s a myth. It’s just an operation for anyone who has severely limiting hip pain.
I have many patients who are in their 30s, 40s and 50s who developed severe hip arthritis for one reason or another and they get their hip replacement done, their pain goes away and they’re back to life. They’re not back to sitting in a chair and barely getting around, they’re back to hunting, they’re back to playing tennis, they’re back to playing with their grandkids and dancing and riding their tractors and working on their cars.
Myth 2 – Hip replacements only last 10 years
A lot of patients have this mind set about how long a joint replacement is going to last. What we tell patients is that it’s not so much how long it lasts, it’s more: What are the chances that you might need another surgery?
The modern replacements that we have nowadays, the 10 year survivorship rate is probably close to 92 to 95 percent. So in 10 years, 92 to 95 percent of people have not needed another surgery. I tell patients a good rule of thumb is that for every year you’ve had the joint replacement in, there’s about a 1 percent chance you’ll need another surgery. So, by 10 years it’s 10 percent, by 20 years it’s 20 percent, by 30 years it’s 30 percent.
The myth that there is a limited lifespan on these things is not true. A certain percentage of patients will need to have surgery again, but that number is quite low, even after 20 and 30 years.
Myth 3 – You’ll be recovering in bed for weeks
People also worry: “How long am I going to be in bed?” Well, you’re going to be in the operative bed for maybe an hour and a half and then after that you shouldn’t be in bed unless you’re sleeping. We want you up and walking. That gets the hip moving, it improves the range of motion and it keeps the blood clots away.
Where we perform [these procedures] at Texas Orthopedic Hospital, the surgery itself usually takes about an hour to an hour and a half, we get the patients up on their feet usually two hours after surgery and some patients go home the same day. For others, they may stay one night but they’re up and walking the same day of surgery.
A lot of our patients are back to office-type work in a couple of weeks and back to more non-sitting work in up to six weeks.
Myth 4 – Total hip replacement is the only option
There’s also a myth that there’s only one type of hip replacement procedure, which is a total hip replacement. There are other procedures, like hip resurfacing, which treat the same problem as [total] hip replacement, but they can allow for higher functionality, meaning there are patients who get hip resurfacings who can run long distances on that, people can play professional sports on hip resurfacings.
Not all hip replacements are created the same, there is a small spectrum there. Some of those alternative options can certainly allow a patient to do high-level athletics. And there are professional athletes out there in the world competing at the highest levels who have had what’s called a hip resurfacing as opposed to a hip replacement.
To people who read Murray’s story and might be discouraged about their chronic pain, what would you say to them?
You don’t have to live with hip pain or feel sad or helpless. We have a very good operation that will allow you to hopefully maintain all of your functionality. The patient satisfaction rate with hip replacement is somewhere between 98 and 99 percent, so it’s a very reproducible and very reliable surgery.
And you also don’t need to worry that just because you’re going to see a hip replacement surgeon that you’re 100 percent going to have surgery. We have surgeon in our title, but that doesn’t mean that you have to have surgery. If you are struggling with severe hip pain and aren’t sure how to proceed, talk to a well-trained hip replacement surgeon and look at your options.