Hockey Doc

The Hockey Doc: Hip arthritis and skating

By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: I am a 50-year-old who developed hip arthritis 18 months ago. I attempted to play through my injury for six months, but then I had to stop. After a thorough workup, I was sent to rehabilitation and after this I have almost no pain. While I have hip stiffness and tightness and the decreased motion, I would like to try and skate again. Do you think this is possible? 

Answer: In recent years, it has been well recognized that hockey players have a much higher risk for development of hip arthritis. It has been found that even in youth hockey players that increased hours on the ice leads to damage of the growth plate and the development of femoroacetabular impingement. This condition is believed to be due to continued microinjury of the growth plate of the femoral neck, leading to a bony bump, which than causes a tearing of the “bumper” of the hip, the labrum. The increased bone on the femoral neck and labral tears can lead to development of arthritis over time. It is well recognized now that the development of hip problems in hockey players is more than in any other sport and significantly higher than in non-athletes in the population.  

Unfortunately, most hockey players do not start to have symptoms until the hip problem is well advanced. A thorough workup is necessary to include evaluation of one’s hip motion and strength, X-rays and an MRI scan to best define the problem. Most hockey players with decreased hip motion and hip pain, surgery to decrease the size of the bony bump and to repair the labrum can be quite effective. However, a large percent of these athletes also have some underlying arthritis, which is very difficult to treat.  

In your circumstance, it appears that the amount of arthritis is such that an arthroscopic hip surgery would not be beneficial. While hip arthroscopy is relatively new portion of sports medicine, there are sufficient studies to demonstrate that athletes who have less than 2 mm of joint space do poorly with hip arthroscopy. In fact, a large number of these go on to needing total hip replacements within a few years.  

In your circumstance, I would certainly recommend that you continue on a low-impact exercise program. While improving your range of motion may not be possible due to bony abutment due to the extra bone overgrowth from this condition, it is important to stretch daily to make sure that your range of motion does not become worse. In addition, participation in low-impact activities, which include cycling, swimming, the use of an elliptical machine and walking can be very effective with a special focus on hip area specific exercises (hip flexion, hip adduction and abduction, hip extension and other areas) can improve your overall strength, decrease your symptoms, and allow you to try to increase your overall functional levels.  

In general, hockey is considered a low-impact sport. It generally does not lead to progressive arthritis when one participates in it like one would with running, basketball or other pounding activities once one develops arthritis. Thus, attempting to return to playing hockey may in fact be beneficial if use it as part of your rehabilitation program. However, if you do experience any significant pain, swelling or stiffness, then it would be recommended to either cut back on your on-ice dash time or to avoid skating if it causes any further progression of your arthritis.

Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado.  He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to This email address is being protected from spambots. You need JavaScript enabled to view it..