Predictors of Career Length after Hip Surgery in Hockey Players
Having hip surgery can be a big decision for a hockey player. Unfortunately, it is a decision that more and more hockey players are having to make. Along with this decision comes other daunting thoughts.
For example, when to have it, how long they will be off the ice, whether they'll be able to play again next year, etc. Knowing which pre-surgery factors put players in a better position to succeed may help make the decision to have surgery an easier pill to swallow.
Before we dive into it, I want to make it clear that the term “prediction” is used loosely within the context of injury research. Historically, we haven't always been great at predicting events (the weather, 2008 stock market crash, the 2019 St. Louis Blues winning the cup from last place, etc.).
We must take precautions before assuming the trends observed are capable of predicting future events. Instead, the purpose of this article is to discuss factors that have shown to lead to more optimal outcomes for hockey players returning to sport after surgery to help players, coaches and practitioners make more educated decisions and recommendations for hip treatment and surgery.
Predictors of Career Length after Hip Surgery
Menge et al. (2016) studied factors associated with career length greater than 5 years after hip surgery in NHL players. In total, 67% of players played 5 years or more after having surgery. Across all players, the researchers found two factors that were best associated with how long players played for after surgery:
1. Duration of symptoms before surgery and
2. Age at time of surgery.
1) Duration of Symptoms
Menge et al. found that those who had symptoms for longer before surgery had shorter careers after surgery. Those who played 5+ years after surgery had symptoms prior to surgery for an average of 9 months, while those who played less than 5 years post-surgery allowed symptoms to persist for an average of 20 months before having surgery. In other words, players might positively impact their longevity post-surgery by electing to have surgery done sooner, rather than later. These results are similar to other studies looking at return to sport after hip surgery.
In a previous article (you can read it here), I wrote about research on return to sport after hip surgery which showed that players who had symptoms for less than 8 months before hip surgery had shorter return to sport times, which would mean more time in sport after surgery.
In the article, I also discussed the potential impact of return to sport time on sport performance. Although Menge et al. did not measure sport performance or hip function after surgery in their study, I discussed some of the deficits in hip function still present at one-year post-op. In a lot of the research articles looking at return to sport after hip surgery, return to sport time is typically 6-8 months.
In Menge et al.'s study, they observed an average return to sport time greater than 9 months (9.6 months) with 67% of players playing 5 years or more after surgery at their pre-surgery level, which is a longer return to sport time than other studies. Spending more time in rehab and return to sport phases focusing on hip function and performance training may improve post-op hip function and sport performance. Further, continuing to focus on hip function in sport training could also positively impact early drop off rates (< 5 years after surgery) often seen after returning to sport, leading to longer careers.
2) Age at Time of Surgery
Menge et al. also found that players who had surgery at a younger age had longer careers after surgery, compared to those who were older. In general, this is consistent with what we would expect, given that younger, healthy individuals typically have faster recovery times. They found that those who played more than 5 years after surgery had an average age of 25, while those who played less than 5 years had a mean age of 30. This could be due to the body taking longer to recover, but it also could be related to the degree of degenerative changes in the joint from aging.
Although, in this study they didn't find any correlation between the degree of degenerative changes and career length, other studies have found significant findings between degenerative changes and hip function (Lund et al., 2017; Davis et al., 2018) which might have an impact on post-op hip function and the need for subsequent hip surgery. Another potential reason for this could simply be that the older players are chronologically closer to retirement, therefore playing less than 5 years after surgery could have had nothing to do with surgical outcomes.
I want to make sure this isn't interpreted as recommending surgery as a proactive treatment or a path that should be pursued at the first sign of hip problems. Instead, I think this speaks to those who may be more inclined to delay treatment or to continue with conservative symptom management strategies, even when there are no signs of improvement.
As coaches and practitioners, we don't have control over the age at which hip symptoms arise. However, we play key roles in guiding athletes to health and success in part through education and recommendations.
What this study by Menge et al shows is that although players may be able to continue to play through symptoms in the short term, it may come at the cost of their ability to play in the long term.
The take-home message is don't let persistent hip pain persist.
Hip pain should not be interpreted as the new “normal” for hockey players. Not only can it affect performance now, but it can also affect players' abilities further down the road. Instead, players experiencing hip pain should seek out early conservative treatment from rehab professionals to manage symptoms and improve hip function. If hip pain persists with conservative treatments and there is no improvement in pain or function, consulting an orthopedic specialist might be required. The evidence suggests that early intervention for hip pain in hockey players could lengthen one's career.
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Matt has done a great job synthesizing the latest hockey research for us here. You can read his previous articles on hockey specialization and hip mobilization linked below.
Follow Matt on Twitter (@mkellypt).
