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Why Andy Murray’s return to tennis after hip resurfacing is a risk

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One of the UK’s greatest ever sportsmen, Andy Murray recently made his tennis comeback following a two-year struggle with hip injuries, almost retiring after the Australian Open earlier this year. Can Murray rediscover the form that made him World Number One and double champion at Wimbledon? Hip surgeons Winston Kim and Adam Hoad-Reddick explain the challenges facing the 32-year-old facing the biggest battle of his career to date.

Speaking to The Telegraph at the beginning of the year, describing the worst 18 months of his career that saw him fall from World No. 1 in the summer of 2017 to world No. 214 by June 2019, Murray said: “My hip was always on my mind because every single step I took was painful. I don’t think I realised how much it was affecting my general well-being and happiness.” The diagnosis was an early onset of arthritis in his right hip and the prospect of lifelong pain.

Facing imminent retirement and a life away from Tennis, Murray made the decision to undergo an operation that is more commonly reserved for those aged above 50, in a procedure described as a “last resort” by leads in that field. By the end of January, the Scot went under the knife for the second time to undertake a hip resurfacing.

“There is no turning back from now,” says Winston Kim, a hip surgeon from Manchester Hip & Knee Clinic. “It was clearly a very carefully considered decision. He will have had an awareness of the intended benefits of resurfacing. If it fails, the next option would be a hip replacement. I’m sure he didn’t take the decision lightly; the vast majority of hip surgeons would be nervous about performing a hip resurfacing because of the potential risks, particularly in such a young, elite athlete.”

 

What is hip resurfacing?

Hip resurfacing is a procedure that involves implanting a metal cap onto the ball of the hip joint and a metal socket into the ‘cup’ of the hip joint. The procedure is a risky one and divides opinion amongst leading surgeons who debate the risk of ‘metal on metal’, particularly for an elite sportsperson and someone of Murray’s age looking to play high-level tennis again.

Adam Hoad-Reddick, a hip surgeon at the Alexandra Hospital in Cheadle, Manchester, says: “It’s slightly controversial, who should be having a resurfacing and whether it’s a better thing or not. Fit young men who want to get back to impact activity are one sub-group of patients who probably benefit from hip resurfacing, but that’s balanced with the risk of metal wear leading to raised metal ion levels.”

 

Is hip resurfacing risky?

Some doctors point to evidence that suggests that high blood metal ion levels can result in future osteolysis, which is the destruction of tissues around the joint of the hip.

“He wants to be able to play again, so he’s doing something relatively risky,” says Kim.

“The average age for resurfacing is in the early 50s, so a 32-year-old elite athlete wanting to return to playing tennis at the highest level within four months is in unchartered territory. Research says that 90 per cent of runners in their early 50s who undergo hip resurfacing are able to return to running. That’s just runners and I’m not even giving you a time frame, and it’s still just a 90 per cent return.”

Kim goes on to explain: “There’s a difference between being able to run and being able to play tennis at the highest level play with abandon.”

 

Can Andy Murray come back?

Andy Murray is one of the most successful tennis players of his generation, and arguably one of the greatest UK tennis players of all time. Murray’s success, including winning three Grand Slam titles and two Olympic Gold medals place him at the top of the tennis mountain, and is built on an innate determination and will to respond to career setbacks.

Hoad-Reddick says that those characteristics, although admirable, may prove to be a hindrance rather than helpful in Murray’s attempt at a tennis comeback, saying: “It’s incredibly important, in terms of willingness to return, to be determined and strong mentally. But it could be a negative. Will he ignore niggles and pain that he should be listening to more? If you push on and push on, you may end up in a chronic situation where you fail to fully recover.”

“I wonder why he’s chosen to come back at four-and-a-half months, rather than say: “I’m not going to play at all this season, I’m going to try and fully recover and come back as a doubles player next year.”

While acknowledging that the people advising Murray will be industry-leading, Kim is also surprised that the Scot is aiming to return to action at Queen’s, less than five months after surgery. “Naturally, surgeons are cautious,” he says.

“Lots would say: ‘Take it easy, maybe think about six months’ time.’

“One should consider what the worst-case scenario is. If he rushes his recovery, the danger is that he sprains a muscle around the joint, which results in tearing a muscle. He has to balance those risks, it’s a very difficult call.”

 

The Bob Bryan example of a tennis return

What about a full return to professional tennis? Is this even feasible? Well, maybe so, it is not entirely out of question.

Famed American doubles tennis player Bob Bryan had a hip resurfaced in August 2018 and recently reached the quarter-finals of the Australian Open and won the Miami Open this season, completing a successful comeback to the tour. “There is no pain, that’s the crazy thing,” Bryan, who Murray described as his ‘bionic brother’, told BBC Sport in April.

“It looks like he (Murray) is doing really great. It’s kind of how I felt after surgery – it felt like there was no hip.”

 

What does the tennis future of Andy Murray hold?

If Murray does manage a successful comeback to tennis, he could look more at playing doubles tennis, which is less demanding on the body than singles tennis, as evidenced by his recent teaming with Serena Williams in the mixed doubles at Wimbledon in 2019.

“It’s probably not the playing that’s the problem,” Hoad-Reddick says. “It’s the hundreds of hours on court and in the gym to maintain his fitness and keep his level up. The physical exertion and cost to his own body will be less if he’s training to do doubles rather than singles. You don’t need the same level of fitness.”

As for Murray himself, it seems that for Murray, just being able to walk pain free and life a comfortable life is the most important thing. “I don’t need tennis to be happy anymore,” he said in the same the Telegraph interview. “I’ve realised what’s important.”

Kim says: “He was struggling to do even basic things. It sounds like it’s been a great success in terms of addressing the pain. It was obviously a quality-of-life decision.” Murray can look forward to a life of playing with his kids, putting on his socks, and even sitting at the dinner table without pain, playing tennis at a high level would be a bonus.

Murray’s philosophical outlook, rather than his fierce competitiveness, will ensure he has the best chance of making more memories on court without risking his long-term health. Will we see Andy Murray’s name on the Wimbledon trophy once more? Well, it’s happened twice before so we wouldn’t rule it out just yet.

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