The American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons both advise against singles tennis after a total hip replacement. Doubles tennis is recommended. More recent guidelines from the European Hip Society recommend both doubles and singles tennis.
This post is an addendum to my longer post, Running After Total Hip Replacement. Even if you’re interested only in tennis, you should read that post first, because it contains relevant background information and summaries of studies that are likely applicable to tennis.
I’m not a medical professional, and I'm not offering medical advice. You should consult with a physician or other qualified medical professional for diagnosis, treatment, and advice. The content on this site is for informational purposes only.
The American Academy of Orthopaedic Surgeons (AAOS) states:
In general, lower impact fitness activities such as golfing, bicycling, and doubles tennis put less stress on your hip joint and are preferable to high-impact activities such as singles tennis, jogging, racquetball, basketball, and skiing.
Similarly, the American Association of Hip and Knee Surgeons (AAHKS) recommends doubles tennis, but categorizes singles tennis as “Do not recommend.”
These current recommendations echo the guidelines published in 2007, which were based on a survey of more than 500 surgeons from the Hip Society and AAHKS. (Full text available here.) For tennis, the survey reported:
Based on those results, doubles tennis was given an overall classification of “Allowed,” while singles tennis was classified as “Not Allowed.”
The results of a 2021 survey of members of the European Hip Society were far more permissive:
Thus, both were classified as “Recommended.” The recommendation for doubles tennis was from 12 weeks after surgery. For singles tennis, 6 months after surgery.
As explained in my detailed post on running, there are at least two plausible explanations for the difference between US and European recommendations.
The first is bearing materials. The 2007 US recommendations were based on the assumption of a metal-on-polyethylene bearing. In contrast, the 2021 European survey asked surgeons to state their preferred bearing. While 78% did choose a polyethylene liner paired with a ceramic or metal head (66% ceramic, 12% metal), 17% chose ceramic-on-ceramic, <5% dual-mobility, and <1% metal-on-metal.
It’s possible that some European surgeons would allow singles tennis only with non-polyethylene bearings, like ceramic-on-ceramic. If the European survey had stipulated polyethylene liners as the US survey did, perhaps singles tennis would have lost support, such that the overall recommendation might have shifted to “Undecided.”
The second possibility for the difference in recommendations is timing. The 2007 US guidelines reflect outcomes from earlier generations of polyethylene liners, whereas the 2021 European guidelines reflect outcomes from highly cross-linked polyethylene (HXLPE) — which significantly reduces wear and related complications.
Searches via Google, PubMed, and Consensus AI turned up very little tennis-specific research.
A 1999 survey of competitive tennis players (50 men, 8 women; average age 70; average 8 years after total hip replacement) found that one year post-surgery, all were playing singles and doubles roughly three times per week. Before surgery, all had hip pain while playing, whereas only 16% did at follow-up. National Tennis Rating Program ratings for the group remained similar (4.25 pre-op vs. 4.12 at follow-up). Players reported improved court mobility, reduced speed, and less pain after surgery. (Some details come from a summary of the study.)
A 2024 study by British researchers followed two groups of patients — each exceeding 500 individuals — one during their first five years post-op and another during their second five years. They found no increase in revision rates with higher-intensity activities. However, they did find that certain activities — such as snowboarding, squash, tennis, and backpacking — may be associated with increased pain.
The only other tennis-specific paper I found was a 2025 registered protocol for a future systematic literature review. The planned review aims to consolidate evidence on post-surgery outcomes in tennis players, including implant types, pre- and post-surgery levels of play, return-to-play timelines, and differences between singles and doubles tennis.
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Posted May 2026.