Returning to professional ballet with a hip replacement before the age of 40

The Impact of intensive ballet practice on the hip

Ballet training usually begins early in life, sometimes as young as six years old. Dancers train intensively, repetitively, and continuously throughout their careers.
The hips are subjected to extreme ranges of motion and repetitive high loads. Pain and injuries are therefore common throughout a professional dancer’s life.

A frequent concern arises : “ What if I am a professional dancer under 40 with hip osteoarthritis? Can I return to professional ballet after receiving a total hip replacement before the age of 40? ”

These are questions our team regularly hears from dancers during consultations.

Signs and diagnosis of hip osteoarthritis in dancers

The onset of coxarthrosis (hip osteoarthritis) in a professional ballet dancer manifests as mechanical groin pain, later radiating around the hip and down the thigh. A progressive loss of joint mobility develops, making dance movements increasingly difficult.

Standard imaging typically shows joint space narrowing, subchondral cysts, and osteophytes.
Sometimes, even before osteoarthritis appears radiographically, cartilage and labral lesions of the acetabulum can be detected. It is not uncommon to also observe hip dysplasia or femoroacetabular impingement (FAI).

When there is severe cartilage damage (with or without dysplasia, with or without osteoarthritis) arthroscopic or conservative surgery is no longer appropriate. At that stage, total hip replacement becomes the only viable option.

Preoperative evaluation : a crucial step

For a professional ballet dancer, a comprehensive physical examination is essential, assessing leg length, joint range of motion, especially external rotation, turnout, flexion, and extension.

While standard X-rays confirm the diagnosis, 3D CT-based preoperative planning is indispensable for detailed analysis of hip anatomy and geometry.

3D Planning and custom-made hip prosthesis

Once the decision for hip replacement is made, the procedure is planned in 3D and life-size, using the patient’s CT scan. A custom-made prosthesis is then designed and manufactured specifically for the patient before being implanted by our surgical team.

This 3D planning combined with a custom implant allows precise restoration of the native hip anatomy, optimizing:

• The center of rotation
• The articular length
• The medio-lateral offset
• The femoral anteversion

Such anatomic precision restores muscular balance, joint mobility, and especially external rotation (turnout), essential for ballet performance.

Choice of implants and surgical approach

Implant selection favors a cementless prosthesis, ensuring solid and durable bone fixation. A ceramic-on-ceramic bearing is particularly suitable for young, active dancers.  In specific cases, a dual mobility cup may be considered.

Surgery must always be performed through an anterior approach, which preserves the musculature.
It is crucial to protect the external rotators, abductors, and periarticular muscles to maintain the dancer’s balance and strength.
The precise positioning of implants is key to reproducing the planned anatomy and ensuring optimal biomechanics.

Rehabilitation and return to dance

Postoperative rehabilitation is structured in phases, beginning with static muscle maintenance exercises, followed by gradual recovery of range of motion.
Dance movements are reintroduced early, starting with floor barre work and physiotherapist-supervised exercises.

The reconditioning phase is essential to achieve symmetrical recovery of all muscle groups, preventing future pain or injury upon return to dance.
A progressive return to professional-level ballet can generally be considered between three and six months, depending on postoperative recovery and preoperative joint condition.

Why resurfacing surgery should be avoided in dancers

In our experience, hip resurfacing is not recommended for professional ballet dancers.
This technique has shown disappointing results in women, requires a posterior surgical approach that involves cutting the external rotator muscles — which is contraindicated — and uses a large-diameter cup unsuitable for dysplastic hips.

Excellent outcomes in professional dancers

In our published studies on professional ballet dancers under 40, outcomes are exceptional, with satisfaction scores between 9/10 and 10/10 and over 95% returning to professional-level performance after surgery.

These results confirm that, with meticulous 3D planning , custom implants, and a muscle-sparing anterior approach , professional ballet can indeed be resumed safely and successfully after hip replacement — even before the age of 40.