Two Hips. Two Knees. What Can Semyon Varlamov’s Injury History Teach Us About Goaltending?

Semyon Varlamov is attempting something remarkable.

At 38 years old, after nearly 22 months of rehabilitation, he is back participating fully in New York Islanders training camp after undergoing partial knee replacements in both knees.

That alone is an incredible return-to-performance story.

But when I started looking deeper into his injury history, I became interested in a different question.

Why both knees?

And then I found something even more interesting.

Both hips too.

Varlamov's lower-extremity injury history goes almost all the way back to the beginning of his NHL career. Groin problems appeared when he was only 21. Knee injuries followed. Then more groin problems. Eventually, his recurring groin symptoms led to hip surgery in 2017, with procedures performed on both hips.

He returned to the NHL, suffered a significant traumatic left-knee injury in 2018, continued playing for several more seasons and eventually reached the point where both knees required partial replacement.

We don't know exactly why.

And that distinction is important.

I don't have Varlamov's imaging, surgical reports, strength testing, range-of-motion measurements or movement data. There is no evidence that his hip surgery caused his knee degeneration, or that playing goalie caused him to need four major joint procedures.

But when the pathology is bilateral, I think it's reasonable to ask whether there is something both sides have been exposed to.

And that's where the position itself becomes interesting.

The Butterfly Is a Whole-Leg Movement

Modern goaltending asks the lower extremity to operate in positions that are very different from normal skating.

Research examining butterfly and RVH positions has demonstrated substantial hip internal rotation combined with knee abduction, knee external rotation and ankle external rotation.

In other words, the butterfly isn't simply a hip movement or a knee movement.

The entire lower extremity has to organize rotation while simultaneously absorbing and producing force.

Research measuring butterfly landings has found forces around 1.45 times body weight at the knee, while the hips approach their passive limits of internal rotation.

One butterfly isn't particularly interesting.

Neither are ten.

But what happens after tens of thousands of them?

Games are only part of the exposure.

There are practices. Goalie sessions. Warm-ups. Off-season training. Camps. Skill development.

And years of repetitions accumulated before a goalie ever reaches professional hockey.

That makes Varlamov's bilateral history worth thinking about differently.

His Hips May Be an Important Part of the Story

Varlamov experienced recurring groin problems for years before eventually requiring hip surgery.

That's an important progression because where an athlete feels symptoms isn't necessarily where the entire problem resides.

Femoroacetabular impingement and associated labral pathology are well documented in hockey players and particularly relevant to goaltenders because of the extreme rotational requirements of the position.

Hip surgery for FAI can actually increase available range of motion.

A systematic review involving more than 2,000 patients found that internal rotation frequently improves following FAI surgery, with reported improvements ranging from several degrees to more than 20 degrees.

That's generally considered a good thing.

But from a reconditioning perspective, it creates another question that I find fascinating.

If surgery gives an athlete more motion, does the nervous system automatically know how to control it?

Probably not.

There is a difference between available motion and controlled motion.

Imagine an athlete who has spent years moving around pain or a structural restriction. His nervous system has developed strategies around the movement options available to him.

Then surgery changes the structure.

The joint may suddenly have movement available that it hasn't had for years.

The surgery can change the anatomy.

Reconditioning has to teach the athlete how to use it.

And for a goalie, we're not talking about demonstrating 25 degrees of hip internal rotation on a treatment table.

We're asking him to control that range while reacting to a puck, dropping into a butterfly, pushing laterally, recovering to his feet and repeating the process under speed and load.

We have no evidence that Varlamov failed to regain that control.

But his history raises a worthwhile question:

After bilateral hip surgery, did restoring range of motion also restore the capacity to control that range under the extreme demands of NHL goaltending?

Something Has to Manage the Rotation

The hip, knee and ankle don't work independently.

When a goalie moves into a butterfly, rotation is distributed throughout the lower extremity.

If the hip doesn't have enough motion, another part of the system may have to provide it.

But even if the hip has the range, if the athlete can't adequately control that motion dynamically, the rest of the system still has to help manage the forces involved.

The knee is part of that system.

Could this have contributed to Varlamov's eventual knee problems?

We don't know.

And his history contains another major variable that shouldn't be ignored.

Trauma.

Varlamov suffered significant injuries involving both knees during his career, including an MCL injury to the right knee early in his NHL career and a major traumatic left-knee injury in 2018 when another player slid into him.

That makes this more complicated than simply calling his knees "wear and tear."

Perhaps the better model is:

Anatomy + repeated exposure + previous pathology + altered movement options + trauma + time.

An acute injury doesn't occur in isolation from the previous 10 or 15 years of loading that joint has experienced.

And chronic exposure doesn't mean trauma doesn't matter.

They can be layered on top of one another.

Other Goalies Are Giving Us Clues

Varlamov isn't the only NHL goalie whose career makes these questions worth asking.

Tuukka Rask underwent hip surgery after chronic hip problems. He described difficulty dropping into and recovering from the butterfly because his hip would catch and hurt.

Carey Price eventually developed significant knee cartilage damage. When discussing why returning to goaltending was so difficult, Price specifically pointed toward the torque and contortion involved in playing the position.

Ben Bishop made a similar observation after his knee problems. He believed he might have been able to continue playing if he were a forward, but the butterfly and the torque it placed on his knee made playing goal unrealistic.

Those comments are important.

A knee doesn't simply have to be "healthy enough to play hockey."

It has to possess enough capacity for the specific demands of playing goalie.

Those are very different standards.

The Part of This Story That Concerns Me Most Isn't the 38-Year-Old

It's the 12-year-old.

Matt Murray has also undergone surgery on both hips.

When discussing goalie workload, Murray has said that his surgeon believed much of his hip damage may have developed between roughly ages 12 and 16, when he was on the ice daily and sometimes multiple times per day.

Murray now intentionally avoids unnecessary butterfly repetitions in practice. If shots don't require him to drop, he may stay on his feet rather than accumulating another repetition simply because a puck was shot at him.

NHL teams are beginning to think similarly.

Some organizations are now monitoring butterfly "drop counts" or goalie workload during practices, and wearable technology is increasingly being used to quantify those demands.

That raises a much bigger question.

If professional teams are starting to manage butterfly volume in fully developed NHL athletes, should we be thinking even more carefully about that volume while athletes are still growing?

Hockey May Need Its Own Pitch-Count Conversation

Baseball has spent years wrestling with this issue.

Throwing is obviously necessary to become a pitcher.

The answer was never to stop young athletes from throwing.

The question became:

How much?

How many pitches?

How many innings?

How much rest?

How much year-round throwing?

How much specialization?

And how should those exposures change as the athlete develops?

Baseball eventually began implementing age-specific pitch counts and mandatory recovery periods.

Maybe goaltending deserves a similar conversation.

A young goalie obviously needs butterfly repetitions.

You cannot learn the position without practicing the position.

But does a 10-, 12- or 14-year-old need to drop on every shot during every drill?

Does every warm-up shot require another butterfly?

Do we distinguish between a repetition that develops a skill and a repetition that simply adds load?

Should goalie coaches track butterfly volume?

Should that volume change during periods of rapid growth?

Should we spend more time developing hip rotational capacity, strength and neuromuscular control before dramatically increasing butterfly exposure?

And perhaps most importantly:

Do we actually know how much is too much?

Right now, we probably don't.

That doesn't mean exposure doesn't matter.

It means we need to start asking better questions.

Don't Blame the Butterfly

The conclusion shouldn't be that the butterfly is bad.

It's fundamental to modern goaltending.

The better question is whether we're preparing athletes to repeatedly tolerate what the position demands.

Varlamov's career provides an extraordinary case to think about.

Both hips operated on.

Both knees eventually partially replaced.

Significant traumatic knee injuries layered into the history.

More than 600 NHL games and decades of goalie-specific movement behind all of it.

And now, at 38, an attempt to return to the NHL after bilateral partial knee replacement.

Maybe Varlamov's history is simply the unique accumulation of anatomy, injuries and an extraordinarily long professional career.

We shouldn't pretend we know.

But perhaps his story gives us an opportunity to look further upstream.

Instead of waiting until a professional goalie has hip or knee pathology and asking how to fix it, perhaps we should also be asking what we're exposing goalies to while they're developing.

Baseball eventually learned that developing pitchers required more than teaching them how to throw harder.

It also required understanding how often they should throw.

Maybe hockey needs to start having the same conversation.

Maybe it's time we started counting butterflies.