What went wrong for Novak Djokovic at the US Open

NEW YORK -- An ailing Novak Djokovic suffered his first opening-round defeat in a Grand Slam event for more than 20 years as he was beaten 7-6 (5), 5-7, 4-6, 6-2, 6-1 by Argentina's Mariano Navone on Sunday.

Djokovic vomited courtside several times and looked in severe pain at times in the last set and a half as the 25-year-old Navone clinched the biggest victory of his career.

The 39-year-old Djokovic battled to the end, but had nothing left as the Argentinian inflicted his first defeat in round one at a major since the 2006 Australian Open. Navone won 11 of the last 12 games to triumph after four hours, 35 minutes.

"When it comes to match itself and overall feeling of how I felt with body and playing, it was really not enjoyable," Djokovic said after the match. "I pretty much despised every moment that I spent on the court for that."

Here's what happened -- and what it might mean.

Djokovic was struggling from the start

The 24-time Grand Slam champion came into the US Open short on match practice, having played just once since his semifinal run at Wimbledon, losing his opener in Cincinnati. After that match, he revealed he had been struggling with a health condition that often flared up in humid conditions.

Everything looked good when he led 4-1 in the first set, but from that moment on, he began to struggle. Several times, he appeared to vomit in the corner of the court. Navone was smart, extending the rallies, retrieving everything, constantly asking Djokovic to hit an extra ball. It paid off as Navone took the opening set on a tiebreak after one hour, 15 minutes.

Djokovic seemed unable to hit through Navone, but he snatched the second set and when he took the third set and broke to lead 2-1 in the fourth, it seemed like he was set for victory. But then the problems intensified, Djokovic bending double, struggling to breathe.

He had a medical timeout for a back issue before the start of the fifth set and when it began, he looked in real pain and was fighting back tears. He was unable to serve anywhere near full speed and Navone pulled away for the biggest victory of his career.

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Novak Djokovic overcome with emotion after winning point in 5th set

Navone deserves huge credit

Navone had never won a five-set match before Sunday and never gone past the third round at a Slam, but he matched Djokovic physically in the early stages and his willingness to chase everything made life extra difficult.

Even when Djokovic forced the issue and created opportunities, Navone showed tremendous resilience, saving eight of the 12 break points he faced, denying Djokovic quick games.

He also held his nerve at the end, when Djokovic somehow cut the deficit to 3-1, threatening a comeback. But Navone held firm, breaking for a sixth time and serving out for a place in round two.

What does this mean for Djokovic's future?

It's going to hurt, for sure. Djokovic is a proud champion and losing in round one is not what he envisioned. In defeat, as always, he showed his opponent great respect with a warm handshake and some kind words, but he will hate going out in the first round.

However, it's too early to say if he will be back at the US Open or not. It's worth remembering that he reached the final at the Australian Open in January and made the semis at Wimbledon, despite very little match practice.

He has talked about playing at the Olympics in Los Angeles in 2028 and though right now, that must feel a long way off, Djokovic has shown that even at 39, he can still compete with the world's best.

But it's getting more and more difficult and his quest for a record-extending 25th Grand Slam title looks a little further away tonight than it did before.

What does Djokovic's defeat mean for the tournament?

For a start, it's the first time since 2003 that a Grand Slam event does not have Djokovic, Rafael Nadal or Roger Federer in the second round.

Secondly, it blows a hole in the bottom half of the draw. With Jannik Sinner out, and Carlos Alcaraz only returning after four months out with a wrist injury, could this be the year when an American man comes through to win the title for the first time since Andy Roddick's 2003 triumph?

Frances Tiafoe and Brandon Nakashima could be the major benefactors in that section, although former champion Daniil Medvedev may fancy his chances of coming through.