Sports and exercise after joint replacement

I saw a patient in my office recently who posed a difficult problem. She was in her mid-thirties and had undergone three surgeries on each of her knees. She now presented with significant arthritis in both knees, and her pain limited her ability to run and play sports. She was frustrated and confused.

Bone-on-bone arthritis and pain that limits activities of daily living is a common clinical scenario for patients in their sixties and seventies. If traditional management of arthritis pain, such as anti-inflammatory medications, activity modification, use of assistive devices, etc., are no longer relieving pain, then joint replacement surgery is a logical decision. But is that decision as straightforward for our weekend warrior in her mid-thirties?

A recent article in the journal Sports Health reviewed the current literature regarding physical activity after total joint arthroplasty. Laura A. Vogel, BS et al. offered the current opinions and recommendations about what levels and types of activities are appropriate after joint replacement surgery.

Knee replacement x-rayFor those of you not yet familiar with the pain of arthritis or the limitations on physical activity, let me explain some of the issues. Joint replacements are surgeries where the surgeons essentially replace worn out bone and cartilage from a joint with metal and plastic. The primary indication for these surgeries is pain, and they generally have good success in relieving it. In fact, in the United States alone, it is estimated that approximately 300,000 knee replacements are performed each year. Tweet this statistic.

As the aging population has stayed or gotten more active in recent years, patients have sought not only pain relief but also increased function after joint replacement. The concern for surgeons is that increased activity could increase the loads on those components and subsequently increase their wear rates. While maintaining physical fitness and health is certainly desirable, does that activity potentially compromise the artificial joint?

Arguments against physical activity

Many surgeons who specialize in total joint arthroplasty only recommend activities and exercise that places low stresses on the joint, such as cycling and swimming. Repetitive impact activities, such as jogging, in theory lead to higher rates of premature wear and increased chances of needing revision surgery. These revision operations are often more complicated and medical riskier surgeries. Several studies in the literature do show higher rates of revision joint arthroplasty in patients with higher activity than low activity.

Arguments for activity

Senior woman joggingAfter surgery, patients should try to maintain an active lifestyle. Not only will physical activity maintain or improve their overall health, it can increase bone quality and subsequently improve fixation of the prosthesis and decrease the chance of loosening. And there are studies that do appear to demonstrate lower rates of loosening in active patients compared to inactive ones.

Take home points

What can physically active patients planning to undergo joint replacement (or maybe recently have undergone one) learn from this debate? Since I do not perform joint replacements myself, I asked H. Del Schutte, Jr., M.D., Associate Professor of Orthopaedic Surgery at the Medical University of South Carolina and joint replacement specialist, for his thoughts.

I asked him for his opinion on activity soon after surgery. “Recovery periods vary. There are some techniques that may lead to an earlier recovery, but most studies show that everyone is the same around 2-3 months, regardless of the surgical regimen. It takes between 6 and 8 weeks for the bone to grow in and the scar tissue to mature. Even so, most patients are allowed to put full weight on their extremity from the day of surgery. In hip replacement, it is important to let everything heal before you begin an aggressive therapy protocol. Most patients are advised to walk as tolerated. Unlike hip replacements, patients with knee replacements may not regain full motion without an early aggressive therapy protocol. There are essentially no activity restrictions afterwards,” Dr. Schutte explained.

As far as physical activity affecting wear rates, he offers his insights to both sides of the argument. “In regards to how active you can be after hip or knee replacement, remember this is a moving mechanical part which can and will wear like any other mechanical part. Currently the materials used as bearing surfaces in hip and knee replacements are strong enough that it is reasonable to expect up to a thirty- or forty-year life span for the implant. These implants are analogous to tires. The more you use them, the faster they will wear. The reason for routine x-ray monitoring of replacements is in part to evaluate the rate of wear. If this process is identified early on, only the bearing surface may need to be replaced instead of the whole implant. This is a much smaller surgery with a much lower complication rate.”

He does point out that the advances in materials and designs have improved patients’ chances of returning to sports and exercise. “With newer implants, it is reasonable that patients with hip replacements can return to full activity, including golf, jogging or running, doubles tennis and skiing. The same is true for knee replacement patients. There is concern among a special category of patients with hip implants – those with metal-on-metal bearing surfaces. In some cases, these implants have been associated with very aggressive and destructive wear patterns. It is essential that these implants be monitored regularly.”

Patients who have or soon will undergo joint replacement should discuss activity restrictions and concerns about certain forms of exercise. Activity recommendations can be tailored to specific patients based on age, medical conditions, type of prosthesis, athletic goals and desires, and other factors. Dr. Schutte concludes, “All in all, it is much better to be as active as possible with your new hip or knee replacement. The advantages to your overall health from increased activity far outweigh any concerns regarding wear.”

Do you think physical activity after joint replacement is more helpful than harmful? Do you worry about wearing the joint out faster? If you have had a joint replacement, or if you are a healthcare provider, I would love to hear your thoughts. Please remember that I do not perform joint replacement and cannot answer questions about them specifically but would still love your experiences.

21 Responses to Sports and exercise after joint replacement

  1. It has been 8 weeks since I had hip replacement. I am a 59 year old very active female. No more pain and am doing great. Thank you for posting this information.

    • I’m glad you found it helpful! And I’m happy to hear that your experiences with joint replacement are positive so far. Thanks!

      • I am a 43 year old active personal trainer. In the past 3 years I have undergone bi-lateral hip replacements and then bi-lateral hip revisions. I’m finally pain free and want to go back to my active colorado life. Thank you for posting this information. It’s a relief that the hardward could last 30 years, I never want to undergo hip revsions again! Is it ok to clip on and off often on a mountain bike?

  2. I had hip replacement in 2007. I am 19 now and i couldn’t feel any better. This article is nothing new with what my doctor has told me. I do wonder if hip replacements are the same as in 2007 or if they made a better progress? I do get mad sometimes because i want to do contact sports because thats what i always liked but i have to live with what i can. I am wondering if it’d be ok if i take up boxing since its mostly upper body use?

    • The materials are slowly getting better, but i do not think there have been any landmark shifts in technology. While I can’t give you advice on what you can or cannot do, I would think boxing would be better than a sport or exercise with repetitive impact of the lower extremity since wear of the prosthesis over time would be a concern for young joint replacement patients.

  3. I think you should do an article on biological joint replacement Dr. Geier. It is the new thing and everyone is going to be doing it soon!

    I am excited because when I get old my joints will be replaced biologically!

  4. I had a knee replacement 4 years ago. I teach an aerobic class once a week but did not ok it with my DR. I guess I am worried he would tell me to quit. I will be 62 this summer and keep it low bounce but it is very active. I exercise almost daily. I was looking for wear-out information and if I should be slowing down. Not looking forward to that.

    • I definitely understand that. Most joint replacement surgeons advise patients to stick to low impact sports and exercise.

  5. I am 66 years old and have arthritis in my hip socket, so will need hip surgery. I have been taking glucosomene for the last 5 years, but it is starting to not help so am planning hip surgery in the fall.

    I am currently riding bike with my wife and have been doing approximately 25 to 30 miles going up some sloped areas. I am feeling discomfort in my hip. What should I do?

    Also, after surgery can I jog at a pace of 9 minute miles? I am active and want to keep in shape.

    • Generally low-impact activity, like swimming, biking, and doubles tennis, is recommended after joint replacement. The main concern is wearing out the components prematurely. That question can be a good one for a patient to ask the joint replacement surgeon prior to surgery.

  6. I’m a 55 yr old female and I had a hip replacement in July 2013 and the second hip replacement Aug 2014. I rollerbladed extensively prior to the first hip replacement. Now my activity has come to a halt. I want to go back to rollerblading and my Doctor said, “ok, but don’t fall”. I’m now scared to do any activity, even walking on an icy sidewalk that may put me at risk for falling. Can you talk a little about the risks of falling and damage that can occur? Thank you

    • I think the risk of any potentially high speed, high impact activity would be that a fall could cause a fracture around the prosthesis, which can be a challenging injury to treat.

  7. Hi,

    i am 35 year old male, I feel like my life is changing sadly .
    I have some cartilage defects on my left knee and on Wednesday i am going to have an Arthroscopi so the doctor can see how big or have a better understanding of what i am going to need but i have been reading a lot and he mentioned that he might have to do Allograft OATS surgery ,
    i coach soccer for living and i used to play soccer for living but i stopped 3 YEARS ago but I was planing on going back before this injury occurred, i am going in to a depression because all of this i never had an injure like this or any surgery .
    can you give me any advise or anything that can help me understanding better ,

    thank you so much in advance

    • That’s probably a better question for your surgeon, since he can judge the size of your defect and pan treatment. Generally people return to exercise and daily activities after osteochondral allograft surgery, as it fills the defect rather than leaving a hole that can progress to further arthritis.

  8. I am a 62 year old male who had a (Stryker metal on plastic)THA of my left hip (posterior approach) in December 2014 at the local Veterans Medical Facility. At my four week post op check up the doctors were pleased with my progress, which is ahead of schedule, and x-rays showed all was in a good position and healing well. My orthopedic surgeon is supportive of my goal to return to non checking ice hockey at approximately 12 months post op. I am working my way into a lower body strengthening program to build muscle support in preporation. Do you have any suggestions where I can research the best possible protective equipment and the usefulness of hip braces? I truly wish to have an informed discussion with my surgeon in July. Thank you for sharing your knowledge and expertise. Respectfully, John

    • You might try the AAOS site. Honestly I don’t do hip replacements as that falls more to the joint replacement specialists, but I would bet that their societies have that kind of information. Good luck with hockey!

  9. I am a 59 year old female who’s had 2 right knee total replacements (2010 and 2012) due to bone on bone knee pain. After the first surgery, my knee became unstable, and I had to go through a revision surgery. I will be getting a partial knee replacement on my left knee in 10 days–bone on bone on the inner part of the knee. I have been playing pickleball since October, and when I mentioned this to my doctor, she said I shouldn’t be playing this sport, or any sport that consists of a pivotal motion, like basketball, etc. Pickleball is played similar to doubles tennis. Would you agree that this is a sport that should not be played by a joint replacement (or knee replacement) patient?

    • To be fair, I am not that familiar with pickleball. Many joint surgeons have different opinions on the level of activity after joint replacement surgery. The argument would be that a sport with a lot of repetitive impact could wear the components of the knee replacement sooner than they would wear out without playing it.

  10. Hello Doctor,
    I am a 66 year old male about to have total shoulder replacement to my left shoulder. An MRI showed 80% of the bone arthritic, with spurs, bone on bone and considerable wear on the joint. I am having second thoughts though. I am a right handed hitting, avid softball player and want to continue in this sport. I was told by a fellow team-mate, who BTW just had a total shoulder replacement done about 1 month ago, stating that his Dr. told him that he would be throwing the ball and playing within 3 months if he did his therapy to the letter. Very encouraging. Now, at my pre-op 2 days ago, my surgeon told me that I should never take a full swing again, for fear of dislocating the shoulder or perhaps causing other injuries to the shoulder. If that is the case then I would have to hang it up. I feel that my surgeon makes more sense, even though this not what I wanted to hear. At least with my arthritic pain and bone on bone, I can still swing the bat around 80 mph. Anti-inflammatory medications do help some, but I hate taking something that may cause more problems in the future. Do you believe that I should just bear with the discomfort until shoulder replacement becomes an inevitable necessity? Any input from you would be very welcome.

    • I can’t give you advice, so I will defer to your surgeon. Typically those surgeries are very successful at relieving pain. Restoring normal function and physical ability is less predictable.

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