Returning to Activity after Total Joint Replacement

The goals of total hip or knee replacement are to relieve pain from arthritis, improve physical function and improve quality of life. A reasonable expectation is to be able to walk and perform activities of daily living without pain. However, patients who were very active before they developed arthritis often want to return to a higher level of activity after joint replacement. Many patients are able to return to recreational activities like golf, tennis, swimming, cycling, hiking and dancing. A small subset of patients is able to return to high-intensity sports such as downhill skiing and running. Ability to return to sport depends on factors such as age, gender, and pre-operative activity level.

Patients can expect significant improvement in walking after knee replacement. Studies report between 18%-55% increase in the total number of steps per day.

Most golf players (82%) are able to return to golf after knee replacement. A study from 2020 of golfers older than 50 who underwent total knee replacement showed that the average time to return to 18 holes was 3.7 months. After two years, players improved their handicap on average by 0.85, increased the amount of time they played and reported decreased knee pain while playing. Most players use a golf cart after surgery, with only 14% reporting that they walk the course.

A study of tennis players who underwent total knee replacement showed return to competitive play at a mean of 5.9 months. There was significant improvement in mobility parameters (including hitting, stopping abruptly, moving forward after serves, changing direction), with patients reporting decreased pain and stiffness with these movements. However, players did notice a loss of court speed after surgery.

The American Association of Hip and Knee Surgeons (AAHKS) provides recommendations about safe activities after joint replacement. Their list of allowed activities for all patients includes cycling, golf, dancing, bowling, rowing, weightlifting, speed walking and cross-country skiing. For patients with experience, AAHKS allows hiking, horseback riding, ice skating, rock climbing, doubles tennis and downhill skiing.

AAHKS does not recommend a return to jogging or running. Still, a recent survey study showed that despite these recommendations, 12% of patients who could run before surgery returned to running postoperatively. A higher percentage of those able to return to running had undergone hip replacement than knee replacement (75% vs. 14%).

High-impact sports like running, or contact sports like football, hockey or soccer can cause accelerated wear of the implants or loosening of the implants from the bone. Revision rates have been shown to be higher for patients with very high activity levels. However, exercise and activity have clear benefits to general health and function, and the overall benefit of moderate activity likely outweighs any risk to the implants.

Postoperative rehabilitation is key for a successful return to recreational or fitness activities. It is important to work with a skilled therapist on a rehabilitation program that incorporates strength, balance, flexibility and neuromuscular function prior to returning to physical activity. If you are thinking about joint replacement, speak with your surgeon about your goals after surgery and how to safely return to the activities you love.    FBN

By Liam Bosch, M.D.

Dr. Liam Bosch is a fellowship-trained orthopaedic surgeon who brings his expertise in hip and knee replacement to Flagstaff Bone and Joint and cares for patients suffering from arthritis. Additionally, he specializes in conducting revision surgeries for knee and hip implants, addressing any complications that may arise. With a dedication to utilizing cutting-edge techniques, Dr. Bosch offers advanced procedures, such as anterior total hip arthroplasty and robotic total knee arthroplasty. His commitment to providing exceptional care and innovative treatments makes him a valuable asset to Northern and Central Arizona. For further information, please visit: www.flagstaffboneandjoint.com.