What activities are allowed after knee and hip replacements?

Patient category: Sedentary 80-year-old

Patients in this category are around 80 years of age and older and lead a relatively sedentary life. The main reason this patient is likely to want joint arthroplasty is to be able to walk around pain-free.

Even if you are a sedentary patient, it’s still important that you walk daily, setting a goal number of steps is crucial (for eg 6000) after your surgery. Regular aerobic exercise will help maintain cardiovascular and lung health, reduce incidence of chronic diseases, and improve your general wellbeing.

With this type of activity level, your prosthesis should last you up to 20 years.

Patient category: 60- to 75-year-old who plays bowls or golf

Patients in this category tend to be around 60- to 75-years-old. They might find that they can no longer walk as far as previously or finish a game of bowls or round of golf due to pain.

These patients are likely to walk well again after surgery. There’s no reason that they can’t return to participating in activities like golf and bowls again after their arthroplasty, provided they do their rehab properly.

Your prosthesis should last for up to 20 years if you fall into this category.

Patient category: 50- to 60-year-old runner

Patients who fall into this category are among our younger patients that come in for arthroplasty. Usually in their 50s or 60s and with arthritis, they are often very active (runners for example) and want to return to the same level of activity after their arthroplasty.

While there’s no evidence to suggest that you can’t run or do high-impact sports after arthroplasty, we can’t guarantee that this will happen. What we can say is that it may be difficult to participate in ultra-events, such as the Comrades or Ironman, after arthroplasty. If you do these events, it’s highly unlikely that you will be able to compete at the same pace or level as before the operation.

Studies show that some patients who have returned to running (and other high impact activities) develop knee pain again or pain in different areas because their body is compensating. It is common for these patients to have swollen knees and discomfort.

It’s understandable that many patients are eager to return to their activities and sports. However, it’s important to remember that you’ve just had major surgery. Your rehab must be done properly, and you need to avoid doing too much too fast.

Patients in this category are likely to wear the prosthesis out in anything from five to 15 years, depending on their level of activity and the intensity of that activity.

The relevance of impact and intensity level

Below we break down activities according to whether they are low or high impact. However, please note that the intensity at which these activities are undertaken also contributes to their impact level. Anything done in extreme becomes a high impact activity. For example, a walk around the neighbourhood is a low impact activity. But speed walking or hiking up the side of a mountain is an intense form of walking which makes it a high-impact activity.

It is also important to have realistic expectations when returning to any activity, regardless of the impact level. If you’ve never played lawn bowls before, it’s unlikely that you’ll be able to do it at a reasonable standard after your arthroplasty. If you already had a degree of skill in the activity that you want to do, the return to that activity will be much easier than for someone who’s never done it before.

When you return to activities, setting goals can help you to measure your progress. For example, walk 250m and back again. Do this daily and measure the amount of time it takes to do it to see if it is starting to take less time.

High impact activities

There isn’t evidence to suggest that high-impact activities will cause loosening of your prosthesis. However, doing high intensity and high impact activities could wear out the plastic, polyethelene liner of a knee prosthesis or of a hip implant, faster. High impact activities also carry an increased risk of falling and fracturing or dislocating joints.

If your goal is to do a high impact sport or activity at the level you’re currently doing it, then you may need to reconsider whether arthroplasty is the right treatment option for you.

As orthopaedic surgeons, we tend to be cautious because we want to ensure the longevity of your implant and try to avoid additional procedures. I like to compare your implant to a car’s tyre. If you’re only driving on the highway, that tyre will last long. If you are driving off-road and 4×4 tracks, it won’t last as long.

High impact activities include:

• Running and jogging
• Tennis
• Squash
• Rugby and other contact sports
• Kite surfing
• Surfing
• Basketball

Low and intermediate impact activities

After a recovery period of 6 – 8 weeks, patients can, after being given the go-ahead by their surgeon, start participating in low to intermediate intensity activities again.

These include:

• Walking
• Swimming
• Bowls
• Cycling at lower speeds
• Playing golf (Although we’ve classified golf as a low impact activity, the amount of force that goes through the knee when you swing a driver in golf is equivalent to running. However, the number of cycles in running is more than the number of cycles in golf, which is why we consider golf low impact and running high impact).

Recovery and rehab

To return to any level of activity after arthroplasty surgery, it’s vital that you religiously follow the rehab programme that your physiotherapist (or biokineticist) has provided. This will ensure that your muscles stay strong and that your balance is good. Focusing on quadricep and hamstring strength is crucial.

Without rehab, your joints may become swollen, and you could experience pain and discomfort. The more diligent you are with your rehab, the sooner you’ll be able to get back to doing the things you enjoy at your pre-surgery level of function.

Another factor in your recovery and return to activities is the amount of confidence that you have in your new joint. Each person is different, and we can’t tell you how long it will take before you have faith that your new joint will support you. The only way you’ll know for sure if you’re confident in your joint is if you try to do the activity in question.

It’s also important to remember that recovery from a hip replacement is usually quicker than for a knee replacement. Please don’t compare your recovery with someone who has had a different joint replaced.

If you are overweight, losing weight will mean that you exert less force on your implant, which means that your discomfort is likely to be less.

Most of my patients can drive anytime from two weeks post-arthroplasty. You will need to be able to walk around your car unaided and do an emergency stop before being cleared to drive.

Patients usually return to work around four weeks after their surgery.

Please contact your orthopaedic surgeon if you have any questions or need more information before or after your arthroplasty.