The good news is that today's advanced joint replacement techniques and implant technologies are allowing more and more patients to successfully return to many of their favorite sports after recovering from these procedures, says Friedrich Boettner, MD, a hip and knee surgeon at HSS. With proper guidance, rehabilitation, and reasonable expectations, returning to sports after hip or knee replacement surgery can remain within reach.

Setting Realistic Expectations

One of the first steps in navigating a return to sports after any joint replacement is to have an open discussion with your surgeon about your goals and desired activities before you move ahead with surgery. "It all starts with patient expectations," says Matthew Austin, MD, also a hip and knee surgeon at HSS. "Every patient is different, and their activity level before the procedure will often dictate what they want and what they can realistically do afterwards.” 

Your surgeon can provide valuable insight into which activities may be suited for your new joint, as well as reasonable timelines for working back up to different levels of athletic participation. If you were a marathoner before developing significant arthritis in your hip, you might be able to one day get back to the starting line, Dr. Austin says. But if you were more of a weekend walker, don’t expect to start doing triathlons. 

"Patients need to understand that the new joint doesn’t make them bionic," Dr. Austin explains. "We give you a new joint surface, and what you're able to do on that surface is related to what you were able to do before you had the surgery."

Low-Impact Activities: The Safest Bets

For most joint replacement patients, low-impact activities like recreational walking, golf, swimming, and cycling are achievable goals that put minimal strain on the new joint. "Generally speaking, most patients after joint replacement can fairly reliably return to these types of recreational sports," Dr. Austin says. 

The timeline for easing back into low-impact pastimes can begin relatively soon after surgery—for both hip and knee replacement—once you regain your basic mobility. If you’re a golfer, that might mean resuming putting around four weeks after surgery, hitting balls off a mat at six weeks, playing nine holes with a cart at the three-month mark, and maybe even playing a full round then, too. Some patients may even be able to return to playing a full round, without a cart, by the three-month mark, Dr. Austin says.

More Aggressive Sports: Possible but With Caveats

For those who were very active prior to developing joint issues, returning to more intense athletic pursuits like long-distance running, extreme skiing, basketball, or martial arts may be achievable as well but might require special implants, bearing options or fixation, says Dr. Boettner. Pacing yourself is also important; as Dr. Boettner cautions, overdoing it can lead to setbacks. "It's important to follow the process,” he adds. “Patients who want to return to more aggressive activities often try to do too much too early.” 

The general recovery timeline for more demanding sports is extended compared to low-impact activities. Skiers, for example, can expect a three- to six-month process of gradually building up the strength and endurance required for that sport, Dr. Austin says. 

Many surgeons discourage patients from returning to some higher-impact activities like long-distance running at all out of concern for the longevity of the joint implant—particularly for those who have had a knee replacement. The good news for pickleballers is that it’s not considered high-impact enough to avoid. “Anyone can go back to pickleball. It’s not the level of sport that we are concerned about after total joint replacement,” Dr. Boettner says. 

Hips vs Knees

Hip replacement causes less pain and stiffness than knee replacement and therefore tends to be an easier procedure from which to recover, Dr. Austin says. Knee replacement patients also have to focus more during rehab on regaining range of motion in their new joint, which can impact their ability to return to certain sports. 

Recovery from total knee replacement tends to take six to 10 weeks versus four to six weeks to recover from a hip replacement, says Dr. Boettner. For either procedure, people with a lower body mass index, men, younger patients, and those with better function in the affected joint or joints before surgery are more likely to resume their regular level of activity, he adds. 

Hip implants are also better able to endure the force of more rigorous sports like soccer and distance running, whereas knee implants are not yet able to withstand such stress, says Dr. Boettner.  

“People are not able to do the same high level of sport with a total knee replacement as a total hip replacement, but they can still live a very active life,” he says. “They can ski, bike, hike, but not at extreme levels. And for the average person, that’s more than enough. If you’ve had end-stage knee arthritis and you can go back to playing one and a half hours of tennis or riding your bike 50 miles, that’s still an amazing outcome.” 

Maximizing Your Outcome Through Rehab

Regardless of your specific athletic goals, adhering to your prescribed rehabilitation regimen is critical for achieving the best possible outcome after joint replacement.

"Patients need to follow their physical therapy regimen to the letter," Dr. Austin advises. "They’ve often gone into their surgery in a weakened state from arthritis, and the surgery itself is a stress on the body that they need to recover from." 

The initial phases of physical therapy focus on regaining basic abilities like walking safely without assistance, navigating stairs, and performing activities of daily living like bending and lifting. As patients progress, the emphasis shifts to rebuilding the muscle strength, endurance, and flexibility required to return to sports. 

"If you've had significant arthritis, your muscles are going to be weaker from disuse," Dr. Austin says. "After surgery, you have to build up that muscular strength and endurance, and you might be stiff before surgery, so you'll need to work on your flexibility as well."

Published 11/10/2023

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