Playing Sports After Joint Replacement Surgery

By Linda Rath | April 24, 2024

Regular exercise is an essential part of any treatment plan for arthritis. It’s the only nondrug therapy that gets an unconditional thumbs-up from arthritis organizations. At least 150 minutes a week of cardiovascular, strengthening, flexibility and balance exercise are recommended based on a mountain of research showing that physical activity reduces pain, increases mobility and may even slow disease progression. But what if you have a total hip or knee replacement? 

A New Trend 

High-impact sports like singles tennis, jogging, running and soccer have for decades been on the “no” list following total joint replacement (TJR). They were thought to loosen the implant or wear down plastic parts too soon. Although there’s no consensus about the best way to exercise after rehab, many experts now allow patients more leeway than just a few years ago. 

William Roberts, MD, chief medical officer for the American College of Sports Medicine, once cautioned against higher impact exercises, especially running. Today, some experts endorse running for former runners as well as for those just starting out. Many recent studies have also shown that restricting movement after hip replacement – long considered necessary to prevent the implant from dislocating – is not beneficial and may actually impede healing.

Here’s what’s driving the change, what activities to consider after joint replacement and how to return to exercise safely.

Changing Restrictions

Some doctors and surgeons are revising their thinking about post-surgery exercise because their patients are younger patients and implants and surgical techniques are better.

Young, active patients. Most joint replacement patients are age 60 or older, but adults in their 40s and 50s are increasingly getting new knees and hips. Many are athletes who have moderate arthritis and want to stay active as long as possible. Others developed osteoarthritis (OA) after an accident or injury. It’s estimated that half of people who tear their anterior cruciate ligament (ACL) – one of the most common sports- and crash-related injuries – will develop OA within five to 15 years.  Many are women, who are up to eight times more likely to tear their ACL than men. Up to 80% of former football and soccer players who have a knee injury also eventually develop OA. The determination of active young adults to play sports is one reason the rules around post-surgery activity are changing. 

One survey of 164 patients who had a partial knee replacement reported that men 55 and younger were able to return to high-impact or moderate-impact sports. Some patients who hadn’t played sports before the surgery started playing them after. 

Things To Consider

Not every patient has the same surgical success, and it’s unrealistic to expect an artificial joint to perform exactly like one you were born with. It may not bend as easily, have the same range of motion or be entirely pain-free. Around 20% of people experience chronic pain after total joint replacement. This can make exercise more challenging but also may make it more important.

Another consideration for younger adults considering joint replacement: Depending on your age, you’re almost certain to outlive your implant, which may last 15 to 20 years. Second (revision) joint replacements are more complicated and usually less successful than the first.

Better implants and techniques. Most ideas about wear and tear on implants originated in the 1990s, but implant materials and surgical techniques have improved since then. For example:

• Ceramic and polyethylene artificial joints tend to last longer and hold up to stress better than older metal versions
• 3-D printing can be used to customize prostheses when off-the-rack implants don’t fit properly
• Robot-assisted surgery allows for more precise placement and alignment of implants
• The minimally invasive anterior hip approach allows surgeons to access the hip from a small incision near the groin without detaching muscles and tendons, potentially leading to a faster recovery with fewer complications.

Rehab Exercise

Even if you weren’t very active before your surgery, faithfully following all exercise recommendations afterward is important for a successful long-term outcome. The standard protocol for decades was for patients to work with a physical therapist to improve range of motion and gain strength and stability in the new joint. Research now suggests that for many, if not most patients, a home exercise program or televised rehab can be just as successful as in-patient physical therapy. This saves time and money, and because it’s more convenient and accessible, many are more likely to stay with it. If you need someone to hold you accountable, stick with in-person physical therapy. 

Lift for the Best Outcome

Resistance training – with free weights, machines, bands or body weight – is a key part of rehabilitation after surgery. It helps preserve the life of the implant by strengthening bones and supporting muscles without stressing the joint. 

Australian researchers in 2024 reviewed 16 studies of hypertrophy training after knee and hip replacement. Hypertrophy training is a type of strength training devoted exclusively to building muscle. The researchers found that having more muscle mass led to the best outcomes after both types of surgery. The studies used different weights and techniques, so it wasn’t possible to pinpoint the best regimen, but leg presses, hip adductions and hip and knee extensions were common.  Weight training usually starts during rehab, and patients are encouraged to continue it two or three times a week after discharge. Learn the proper techniques from a physical therapist so you can safely increase your weight over time.

Post-Rehab Exercise: What, When and How Much?

After surgery, you receive detailed instructions about how and when to exercise during the three- or four- month rehabilitation period. After that, it’s not as clear-cut. The best types of post-rehab exercise depend on many factors, including your fitness, strength, mobility and balance, overall health and prior activity level. If you played sports before you developed arthritis, you’ll probably want play again. If you’re more sedentary, not in top shape or anxious about your implant, stick to low-impact exercises like biking – on the road or in the gym – elliptical training, rowing, swimming and walking. Experts say many people can safely engage in higher-impact activities once they’re fully healed from surgery, but a lot depends on want you want to achieve and are comfortable doing. 

When to Get Back in the Game

Not everyone recovers from surgery at the same rate. Patients who have knee implants are likely to have more pain and take longer to heal than hip implant patients. Former athletes and healthy younger patients typically heal faster than sedentary older ones. In general, if you don’t have serious health problems or lingering surgical pain, you may be ready for more vigorous activity three to six months after your surgery.

Although body cues are important, always check with your surgeon or physical therapist before you ramp up exercise. Also, keep these tips in mind:

• Work on imbalances. You’ve been diligent about walking and resistance training but may still have imbalances because your stronger knee or hip has been compensating for the operated one for quite a while. If this sounds like you, work on the imbalances with a trainer or physical therapist to reduce the risk of injury.  
• Observe the 10% rule. Start slowly and increase your activity level by about 10% a week. If you want to get back to running, for example, start with walking, then easy walk-jog intervals, and slowly increase your pace and distance. The same applies to any other sport or activity. 
• Soreness vs. pain. It’s natural to feel some muscle soreness when you first jump back into vigorous exercise, but you shouldn’t have pain. If your new joint hurts, talk to your doctor. You may need to strengthen the supporting muscles more or do other kinds of exercises for a while longer.

The shifting landscape of post-surgery recommendations can be confusing, especially because some surgeons and patients disagree about the right approach. There’s nothing wrong with scaling back the intensity of your exercise, but if you’re determined to return to higher-intensity workouts, find a physical therapist or sports medicine doctor to guide you to do so safely.