Kategoria: Joint Replacement (EN)

Polish version

After an uncomplicated hip or knee replacement, most patients can gradually return to low-impact activity such as walking, cycling and swimming once the wound has fully healed. There is no single date when every sport becomes safe. Running, jumping, contact sports and activities involving sudden changes of direction require much more cautious assessment because higher loads also increase the consequences of a fall or injury.

The important question is not only how many weeks have passed since surgery. Healing, muscle strength, balance, range of motion, gait stability, the joint’s response to exercise, the type of replacement and the patient’s previous experience in the sport all matter.

Do you have to give up sport after joint replacement?

No. The purpose of joint replacement is to improve function and quality of life, and regular physical activity is an important part of maintaining overall fitness. Current evidence shows that a large proportion of patients return to recreational activity after surgery, particularly low-impact sports.

In a meta-analysis of knee arthroplasty including 45 studies and 14,498 knees, approximately 85% of patients returned to physical activity or sport, with a median return time of 4.1 months. The authors emphasised, however, that certainty of evidence for the analysed outcomes was very low. These figures describe a population; they are not an individual clearance date for sport.

A similar pattern is seen after total hip arthroplasty. In a review of 57 studies, the pooled return-to-sport rate was about 85%, with a mean time of approximately 16 weeks. Return to low-intensity activity was much more common than return to high-impact sport.

Which activities are usually easiest to resume?

Return is most predictable for activities with lower joint loading and a lower risk of falling. These commonly include:

• walking and brisk walking;
• stationary cycling, followed later by outdoor cycling in safe conditions;
• swimming once the wound is fully healed;
• water-based exercise;
• golf;
• controlled strength training appropriate to the stage of recovery.

This does not mean that every activity can be restarted immediately. Entering a swimming pool before the wound has fully healed can create wound problems, while cycling in traffic requires substantially more balance and reaction speed than exercising on a stationary bike.

What about running, tennis, skiing and contact sports?

The greater the impact, jumping, cutting and risk of falling, the less useful a simple rule such as “you can return after this many weeks” becomes. High-intensity sports are resumed much less often after joint replacement than low-impact activities.

This is particularly relevant to regular running, contact sports, games with frequent changes of direction, intensive tennis, combat sports and activities with a substantial risk of falling. The issues are not limited to implant wear: dislocation, periprosthetic fracture and an injury requiring another operation also need to be considered.

This does not amount to an automatic ban on every demanding sport. A patient who has skied recreationally for years and regains full control of the limb after surgery is different from someone planning to start a high-fall-risk sport only after joint replacement. The decision should be individual.

Is return to sport the same after hip and knee replacement?

Not entirely. After hip replacement, early limitations may relate to tissue healing, muscle weakness, pelvic control and fall risk. After knee replacement, swelling, limited flexion, stiffness and quadriceps weakness often remain relevant for longer.

After unicompartmental knee arthroplasty, some patients return to activity more readily than after total knee arthroplasty. In the recent meta-analysis, the probability of returning to physical activity or sport was higher after unicompartmental replacement, but the certainty of this finding was rated very low. It should not be treated as a guarantee of faster return for an individual patient.

How does an orthopaedic surgeon assess readiness to increase the load?

Before moving to more demanding activity, function is more useful than the calendar. Favourable conditions for increasing load generally include:

• a fully healed wound;
• no increasing pain at rest;
• stable walking without a pronounced limp;
• enough range of motion for the planned activity;
• adequate strength in the operated limb;
• good balance and movement control;
• no marked increase in swelling after the current level of exercise.

If a higher load produces a clear increase in pain or swelling that does not return to the previous level, progression may have been too rapid.

How should return to sport be progressed in practice?

A staged return is the safest approach. First rebuild basic function: walking, range of motion, strength and balance. Then increase exercise duration and intensity. More complex sport-specific movements should be introduced later.

Avoid increasing duration, intensity and technical difficulty all at once. For sports requiring rapid reactions, it is useful to regain movement control first in a safer environment. Patients returning to more demanding disciplines may benefit from physiotherapy assessment and an agreed plan with the operating surgeon.

When should activity be stopped and medically reviewed?

New severe pain after a fall, sudden inability to bear weight, obvious deformity, a sensation that the joint has moved out of position or a sudden loss of function requires urgent assessment. Fever, increasing redness, warmth or wound drainage also warrants prompt review.

New calf pain and swelling may require assessment for deep-vein thrombosis. Shortness of breath, chest pain, coughing up blood or fainting requires immediate medical attention.

The key principle

Returning to activity after joint replacement is desirable, but the type of sport should match the stage of healing, current function and the risk of injury. Average time points from studies are useful for planning recovery, but they do not replace assessment of the individual patient.

In a publication by Tomasz Poboży and Maciej Kielar on selection of hip prostheses, everyday activity and the patient’s future plans were highlighted as relevant elements in treatment planning. That paper does not define the timing of return to sport, but it illustrates why activity level should already be considered when planning surgery and selecting an implant strategy.

Back to: Before and After Orthopaedic Surgery

References

1. Poboży T, Kielar M. The use of various types of hip prostheses depending on the patient’s age and level of everyday activity. Medical Studies/Studia Medyczne. 2015;31(3):213–222. DOI: 10.5114/ms.2015.54763.
2. Braz R, Gomes E, Valente C, et al. High rate of return to low-impact physical activity or sports after total and unicompartmental knee arthroplasty: A systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2026;34(9):3415–3428. DOI: 10.1002/ksa.70267. PMID: 41527885.
3. Pasqualini I, Emara AK, Rullan PJ, et al. Return to Sports and Return to Work After Total Hip Arthroplasty: A Systematic Review and Meta-analysis. JBJS Rev. 2023;11(8). DOI: 10.2106/JBJS.RVW.22.00249. PMID: 37549241.
4. Pasqualini I, Emara AK, Rullan PJ, et al. Return to Sports and Return to Work After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev. 2023;11(7). PMID: 37499045.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version

After an uncomplicated hip or knee replacement, the decision to stop using crutches should not be based on the number of days since surgery alone. What matters most is whether you can walk safely, without a clear limp or giving way of the operated leg, with adequate balance and muscle control. Many patients begin weight-bearing very early, often as tolerated, but progression from two crutches to one and then to unaided walking should reflect the operation performed and the individual postoperative instructions.

Can you put weight on the operated leg immediately after joint replacement?

After a typical, stable primary hip or knee replacement, contemporary recovery programmes favour early mobilisation and getting out of bed as soon as practical. ERAS recommendations for hip and knee replacement support early mobilisation, while current physical therapy guidance after total knee arthroplasty emphasises early recovery of walking, balance and efficient movement patterns.

For uncemented total hip arthroplasty, a meta-analysis of 17 studies found no evidence that immediate unrestricted weight-bearing increased excessive stem micromotion, failure of bone integration or revision risk compared with partial weight-bearing. This does not mean, however, that every patient after every operation may load the leg without restriction.

When may the instructions be different?

Temporary weight-bearing restrictions may be needed after revision surgery, an intraoperative or periprosthetic fracture, bone grafting, an osteotomy, repair of additional soft-tissue structures, or whenever the reconstruction needs protection while healing. For that reason, the operating surgeon’s discharge instructions take priority over any general rehabilitation timetable.

How do patients usually progress from two crutches to one?

A common sequence is a walking frame or two crutches, followed by one crutch or a walking stick, and finally unaided walking. There is no requirement for every patient to move through each stage at the same time.

• Two crutches or a walking frame are useful while gait remains uncertain, the leg is weak, pain limits loading or there is a meaningful risk of losing balance.
• One crutch or a walking stick may be the next step when the patient can safely transfer weight onto the operated leg without clearly increasing the limp.
• Unaided walking is best introduced when removing support does not worsen gait quality.

When one crutch or a walking stick is used after hip or knee surgery, it is usually held on the side opposite the operated leg. This reduces the demand on the muscles that stabilise the pelvis and can help maintain a better gait pattern.

How can you tell when it is reasonable to try walking without crutches?

Functional criteria are more useful than a fixed date. Reducing support is reasonable when:

• you can walk on a level surface without a pronounced limp;
• the operated leg does not feel as though it is giving way or suddenly buckling;
• your balance allows you to turn, stop and rise from a chair safely;
• pain and swelling remain controlled after increasing your step count;
• after knee replacement, quadriceps control is sufficient to keep the knee stable during weight-bearing;
• after hip replacement, pelvic control is sufficient and walking without a crutch does not produce marked trunk leaning;
• the orthopaedic surgeon has not prescribed a temporary weight-bearing restriction.

Is it better to keep one crutch for longer or stop using it as soon as possible?

If walking without the crutch produces a clear limp, shorter steps, trunk leaning or reluctance to load the operated leg, it is usually more sensible to continue using support for a while and work on strength and gait quality. The goal is not to “get rid of the crutches” as quickly as possible, but to regain safe and reasonably symmetrical walking.

Conversely, there is no benefit in continuing with two crutches purely out of habit when there are no loading restrictions, walking is stable and the patient can reduce support without deteriorating gait. Current guidance after knee replacement emphasises functional training, balance and gait retraining rather than the passage of time alone.

What if pain or swelling increases after reducing support?

A temporary increase in muscle fatigue after greater activity can occur. If changing the way you walk clearly increases pain, swelling or limping, reduce the load and briefly return to the previous level of support. Symptoms that worsen from day to day should prompt assessment of the cause rather than continued attempts to push through them.

When should you seek urgent assessment rather than wait for a routine review?

Urgent assessment is particularly important if there is:

• sudden shortness of breath, chest pain or fainting;
• markedly increasing one-sided calf swelling with pain or tenderness;
• fever accompanied by increasing redness, warmth or wound drainage;
• sudden severe pain after a fall or twisting injury;
• a new deformity, obvious limb shortening or inability to bear weight after previously making progress;
• a sudden substantial loss of function instead of gradual improvement.

Stopping crutches is only one stage of recovery

Independent walking does not mean rehabilitation is complete. Strength, balance and tolerance of longer periods of activity continue to improve. Readiness for driving, returning to work and returning to sport should be assessed separately rather than inferred simply from the ability to walk without a crutch.

Back to: Before and After Orthopaedic Surgery

References

1. Bove AM, Carroll LA, Cone S, et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Physical Therapy. 2026;106(7). DOI: 10.1093/ptj/pzag058.
2. Huang L, Han W, Qi W, et al. Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Front Surg. 2023;10:1225649. DOI: 10.3389/fsurg.2023.1225649.
3. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthop. 2020;91(1):3–19. DOI: 10.1080/17453674.2019.1683790.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.