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After your knee replacement, you may be wondering what activities can’t I do and what activities can I do? This blog will answer both of these questions! It is important to first understand what a high-impact activity is and what a low-impact activity is. A high-impact activity is characterized by rapid and abrupt movements, while a low-impact activity is characterized by smooth and gentle movements.[1]


Examples of high-impact activities include:
1) Skiing (especially downhill and moguls)
2) Contact sports such as hockey and football

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Examples of low-impact activities include:
1) Walking
2) Jogging
3) Biking on level surfaces
4) Swimming
5) Golf

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What Can’t I Do?


A discussion of the current evidence is crucial to allow you to make a reasonable decision for your own knee replacement. A study that compared 2 groups of people who had knee replacements and assigned one group to high impact sports and the other group to low impact sports and determined how many in each group had to have a knee replacement revision would provide the strongest evidence. However, as this kind of study doesn’t exist, the best alternative we have is expert opinion.

Expert opinion from a group of orthopedic surgeons is that participation in high-impact sports should be avoided if possible, but limited at the very least, following knee replacement.

One example of expert opinion is through a study that surveyed 41 orthopedic surgeons on their recommendations regarding downhill skiing. Their consensus was that people should avoid high-impact activities like downhill skiing after a knee replacement for the following 2 reasons:[2]

1) Risk of knee periprosthetic fracture, which means a fracture of the thigh or shin bone near the knee implant.
2) Risk of breaking or damaging the implant itself.

Another example of expert opinion was a study that surveyed 101 orthopedic surgeons, which concluded that surgeons worried about how high-impact sport can negatively impact the longevity of the knee implant.[1]

However, if high-impact sport is something essential to you then you should discuss this with your surgeon PRIOR to your knee replacement. Generally, if you do participate in high-impact sport, you should adhere to the following restrictions:[2]

1) Limit your speed and intensity.
2) Regain normal strength and range of motion in your operated knee. Range of motion is a measure in degrees of how far your knee bends and straightens.
3) Depending on your experience level with that activity, the more experienced you are the more likely you will be allowed to return to your prior level of sport or physical activity.

What Can I Do Instead?


In the absence of high-impact sports you should still remain physically active after a knee replacement. In fact, physical activity is crucial to improving the function of your knee and your overall health.[1]

One study that surveyed 101 orthopedic surgeons found that the majority of surgeons allow return to low-impact sports within 3-6 months after a knee replacement surgery.[1]

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It is also important for you to understand that activity recommendations made by your surgeon will be mostly based on their experience and training[1] and in their experience high-impact activities may have resulted in higher volumes of revision surgeries, which as mentioned above, is a follow-up surgery that is performed to either replace or fix a damaged knee implant.[3] What that means for you is more time and money spent on rehabilitation. So please ask your surgeon how they have arrived at their activity restriction recommendations.


Other Things to Keep In Mind


Apart for activity participation, for at least 3 months following surgery, you should keep in mind:[4]

1) Taking small steps when you are turning.
2) Trying not to pivot on the leg that was operated on.
3) Keeping your toes pointed straight ahead.
4) Avoid jerking the operated leg.
5) Not lift too much weight. This doesn't just mean in the gym, this also means with everyday tasks such as groceries.
6) Avoid any seat that is too low (e.g. stool, sofa, rocking chair, soft chair)

Additionally, you may need to wait at least 4 weeks before driving again.


Conclusion


It is important that you are careful how you move your knee after surgery, especially the first few months after surgery. After 3-6 months you may be able to return to low-impact activities such as walking, swimming and golf. With time, you may be able to return to select high-impact activities. However, it is important you consider your own health status, your previous experience with the high-impact sport and consult with your health care provider before making the final decision.

If you are recovering from a knee replacement or are awaiting your knee replacement, Curovate has developed an app to help you return to your physical activities. Download the Curovate app to get started with your knee replacement recovery at home with video guided physical therapy exercises, progress tracking, and the ability to measure your knee range of motion. Click on the links below!

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References

1. Vu-Han TL, Gwinner C, Perka C, Hardt S. Recommendations for Patients with High Return to Sports Expectations after TKA Remain Controversial. J Clin Med. 2020;10(1):54. Published 2020 Dec 26. doi:10.3390/jcm10010054

2. Buckley A, Duffy P, Korley R. Downhill skiing following total knee arthroplasty: a survey of Alberta orthopedic surgeons. Can J Surg. 2021;64(4):E414-E418. Published 2021 Jul 23. doi:10.1503/cjs.009720

3. Swanson EA, Schmalzried TP, Dorey FJ. Activity recommendations after total hip and knee arthroplasty: a survey of the American Association for Hip and Knee Surgeons. J Arthroplasty. 2009;24(6 Suppl):120-126. doi:10.1016/j.arth.2009.05.014

4. Taking care of your new knee joint: MedlinePlus Medical Encyclopedia. MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000369.htm. Accessed June 10, 2022.

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