Total Knee Replacement Precautions: What activities are OK?

Stuart C. Kozinn MD / Scottsdale Joint Center

So now you have been told the only way to get rid of your burning, grinding, bone-on-bone knee pain is a "Knee Replacement" - a new knee. This is now one of the most common orthopedic operations in the USA. Over a half million knees are done every year. It is predicted there will not be enough surgeons to do all the necessary total knees in the next decade. Osteoarthritis of the knee is rising at an "epidemic" rate, just as patients are demanding a more active life style. Now younger patients in their forties and fifties are more common total knee candidates. I allow my partial knees to do a bit more than my total knees. Not because they can't fail, but because they are easier to re-do if a problem develops!

But what can you actually do with your Total Knee?, and more important what activities CANT you do?. In a perfect world without (lawyers and liability for implant failures), we might let total knee patients do "anything they wanted to". We have to "over treat" everybody with a total knee, even though some patients might be able to safely do more things. A thin very fit woman would likely do better playing singles tennis then an overweight, out of shape man.

In fact, some of my patients choose to run, play basketball and racquetball against my general medical advice. In my 25 year personal experience the vast majority of these "non-compliant" (spirited/adventurous?) patients actually do very well, ...much better than expected! Unlike hips, total knees do not easily "dislocate", or come out of joint. So we are less concerned about that happening in the middle of a strenuous activity. However, we know that total knees do NOT last forever. They are little machines that will take care of you longer , if you take care of them!

How do total knees gradually fail? For starters, they are CEMENTED into the bone. And just like cracks form in the sidewalk over years after extremes of weather, cracks can occur in cement inside your knee. This is more likely if you "beat your knee up" on a regular basis. This is why we do not recommend running for daily exercise after a knee replacement. The constant repetitive "jarring" could lead to cement cracks and eventual loosening of the implant. I do let my patients play tennis (doubles is safer), ski, wakeboard, play golf, bike ride, swim, and do similar sports. Bike riding, Yoga and swimming are the best exercises. After 25 years of doing total knees, a very small percentage of my knees have failed. Some have required revision surgery ( Re-do). Fortunately, re-dos actually perform quite well. Years ago I took care of a professional baseball player with a total hip. He wanted to play again. he knew the risk, but his major question was, If my hip fails, can you re-do it?" With a yes answer, he was comfortable playing, and I watched him jog around the bases flawlessly after hitting a home run.

Some knee failures occur after the plastic bearing (or cushion) between the metal parts has worn down over many years. The plastic particles can have an inflammatory effect on the knee, causing swelling, and some bone loss. That is why we are always searching for a better, more durable plastic. the cross linked polyethylene plastic liners we use now ARE more durable than the ones used 20 years ago. So we don't really know how long they will last. Lab simulation wear testing suggests the plastic can last out thirty years or so. I now tell patients that 80 percent of my total knees will still be functioning well twenty years out, I just don't know which 20 percent will have some problems. Interestingly enough, so far in general it has NOT been the more athletic patients that fail sooner. I have seen more failures in overweight women with soft bone. After menopause, some women develop osteoporosis, and I have seen failures where their own weight causes the implant to "crush into" the bone, causing pain and loosening. My patients should all take calcium and vitamin supplements to keep the bone strong!

So what activities are OK?

Tennis ( doubles is better, but I will allow singles for those that must do it).

Golf (use a cart if you get fatigued or your leg tends to swell after a full day up)

Bike Riding (Don't crash or fall!)

Swimming ( best overall exercise, but the hardest to do regularly - also a little boring)

Hiking ( be reasonable - don't do Camelback to the top)

Skiing ( snow and water ok - snow skiing more dangerous in general as you add velocity to torque - watch out for the other guy on a snow-board. Ski at your own risk!

Skating - ice hockey is ok if you eliminate the body checks!

Gym / machine work outs ( don't do a lot of full weight squats, as it puts increased pressure on the knee caps).

Aerobics ( it depends - less jumping is better)

Yoga - great for everything

Softball - seems to be OK, unless you play like Derek Jeter ( then goes to "no" list below!)

What activities are NOT ok?

Running ( you do it at your own risk - it is possible to do it - and it make takes years , but eventually it may damage the cement bond.)

Football ( same as above)

Soccer ( same as above)

Volleyball - with jumping ( same as above)

Basketball (same as above)

Racquetball ( a little rougher on the kneecaps than tennis due to increased and more frequent bending)

So, everyone is an individual, and we all make our own risk vs. benefit decisions. If not playing a sport will make you "depressed, lazy, and fat", then maybe taking the risk of earlier loosening is worth it to you. After all..."the knee replacement can be re-done".

PS: Boxing is OK!

Please come in to talk about your specific needs. Visit our website at for more info.

Stuart Kozinn MD

Medical Director Total Joint Center - Scottsdale Healthcare.

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