Total Knee Replacement for Athletes

A Sports Medicine Perspective

Posted 12/6/22

Will I still be an athlete after a knee replacement?  What will I be able to do?  Will I be better or worse?  How do I know what is best for me?  People with active lifestyles …

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Total Knee Replacement for Athletes

A Sports Medicine Perspective


Will I still be an athlete after a knee replacement?  What will I be able to do?  Will I be better or worse?  How do I know what is best for me?  People with active lifestyles face these questions when considering a knee replacement.

Athletes commonly experience the symptoms of osteoarthritis as a result of knee injuries and surgery from years past.  Things that use be easy and pain free gradually become harder and more uncomfortable until they cannot be ignored any longer.  The athlete comes to a crossroads where they need to decide to stop or modify their present activities or seek treatment for their arthritis.  A knee replacement or Total Knee Arthroplasty (TKA) commonly becomes a part of the conversation.  This is due in part to the fact that a knee replacement is a routinely successful operation that eliminates pain and restores function to a worn out joint.  But the operation is not without its risks and success is dependent on commitment to the preparation and recovery process. 

How Do I Know If It’s Time?

Ask yourself the simple questions, Is my pain manageable?  Can I do the things I want to do?  If the answer is yes, you are successfully living with arthritis.  If the answer is no, then your arthritis is not sufficiently managed.  There are several treatment options available other than surgery that you may wish to explore before having a knee replacement.  Alternatives to surgery include anti-inflammatory medication, injection therapy and physical therapy.  Sometimes symptoms are due to other problems that are found in the knee like a torn cartilage or meniscus. In this case, a knee arthroscopy may be a reasonable solution.  (These alternatives are reviewed in more detail elsewhere in the article.)  If after considering and exploring these options your pain is still unmanageable and your activities still limited, it may be time to consider TKA. 

What Can I Expect?

In a Total Knee Arthroplasty (TKA), an incision is made down the front of the knee and the muscles and tissues are retracted away to expose the joint.  The surfaces of the bone that have worn down are leveled off to a smooth, flat surface and the replacement surfaces of metal and plastic are precisely fit and fixed to the bone.  In doing so, the deformities and restrictions are corrected.  The muscles and tendons are allowed to return to their normal position.  The healing process begins and in the days and weeks to follow, the tissues will heal, and muscles regain their function.  This requires time and work that only the patient can do.  To be successful, you have to commit to taking the time to heal, working with rehab professionals and staying within a healthy balance of healing and exercise as outlined by your surgeon.

Returning to Sports

Eventually you will progress beyond basic rehab and start to focus on more complex and athletic activities.  This takes on average 3 or 4 months for people to be able to perform all of their work type activities.  Getting back to sport can take longer, on average 6 months with a more gradual progression.  Tissue healing, restored muscle strength and full range of motion are basic requirements before considering sports activities.  There is no getting around this and make take additional time.  In making the transition to sports, your particular sport or activity may benefit from some additional “sport specific” therapy that trains the actions used in your planned activity.  This brings us to the ultimate question of what sports are ok and what sports are off limits after TKA.

What Sports Are OK after Knee Replacement?

Traditionally, surgeons have balked at returning their patients to vigorous sports activities after knee replacement in favor of limiting stress in order to promote longevity of the artificial components. There is a limited amount of data or literature outlining the outcome of patients attempting to return to sports. Over time however, the design and quality of the component parts, improved surgical techniques and advanced rehabilitation programs have allowed for new levels of performance and function after TKA. This coincides with changes in patient’s expectations and increased desires to maintain an active lifestyle including recreational and competitive sports activities.  As a result, as the bar is being raised, the guidelines are evolving.  It is important to note that while the function of a total knee replacement has never been better, it has not reached the level of a normal knee that has not been replaced. 

Always OK

Activities that have traditionally been recommended include walking, hiking, cycling, swimming, golf and tennis.  These are activities that can be modified in intensity to match the patient’s level of function and don’t cause high levels of stress on the knee. 

Sometimes OK

Activities that are more vigorous tend to involve twisting, cutting, and overall higher loads of stress on the knee. This would include rock climbing, running, skiing (snow and water), snowboarding, softball, basketball and more.  The first thing to consider is your ability level prior to surgery.  If you haven’t been able to do it before the time of your surgery, you are not likely to be able to do it after.  Research shows that what you were doing before surgery is fairly predictive of what you will do after your recovery and rehabilitation.  Achieving a full range of knee motion, adequate muscle strength, muscle endurance and balance are necessary to meet the demands of your sport but also serves to protect the knee and off load increased stress to the replaced joint that can cause it to wear out prematurely.  Be aware that engaging in vigorous activities comes with an increased risk of injury from the sport and the possibility of more surgery including surgery to revise or modify the knee replacement as part of the treatment process.  While it is thrilling to return to a favorite sport without pain, it is wise to have an increased awareness of safety to keep you in the game. 

It Takes a Team

Not all surgeons share the same outlook when it comes to returning to sports after a knee replacement.  Make sure that your expectations are well aligned with your surgeon and your physical therapist before going to surgery.  Get a second opinion if you have to.  Consider a sport medicine expert who is well versed in total knee arthroplasty who can work with you to determine if knee replacement is the best option for you at this time and can work with you to achieve your goals.  It really does take a team to have a successful total knee replacement and like many things, the key is in the preparation.


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