NOYES KNEE INSTITUTE
Frank Noyes, MD
Helpful Rules for Return to Activities of Daily Living
and Recreational Sports after Knee Replacement
Is the total knee replacement strong enough to allow safe return to recreational activities?
Yes, the engineering design and component materials allow for light recreational sports. Impact sports are not advised such as running, basketball, or other high impact activities although some patients perform at their own risk. The concern is that repetitive impact loading may increase loosening and wearing of the knee components.
Are the ligaments and bone around the knee replacement strong enough to perform recreational activities?
Yes, in general this is not a problem. The surgeon will determine after surgery if the knee joint has good ligament stability and alignment. There is always the small possibility of loosening of the implant at the bone cement junction. This can occur with normal activities of daily living and is not necessarily related to recreational activities. It is important for females to maintain good bone health and obtain a Dexascan and use supplements of calcium and vitamin D. A vitamin D blood testing may be considered. Your PCP should establish a monitoring program for good bone health.
What is the primary problem I may experience with return to recreational activities?
First there must be good muscle strength and function. Many patients put off the knee replacement for years during which time the muscles become weak and have disuse changes. Some of these muscle changes may be permanent. Once you have a new knee joint that is not painful the muscles can start to rebuild and function again in a more normal sense. Many patients have muscle strength deficits that do not allow them to climb stairs or get up from a chair. Muscle weakness of the lower extremity needs to be corrected by intensive physical therapy over many months after surgery.
What type of therapy programs exist to correct muscle weakness after surgery?
The answer is there are many types that need to be tailored to each patient. Let your therapist know if any exercise causes pain or aggravates arthritis in the hip or spine. A comprehensive program also involves home therapy sessions that you conduct on your own following your therapist instructions. The more diligent the patient is in performing the exercises after surgery the better the result in overcoming muscle weakness. The exercises also involve the hip joint, calves and ankles and abdominal core strength and exercises to improve flexibility.
How long is the physical therapy program after knee replacement?
The answer is different for each patient. In general, it takes 12 to 16 weeks of therapy both in the office and doing exercises at home to regain knee strength and function to a reasonable level to allow activities of daily living. The patient sees the PT twice a week for 4-6 weeks and then once a week assuming good return of knee motion and strength. It is strongly recommended to join a health club exercise facility to continue muscle strengthening for 12 months after surgery.
Is the return of knee motion a problem that may limit my ability to perform activities of daily living?
The answer is yes, very much so, and the return of functional knee motion is just as important as regaining muscle strength. The two go together. Many patients have a loss of knee extension and flexion before surgery and the muscles have shortened prior to surgery. The surgeon uses special techniques at surgery to regain normal knee motion with the joint implant however this is under anesthesia with the muscles relaxed. After surgery, the muscles return to their shortened state and must undergo a stretching and flexibility program that is very important in the first 6 weeks of surgery.
About 10% of patients will have a major problem in gaining a functional range of knee motion and develop excessive scar tissue about the knee joint that limits knee motion. This requires the patient enter into a special rehabilitation program, with extended therapy visits, use of special appliances, and even a gentle knee manipulation. At our knee enter we have special program as an MD-PT team, with a national reputation for expertise in dealing with these problems. We have published numerous articles and scientific studies in returning patients to all levels of activity and athletic pursuits. Let your MD-PT team know of your goals so we can adjust and tailor the program for you.
Once I have successfully completed the first 12-16 weeks of therapy after surgery are there special therapy instructions to return to recreational activities?
The answer is yes, a more intensive muscle strength program will be required as recreational activities require greater muscle strength to maintain knee function and stability under higher recreational demands. Your PT will measure your muscle strength using a special machine and provide you a written report so you will know exactly where you are weak and the exercises you need to perform. It really takes up to one year to regain good muscle strength and function and every month after surgery you will feel better and stronger. The mistake is to go back to recreational activities too early before the suitable return of muscle function that also includes balance and return of muscle strength to the entire lower limb and hip joint.
How long is the therapy program to return to recreational activities?
The answer is there are different phases depending on the type of activity. For return to golf, generally this is successful at 6 months after surgery using a golf cart. For biking, hiking, and activities such as these, in general, they may be started at six months but specific words of caution are necessary to avoid overdoing activities and preventing knee swelling.
What are the mistakes in returning to recreational activities?
The first mistake is to return too soon where there is still swelling in the knee joint. It takes up to a year or longer for the knee joint lining which controls swelling (synovial lining) to return to normal and to not be irritated and secrete fluid with increased activity. Be careful to limit activities until the knee swelling is under control. This may require anti-inflammatory medications and frequent icing during the day. This can be a real problem in patients whose occupations require them to walk over 4 hours a day. Breaking up the length of time walking, taking frequent breaks to elevate the lower limb, use of ice and a compression wrap are important. If you have a strenuous work environment then return to any recreational sports will be a problem.
Are their limitations with combining a gym exercise program and frequent recreational activities?
Yes, there are only so many hours in a week that your knee joint will allow you to do strenuous activities, whether it is work, a gym work out or doing light sports. This is where a balance of the total activities a patient performs in the first year of knee surgery is necessary and your PT can assist you with these decisions. For patients who have been active their whole life it is important to know that you will not be able immediately resume an active recreational lifestyle.
First comes the mandatory therapy to return to daily living activity. Next comes the extended therapy and exercises to overcome the muscle weakness and deficits that occurred as a result of the knee arthritis. Next comes a healing and recovery stage that is different for every patient. Finally. is the gradual return to recreational activities making sure you are ready for this final stage.
From a positive note if you stay with the program, and seek professional PT support, then approximately two-thirds of patients or more can perform their desired recreational activities after knee replacement. However there remains a small percentage of patients that experience knee swelling or pain that must limit their recreational activities even though they are doing very well and much improved overall with daily living activities. If you have trouble returning to activities we need to know to treat any problems that may be present.
What is a balanced activity program to perform after knee replacement?
The best program for an active patient is the 10-20-30 program; ten minutes flexibility of major joints and spine, 20 minutes strength training both upper and lower extremities, and 30 minutes aerobic training to maintain heart fitness and reduce heart disease that may occur with low activity due to arthritis. An exercise that combines the upper and lower extremities is ideal such as an Ellipse type machine. The lower track can either slide or be a stair stepper. The upper arm push and pull on the levers. Your PT can assist you with this program and provide useful information.
As a final positive note; we believe a patient with a total knee replacement should undergo the same type of comprehensive staged exercises as we use for sports and our athletes. It is required to modify some of the exercises however the concept is to regain muscle strength and function, balance, and rehabilitate other areas of the body. Many patients improve yearly after surgery, so if the initial return to recreational activities is not successful we advise to continue a well-balanced and professionally directed program that will often be successful in the long term.
Good Luck and THANKS for choosing the Noyes Knee Institute Team