Kneeling ability after total knee replacement

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Abstract

Kneeling ability is consistently the poorest patient-rated outcome after total knee replacement (TKR), with 60–80% of patients reporting difficulty kneeling or an inability to kneel.

Difficulty kneeling impacts on many activities and areas of life, including activities of daily living, self-care, leisure and social activities, religious activities, employment and getting up after a fall. Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients.

Research has found that there is no association between range of motion and self-reported kneeling ability. More research is needed to understand if and how surgical factors contribute to difficulty kneeling after TKR.

Discrepancies between patients’ self-reported ability to kneel and observed ability suggests that patients can kneel but elect not to. Reasons for this are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation.

There has been little research to evaluate the provision of healthcare services and interventions for patients who find kneeling problematic after TKR. Increased clinical awareness of this poor outcome and research to inform the provision of services is needed to improve patient care and allow patients to return to this important activity.

Cite this article: EFORT Open Rev 2019;4:460-467. DOI: 10.1302/2058-5241.4.180085

Introduction

The primary reasons that patients elect to undergo total knee replacement (TKR) are to gain improvements in pain and walking ability. 1 However, patients often have high expectations of the outcome of their TKR and want more from their operation than pain relief and improvement in basic mobility. 2 This includes a return to important higher function activities, such as kneeling. 1–3 The majority of patients expect to be able to kneel after TKR, 2,4,5 however, these expectations are frequently not met, 1,6 with between 50% and 80% of patients reporting that they have difficulty kneeling or do not kneel in the months and years after TKR. 7–14 An inability to kneel can have a detrimental impact on many activities and areas of life and is a source of dissatisfaction. Despite this, kneeling ability after TKR is an underacknowledged outcome, and has received little attention in the research literature. The aim of this instructional review article is to raise awareness of this problematic outcome and provide a comprehensive overview of prevalence, impact, aetiology, management and directions for future research.

Prevalence

Kneeling is considered as one of the most important but also most difficult to do activities for patients with TKR, 7,15–19 and is the poorest patient-rated outcome after TKR. 8,20-23 An overview of cohort studies assessing the prevalence of kneeling difficulties after TKR is provided in Table 1 . Prior to TKR surgery, the majority of patients experience difficulty kneeling on their osteoarthritic knee, 9–11,24 and post-operative improvements in kneeling ability are rarely achieved for most patients. 9 These problems with kneeling continue for many years after surgery, with 67% of patients reporting difficulty with kneeling at five years post-operatively. 11 Compared to older people with no knee disorders, significantly more people with TKR have difficulty kneeling. 15 Therefore, kneeling difficulty is the most prevalent poor patient-reported outcome after TKR.

Table 1.

Overview of prevalence of kneeling difficulties after total knee replacement from cohort studies

Study and countryNumbers of patients and post-operative time point(s)Kneeling assessmentFindings
Artz et al, 2015 9
UK
196 patients at 1 year
184 patients at 2 years
OKS kneeling question63% extreme difficulty or impossible at 1 year
65% extreme difficulty or impossible at 2 years
Baker et al, 2007 8
UK
8231 patients at ⩾ 1yearOKS kneeling question57% much difficulty or impossible
Benfayed et al, 2017 14
UK
251 patients at 1 yearDifficulty performing four kneeling positionsUpright kneeling on operated knee: 63% extreme difficulty or impossible
Upright kneeling on both knees: 67% extreme difficulty or impossible
Kneeling at full flexion: 87% extreme difficulty or impossible
Kneeling with hands on ground: 74% extreme difficulty or impossible (estimated from graph)
Dawson et al, 1998 23
UK
87 patients at 6 monthsOKS kneeling question62% extreme difficulty or impossible at 6 months
Hassaballa et al, 2003 10
UK
109 TKRs at 1 year
75 TKRs at 2 years
OKS kneeling question58% extreme difficulty or impossible at 1 year
56% extreme difficulty or impossible at 2 years
Roos et al, 2003 13
Sweden
97 patients at 6 monthsKOOS kneeling question74% patient did not kneel at 6 months
Sharkey et al, 2011 12
USA
49 patients at 3 weeks to 5 yearsSingle question on presence of kneeling difficulties82% difficulty kneeling
Weiss et al, 2002 7
USA
176 patients ⩾ 1year post-opQuestion within Knee Function Survey72% had some knee symptoms when kneeling
Wylde et al, 2017 11
UK
245 patients at 3 months
236 patients at 1 year
219 patients at 2 years
231 patients at 3 years
210 patients at 5 years
Single item question on difficulty kneeling58% much difficulty or impossible at 3 months
65% much difficulty or impossible at 1 year
69% much difficulty or impossible at 2 years
69% much difficulty or impossible at 3 years
67% much difficulty or impossible at 5 years

Notes. OKS, Oxford Knee Score; KOOS, Knee injury and Osteoarthritis Outcome Score

Although it is evident from the existing literature that kneeling difficulties are highly prevalent after TKR, there are complexities and variability in kneeling ability which are often not captured. The majority of studies assess self-reported kneeling, commonly by using the kneeling question on the Oxford Knee Score which asks about the amount of difficulty experienced with kneeling down and getting up again afterwards. 23 This provides a basic estimate of kneeling difficulty but does not account for factors that can affect a persons’ kneeling ability, such as kneeling position, duration and surface being knelt upon. There are a number of different positions of kneeling and these have been illustrated previously. 14,25–28 For example, a person may be able to kneel at 90 o flexion on a soft mat transiently to pick up an item off the floor but would experience much difficulty in participating in prolonged kneeling at full flexion on a hard surface e.g. for prayer. A more comprehensive assessment of kneeling ability, in conjugation with an evaluation of expectations, motivations, purpose and importance of kneeling, would provide further understanding of this problem.

Impact

Kneeling is important for many activities and areas of life and is considered a valued activity for most patients with TKR. 5,7,13 In one study with patients who were 12 months post TKR, 63% of patients had needed to kneel in the past four weeks but only 14% of patients were able to kneel easily. 29 Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients. 5,6 The impact of difficulty kneeling on specific areas of life is discussed below and summarized in Figure 1 .

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Impact of difficulty kneeling after total knee replacement.

Daily activities

Difficulty kneeling after TKR can impact on a number of daily household and self-care activities, including cleaning, reaching items from low cupboards or picking them up from the floor, decorating, and getting out of the bath. 30 In Middle Eastern and Eastern cultures, kneeling can be an integral part of many daily activities, including when eating meals. 19,25 These limitations can be disruptive to patients’ daily lives and many patients adapt their activities to minimize the impact, as is a common approach to managing chronic musculoskeletal conditions. 31 Examples include sitting on a stool for household chores like low-level cleaning, using assistive devices such as grabbers, and home modifications such as conversion of a bath to a shower. 30 However, despite these adaptions, some patients are unable to continue with some of their usual daily activities because of problems kneeling. In such cases assistance is often needed from friends or family members, or patients may need to employ others to complete these tasks on their behalf. 30 Consequently, patients may experience a lack of independence and control due to being unable to perform basic household and self-care tasks because of their difficulty with kneeling, which can lead to distress and frustration. 24 Catering for these limitations may also pose a financial burden on patients and social services, and/or a caring burden on family members.

Social participation

Assessment of the success of TKR is often focused on pain relief and improvement in the ability to carry out basic activities of daily living. However, enabling patients to engage in leisure activities and social participation is increasingly being recognized as a core aim of elective operations such as TKR. 18,32 Difficulties with kneeling can adversely impact on a number of leisure, family and social activities. 30 For example, gardening is an important leisure activity for many patients with TKR 18 which is negatively affected by difficulty kneeling. 30 Exercise and sports, playing with grandchildren, and volunteering activities can also be negatively affected by problems with kneeling. 30 Religious activities often involve praying, requiring prolonged periods of kneeling, particularly in Middle Eastern and Asian cultures. For example, Muslims may pray up to five times a day, requiring full-flexion kneeling. 25 In a study involving female Korean patients, 54% of patients knelt for religious reasons before surgery but only 1% of patients could perform this activity after TKR. 19 The limitations imposed on people’s ability to participate in valued social and leisure activities due to kneeling may be a contributing factor to social isolation and loneliness after TKR. 33

Employment

Falls

Falls are a common problem in older adults, with one in three community-dwelling adults aged 60 years or over falling each year. 43 The majority of falls result in no injury or minor injury only 44 and therefore being able to get up independently after a fall is important. Kneeling is an intermediate position to enable people to get up after a fall, particularly in people with physical limitations. 27 Being unable to kneel and therefore rise from the floor after a fall can have a negative impact on people’s confidence and independence, particularly when doing outdoor activities alone, such as walking the dog, gardening or fishing. 30 Nervousness and fear of being unable to get up after a fall can cause people to self-impose restrictions on their activities, leading to physical deconditioning, psychological distress and social isolation. 45

Aetiology

Understanding the underlying factors contributing to the difficulty that patients experience with kneeling after TKR is key to designing interventions to improve this important outcome. Research has established that there are discrepancies between a patient’s perceived ability to kneel and their observed ability. In one of the first studies focusing on kneeling after TKR, 56% of patients perceived they were unable to kneel but 80% could kneel easily when observed. 46 Similar observations have been found in subsequent studies. 26,47 This suggests that patients can kneel but elect not to. 26,46,47

Several studies have evaluated the relationship between surgical factors and post-operative kneeling ability. Type of implant and whether the patellar has been resurfaced have been found to not be associated with kneeling ability. 9,10,47,48 Research has found that there is no relationship between knee flexion and self-reported kneeling ability. 9,47 The amount of knee flexion reported to be required for upright kneeling is 90 o and 110–111 o is needed for kneeling at full flexion. 47 It has been shown that mean flexion of 114 o can be achieved by three months post-operatively and further small increases can occur between three months and 12 months post-operatively. 49,50 In another study, the mean range of motion was 114 o in patients who were able to kneel and 110 o in patients unable to kneel, 47 highlighting that flexion is not an important cause of kneeling problems. However, flexion is an important outcome after TKR and innovations in implant design which aim to increase flexion have been evaluated. For example, numerous trials have been conducted to evaluate high-flexion TKRs, although synthesis of the evidence suggests that they provide similar flexion to standard TKRs. 51 However, there is some preliminary evidence to suggest that modern implant design features which reduce patellofemoral joint forces, such as sided patellofemoral groove, flared posterior condyles and a single radius of curvature, can lead to better flexion. 52

Skin incision has been found to be associated with numbness and kneeling ability. In one small non-randomized study, patients reported that discomfort on kneeling was lower in patients with a lateral incision compared with a midline incision. 53 A randomized controlled trial (RCT) found that patients who received an anterolateral skin incision had a smaller area of cutaneous hypesthesia and better observed kneeling ability compared to patients with an anteromedial skin incision. 54 The findings from these studies indicate that skin incision may have an impact on kneeling ability through numbness. Many studies have compared the clinical outcome of fixed vs mobile-bearing TKR designs; however, few studies have evaluated kneeling ability, and those that have report conflicting results. 9,48 More research is needed to understand whether and how surgical factors contribute to difficulty kneeling after TKR.

Given that patients’ self-perception of kneeling ability is poorer than their observed ability, it is important to evaluate patients’ reasons for their limitations. Studies that have asked patients why they have difficulty kneeling have found that the reasons are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. 14,26,29,30,46,47,55 Self-reported kneeling ability has been found to be associated with knee pain severity, numbness and hypersensitivity. 9,29,55,56 Patients’ reports of sensations on kneeling can range from mild discomfort to severe pain. 30 Pain is often associated with tissue damage, and therefore patients are concerned that they are causing damage to their TKR by kneeling. This misconception can be reinforced by advice from third parties, including surgeons, healthcare professionals, friends and families. One study found that a range of healthcare professionals advised patients not to kneel, most commonly nurse practitioners, followed by orthopaedic consultants, general practitioners and physiotherapists. 14 Although the reasons for this have not been fully investigated, they are likely to be related to concerns regarding the safety of kneeling. In terms of kinematics, kneeling generates external load over the patella and tibial tubercle. This loading on the anterior aspect of the knee can displace the tibia in a posterior direction with respect to the femur. However, research that has evaluated the displacement of the femoral component relative to the tibial component with a range of TKR implant designs has found that the femorotibial anteroposterior articulation remains within the intended articular range of the implants, and subluxation and dislocation are highly unlikely. 57–60 Also, no association between high-flexion activities, including kneeling, and aseptic loosening of the femoral component have been found. 61 Therefore, there is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knees, as long as kneeling on a rough or uneven surface is avoided as this could lead to damage of the overlying skin and the introduction of bacteria and potential for infection of the knee prosthesis. This is supported by the advice from Versus Arthritis, the largest charity for people with musculoskeletal disorders in the United Kingdom, who recommend that patients can try kneeling on a soft surface from three months post-operatively. 62

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Healthcare services and unmet need

There has been little research to evaluate the provision of healthcare services and interventions for patients who find kneeling problematic after TKR. One study found that most patients do not speak to healthcare professionals about their difficulties kneeling. 30 Reasons for non-disclosure include that they do not think that their limitations are sufficiently severe to seek healthcare, that it is normal to not be able to kneel, and that nothing that can be done to improve their kneeling ability. In the context of being satisfied with other aspects of their outcome, some patients appear willing to accept not being able to kneel. For those patients who do raise their problems kneeling with a healthcare professional, they perceive a lack of interest from the healthcare professionals and few patients receive advice about how to improve their kneeling ability. This highlights a clear unmet need among patients for education and rehabilitation aimed at improving their kneeling ability after TKR.

The James Lind Alliance Priority Setting Partnership identifies research questions which have direct relevance and benefit to patients and the clinicians who treat them. One of the James Lind Alliance top 10 priorities for research into hip and knee replacement is ‘What is the most effective pre and post-operative patient education support and advice for improving outcomes and satisfaction for people with osteoarthritis following hip/knee replacement?’. 63 Despite the prevalence and impact of kneeling problems after TKR, there has been limited research to evaluate whether patient education and rehabilitation could benefit patients.

A study published in 2004 involving patients with TKR, unicompartmental knee replacement (UKR) or patellar resurfacing asked patients whether they could kneel and then a healthcare professional observed them kneeling, followed by a questionnaire six months later. 26 Of the patients who perceived they could not kneel but actually could kneel when observed, 80% reported that they could kneel with little or no difficulty six months later. This suggests that the encouragement and opportunity to practice kneeling with a healthcare professional was enough for many patients to continue with this activity. Four years later, an RCT involving 60 patients with UKR was published. This RCT found that a 30-minute physiotherapy intervention designed to provide verbal and written information on kneeling delivered at six weeks post-operatively improved patient-reported kneeling ability at one year after surgery compared to usual care. 64 However, patients often report a quicker recovery and better outcomes for kneeling after UKR compared to TKR. 5 As the authors of the trial concluded, further randomized evaluations of interventions to improve kneeling for patients with TKR are needed. However, no RCTs involving patients with TKR have evaluated the effectiveness of interventions specifically aimed at improving kneeling ability. A cohort study has investigated whether providing pre-operative patient education about kneeling improves patient-reported kneeling ability up to one year after surgery. 55 Before surgery, patients were advised that they may have discomfort or pain on kneeling and that this would not damage their replaced knee and then a nurse demonstrated a safe kneeling technique. By 12 months post-operatively, 72% of patients reported that they could kneel, which is higher than reported in other cohort studies (overview provided in Table 1 ). While these findings are promising, this was a cohort study with no comparator group, and therefore the conclusions that can be drawn are limited. There is a clear need for further research to develop an intervention to improve kneeling after TKR and evaluate whether it is clinically and cost-effective.

Implications for clinical practice and directions for future research

The first step to improving care for patients is to promote clinical awareness of this poor outcome after surgery and its importance to patients, and to empower patients to feel that this long-term problem is recognized. For this to happen, healthcare professionals need to recognize that kneeling is the most unsatisfactory patient-reported outcome after TKR and that problematic kneeling can have a considerable negative impact on health-related quality of life. Informing patients of this prior to surgery would enable patients to set realistic expectations of their post-surgical outcome. An RCT is currently ongoing to evaluate whether providing patients with additional education prior to surgery to set realistic expectations, including regarding kneeling ability, can improve satisfaction at 12 months post-operatively. 65 However, more research is needed to provide healthcare professionals with an evidence base to guide their discussions with patients and provision of healthcare services. Further research to understand more about the surgical and implant-related factors that are associated with kneeling ability could inform shared decision-making about surgical options with patients for whom kneeling is a particularly important outcome, e.g. for return to work. More research is also needed to design and evaluate interventions to improve kneeling. This would need to address the multifactorial reasons for which patients have difficulty kneeling after TKR, and patients have identified that they would like more information before surgery about post-operative kneeling ability, a more holistic approach to account for their other co-morbidities, use of kneeling demonstrations and provision of advice that kneeling is safe and will not damage their prosthesis. 30 Such an intervention could give patients the knowledge and confidence to return to kneeling activities and enable them to feel more in control and independent after their TKR. Alongside generating evidence on the effectiveness of interventions, work is needed to understand healthcare professionals’ perceptions on kneeling to inform the implementation of research findings into clinical practice.

Conclusions

Patients have growing expectations of being able to return to a full and active lifestyle after their TKR. To meet these expectations, research is needed to evaluate how to optimize higher-function activities such as kneeling. The majority of patients experience difficulty kneeling after TKR, which can have a detrimental impact on many activities and areas of life and is a source of dissatisfaction. Increased clinical awareness of this poor outcome and research to inform the provision of services is needed to improve patient care and allow patients to return to this important activity.

Footnotes

ICMJE Conflict of interest statement: VW and AWB declare institutional grant funding from Stryker for activity outside of the submitted work. NH declares receiving funding for providing educational activities as faculty on courses for Stryker and Smith and Nephew.

Funding statement

This article was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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Can I Run After Knee Replacement

It is important to note that running on a replaced joint does carry some risk. Experts cant agree on how risky it is, exactly. But this article would not be complete without this disclaimer.

If an artificial knee becomes damaged or comes loose, it will have to be replaced. And secondary surgeries are often more complicated than the first surgery. They also have a lower success rate.

Knee replacement surgery always starts with a long conversation between patient and provider. The choice to run on an artificial knee is no different. Patients should always let their doctors know if they intend to run on a replaced knee. And the sooner, the better. This will set the tone for all future exchanges and ensure everyone is on the same page.

The doctor can also outline any risks specific to the patient. The patient should carefully consider these risks when making the decision to run.

Biomechanical Expectations During Rehabilitation

In order to avoid the pitfall of returning to running too soon, its imperative to establish checkpoints in the rehabilitation process to ensure forward progression and keep you on the right path.

A solid rehab protocol will address the issues listed above , but should also address changes in gait and loss of strength.

Some of your primary benchmarks for a safe, post-op gait include the following abilities:

Each of these foundational skill sets will help you achieve full functionality in the quadriceps muscles, which is imperative for recovery. Your quads are directly connected to the knee via the quadriceps tendon, and any deficiencies or compensations with the muscle can cause increased pressure and forces at the joint. So, its essential to develop sufficient muscle strength and full contraction before you begin a walking program .

As you progress through quadriceps reactivation and move into walking , its important to address the how in addition to the what and this is where biomechanics come in.

The patterns you teach your body during rehab will have a bearing on whether or not you can return to pain-free running. If the motions you train arent biomechanically sound, you open yourself up to future re-injury or pain with running.

And that leads us to one, huge consideration in training your knee for running

Fitness After Knee Replacement Surgery

So many of you have emailed with questions about your own knee issues after I shared my journey of running after knee surgery. Unfortunately some of you have questions I couldnt answer because you were undergoing a full or partial knee replacement.

I didnt want to leave you hanging, so I reached out to Robin, a former ultra marathoner, who has been on this journey for the last year and has some incredible insights.

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Add In Resistance Training

The old advice states that high-impact sports may cause knee replacement implants to come loose. Some doctors are now challenging that idea. They think that implants come loose as the bone around it becomes weaker. But there is a solution! Resistance training helps to increase bone density. And the best part is that athletes can start even before theyre ready to run. Athletes can focus on their arms, core, or uninjured leg using machines. Its a good idea to stick a trainer at first, especially during recovery. They can help athletes avoid injury

When A Knee Replacement Is Needed

Our Treatment Process

Knee replacement surgery is usually necessary when the knee joint is worn or damaged so that your mobility is reduced and you are in pain even while resting.

The most common reason for knee replacement surgery is osteoarthritis. Other health conditions that cause knee damage include:

  • knee deformity with pain and loss of cartilage

Can I Jump Rope After A Total Knee Replacement

Just as with running and jogging, it depends.

I have been an avid CrossFit member for over 6 years now. In my class several members have undergone a total knee replacement.

Jump rope is a common part of CrossFit and other workout programs. When done properly and with the guidance of your surgeon or physical therapist, jump rope may be a great exercise after a total knee replacement.

Consider the variables below and talk to your physical therapist before jumping rope:

1.) Body size larger bodies are required to absorb more impact.

2.) Training history a person who has been using jump rope as a trainning stimulus will be far more likely to return to jump rope after surgery.

3.) Age, strength, and other factors in my clinic I have worked with individuals ranging in age from 28 to 82 who have received total knee replacements.

Stair Climbing And Descending

The ability to go up and down stairs requires both strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good” and “down with the bad.” You may want to have someone help you until you have regained most of your strength and mobility.

Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than the standard height and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Stair climbing and descending using a crutch

A Few Alternative Exercises I Prefer

I have been very active all of life and I continue to be active after knee replacement. I have been able to continue with some of my old activities but I have also found new activities that I can enjoy.

Until I was 55, I played softball and basketball on a regular basis. I still play catch now and then, shoot a few baskets, and make a trip to the batting cages but I no longer engage in competitive play.

Pickle-ball has taken the place of softball and basketball. I play doubles and the reflex reactions and cardio workout keep me fit and sharp.

I can choose to play recreationally or I can opt for more competitive games. Pickle-ball was a great way to meet new friends when I moved to a new area.

Occasional games of golf and ping-pong also help to fill the gap left by basketball and softball. Before knee replacement I walked, hiked, swam and cycled.

All four are enjoyable ways to get outside and build up the muscles in my legs and get some cardio benefit as well.

Swimming as become one of my favorite exercises because I am able to get a full body workout. Continue to work out 3 to 4 times in the gym .

Have your physical therapist develop a workout program for you once you complete formal physical therapy.

Does Running Lead To Knee Replacement

Is running bad for the knees and does it cause knee replacements? This belief is incorrect.

This is a long-standing misconception probably because injuries to the knees, shins and joints are quite common in runners. The theory says that running wears out the knees, erodes the protective cartilage in the kneecap and thus reduces the knees ability to cushion the blows and ultimately leads to arthritis.

However, the truth is that long-term running is probably good for your knees. Consider, for example, a Stanford University study. Scientists were interested in whether or not regular running on long distances causes more frequent occurrence of osteoarthritis in the knees. Over a period of 20 years, two groups of older runners were compared with a control group of non-runners of similar age. At the end of a 20-year study period, the researchers concluded that arthritis did not occur more frequently in runners than in non-runners. On the contrary, degenerative changes occurred faster in the knees of non-runners compared to the knees of runners.

Another study by Austrian scientists involved scanning the knees of a small group of dedicated marathoners in 1997 and then again in 2007. The result of the research is almost the same: the condition of the knees of no runner has deteriorated over the ten years that have elapsed between the two tests. In other words, running seems to have protected the runners knees from damage.

Also Check: Bioknee Cost

Is Running Safe After Meniscus Surgery

If youre a runner, youve likely lived firsthand the unique bond that comes with running as a sport theres that unparalleled appreciation for hitting the road, finding your stride, and finding escape through running.

But to have that world suddenly interrupted by injury is shocking, to say the least.

To make matters even more difficult, if youve specifically endured a meniscus injury or surgery, youve likely been told to stop running altogether.

Not only has the initial injury sidelined you from training, but youre also directly discouraged from running again by medical professionals. And as you probably know, being told that you cant and shouldnt run again is equivalent to asking you to give up your passion and source of stress relief.

However, were here to tell you: unless there are concrete facts to justify why you may have to put an end to that running career, its entirely possible to ensure a safe return to running.

Our team is determined to help runners rehabilitate and get back to doing what they love the right way.

The Athletes Tendency To Put Off Medical Knee Assessment And Surgery

Knee operations are a terrifying thought for anyone, but to an athlete, theyre unthinkable. We just cant shake the fear that an op is only going to make things worse or completely obliterate our ability to run.

As such, its common for us to just wince through the pain, putting off medical assessment. I certainly did. In fact, for a long time, I didnt seek medical help because I simply thought nothing could be done, that this was my lot in life and that Id lost the genetic lottery. But the earlier you see a specialist, the better.

The longer you endure the pain in your knees, the more damage is being done, which will limit your options in terms of treatment. Remember, you dont have to agree to any surgery, but requesting a medical consultation is key, and until then, make sure youre running in supportive footwear.

Ive been using Nike Zoom Pegasus Turbo 2 running shoes. Obviously, they havent solved my issues, but they do a great job of reducing the burden of walking and running on my knees.

How Active Can I Be After Joint Replacement

A combined 280,000 joint replacement surgeries were performed in 2016, according to the American Joint Replacement Registry. While the statistics for 2017 have not been released as of this article, the numbers are expected to increase continuing a trend that began in 2012.

As life expectancies continue to rise, more people will experience conditions like arthritis and osteoporosis that damages their joints. Consequently, more people will turn to surgeons to have artificial joints put in to relieve their painâpain that often keeps them from active lives.

Artificial joints are remarkably resilient, and itâs rare that a knee or hip replacement doesnât last a patient the rest of their life. But care has to be taken not to put undue stress on the artificial joint, as this can wear it out much more quickly.

This article provides a list of approved activities following joint replacement surgery. This article also contains activities that require precautions as well as activities to avoid.

How Do I Start Running After Knee Surgery

Why does my knee feel weird after my total knee replacement?

There are few studies on the impact of high-stress sports on artificial knees. And many of those studies no longer apply due to advances in materials and surgical techniques. This, unfortunately, means that there are also few studies on exercise after knee replacement. Most of the available advice comes from runners who underwent the procedure themselves.

People after knee replacement must consider this lack of evidence when deciding whether or not to run. The suggestions outlined below may help reduce the risk of injury. But running knee surgery , will always carry risk. Only the athlete can decide if the benefits are more important.

Follow this return to running program after knee surgery:

Dick Beardsley 61 And Minus Two Knees Runs Faster Than You

The former pro has had two full knee replacements in the past decade. Neither slowed him downand they don’t have to slow you down, either.

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Dick Beardsley is out in front again. More than 30 years ago, the now 61-year-old legendary runner podiumed at storied, high-profile marathons and qualified twice to run in the U.S. Olympic marathon trials. Today, defying both odds and naysayers, Beardsley still logs impressive milesdespite the fact that his left knee isnt what it once was.

Nor is his right.

Beardsley, who runs as many as 50 miles per week on two synthetic knees, is a testament to the notion that artificial parts neednt slow you down.

Everything is going good, says Beardsley, a chipper Minnesotan who delivers motivational speeches around the world and co-owns the Lake Bemidji Bed and Breakfast, about 200 miles north of Minneapolis. I love getting out there for an hour every morning.

But recovery time from the surgeries isnt the only hurdle facing joint-replacement vets. They often must override physician resistance.

The whole point of joint-replacement surgery is to get your patients out again.

After a joint replacement, most doctors will tell their patients to slow down, suggesting they replace their beloved runs with, say, mall walking. We get the cautiousness. Medicos still quote the old Hippocratic Oath, First, do no harm.

Under two hours, says Beardsley. I was pretty tickled.

Additional Factors To Consider However:

Past fitness levels and exercise history

Body size of the individual

Prior participation in the sport or activity

Bone health and tissue healing

Age of the individual

Psychosocial benefits of these activities

Risk of other health factors that may decline without performing this activity

* Recommendation: when possible, consult with your surgeon and rehabilitation team to determine what is the best solution for YOU based on the factors mentioned about. This is a complex question and requires extensive investigation into the benefits and possible risks associated with your activity.

Can You Run With A Knee Replacement

Running is a good aerobic activity, but should you run after knee replacement surgery? Unlike other aerobic activities, running has a high impact on the body.

Running or jogging can cause strain and stress on your knee replacement. Most doctors, including my own, will say that running and jogging is possible after TKR, however they would not recommend either activity.

Joint replacement and the recovery process that follows is not easy, especially for weight bearing joints like the knee.

This article will look at the pros and cons of running and jogging after knee surgery and Ill share my experience with running and jogging.

What Matters Most To You

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have knee replacement surgery

Reasons not to have knee replacement surgery

I want to be able to do low-impact activities, such as swimming and golf, as well as chores and housework.

My knee doesn’t really get in the way of the physical activities I like or need to do.

I have more bad days than good.

I have more good days than bad.

I’m not worried about the chance of needing another replacement surgery later in life.

I’m worried about needing another surgery later in life.

I’m ready and willing to do several weeks of physiotherapy after the surgery.

I don’t want, or I won’t be able, to have several weeks of physiotherapy.

I know that problems sometimes occur with surgery, but getting pain relief and getting back some use of my knee is worth the risk.

I’m very worried about problems from surgery.

The Bottom Line About Running After Knee Replacement

Athletes should not rush into running after knee replacementor really, after any kind of surgery. They should weigh all the pros and cons to determine if its the right sport for them. Some athletes may find that running and elliptical machines are enough to keep them active. Both of these options put less strain on the joints. On the other hand, some athletes may find that nothing compares to the freedom of running. Ultimately they have to listen to their doctor and their body. Then choose the path thats right for them.

How I Returned To Running After Knee Surgery

Dont worry, youll run again, just be patient.

I cant count the number of times someone said this to me and I had to bite my very blunt tongue because honestly, I never once considered that I wouldnt run again.

It wasnt an option. Maybe thats because Id already spent 8 months of dancing around an injury leading up to surgery. Maybe its because Im stubborn. Maybe its because Im an optimist.

But for the recordmost injured runners dont want your platitudes. They make our endorphin starved brains a little angry. Not because we dont believe you have the best intentions, but because we arent really the kind to sit around feeling sorry for ourselves, we want to TAKE ACTION. Take no prisoners, fight the good fight and all that jazz.Im now celebrating 9 1/2 weeks post knee surgery and to the amazement of many have been running since week 5 without pain. This week in fact, I hit 6 miles which felt pretty epic since 2 weeks ago 1.5 miles was pure bliss.

Going in to surgery I knew I would runI just didnt know when or what to expect.

Im sharing what worked for me in hopes that it helps calm someone elses nerves! The key here is to know that while I got up to running much faster than expected, I didnt do it against anyones orders! I wasnt taking chances or risking long term recovery for a couple uncomfortable trots.

Knee Replacement and long distance hiking

I am a 59 year old woman hiker and am looking at a partial knee replacement as soon as the doctor has an opening in her schedule. (Probably December) I have had arthroscopic surgury three times on my rt knee, synvisc injections x2, cortisone injections x6 and live on meloxicam and ibuprophin. I was planning to do a 540 mile hike this spring with a friend who really needs me with her to hike safely as she has a lot of major health issues (I am a certified wilderness first responder). My latest MRI shows multiple miniscus tears, tendonitis, inflamation of the fascia and arthritis of the knee cap and femur end. The orthopedists do not think the miniscus can be saved some of the tears go completely across and so think a knee would be the best course especially as I will be without major health insurance in just over a year.

My question is what are the chances I can hike again after a knee replacement and, if I am able to how long do you think it could be? If I am unable to be in the backcountry pretty much I will need to find a new career as being a wilderness responder requires hiking long distances often helping transport someone out of the woods.
I weigh 190 lbs and am 6′ 3″ tall BTW and carry a 30 lb back pack which can go up to 35 depending on how many days between resupply.

Tykey

big-cheese

Hi Debbie, and welcome to Bonesmart. Of course you will be able to hike again, but I’d suggest you read on here about the success (or not) of partial replacements. Many surgeons won’t do them any more because having a full replacement is often needed within 2 or 3 years. They don’t seem all that successful, particularly if a FULL recovery is that important to you.

You will have to be patient though, I love walking as well, but after 6 months , 3 or 4 miles was enough for my knee. Now, after 2 years, I’d feel confident of tacklng a really long hike. So don’t think you’ll be back on the trail really quickly, after 6 months you should be walking without pain, but it will get swollen and sore if you overdo it.
Good luck

just13

member

Hi Debbie welcome to bone smart as you I’m 59 and thought the same about what the future would hold, am very active but it was time like tykey said my doctor and many don’t do partial because of the damage if done why go thru the PT and then go through the pain years later 2 mouths day I had a full knee replacement and it’s not easy but need to take baby steps it’s a long journey good luck and keep us posted it’s a great site

zjrog

post-grad

United States

Joined Apr 24, 2011 Messages 1,244 Age 59 Location Tooele, Utah Gender Male Country United States

I won’t speak to the partial vs full since I’m not qualified. But many of us have returned to hiking, and I had planned some summits in my area this fall, but took a bad fall off my bicycle over the summer and still recovering. Hiking, running, don’t see any reason not to. Just don’t be in too big a hurry to get back to long distance. Your body WILL tell you when and how much it can handle. Cycling/stationary biking is good exercise and helps with flexibility and lets you get your strength and some stamina back. Sounds to me that you aren’t one to sit still long, so please take this advice. Go slow with the recovery. It is easy to overdo things and cause yourself more pain and possibly injury.

From the guy that jumped off an ATV at 7 months.

Debbie hikes

new member

Thank you all for your encouragement and the advise about full knee vs partial. That makes a lot of sense. I will try going slow and taking my time. For me a short day on the trail is 14 miles. But the woman I am supposed to go with will be unable to do more than ten if that. We are supposed to start in Damascus Va and go north on the Appalachian Trail. But for those of you who know while VA is easier than many states on the AT starting in Damascus gives us the biggest mountains in VA in the first two weeks. our first day includes 3000 feet in four miles or so (which is not bad by AT standards but is still a bunch of up. I am in pretty good shape as far as my leg muscles are concerned even with the bad knee I did 760 miles this year. I hope that will help my recovery. But it does take time, I am a large woman frame wise and tall too so that plus age are going to be adverse factors. I will try to play it by feel. A lot will depend on how fast I can heal and what the surgeon does (and when as I am Still! waiting for a date.

Celle

MODERATOR EMERITIUS

New Zealand

Joined Nov 19, 2011 Messages 46,057 Location New Zealand Gender Female Country New Zealand

Hi Debbie, and welcome to Bonesmart. Of course you will be able to hike again, but I’d suggest you read on here about the success (or not) of partial replacements. Many surgeons won’t do them any more because having a full replacement is often needed within 2 or 3 years. They don’t seem all that successful, particularly if a FULL recovery is that important to you.

You will have to be patient though, I love walking as well, but after 6 months , 3 or 4 miles was enough for my knee. Now, after 2 years, I’d feel confident of tacklng a really long hike. So don’t think you’ll be back on the trail really quickly, after 6 months you should be walking without pain, but it will get swollen and sore if you overdo it.
Good luck

I understand that many surgeons prefer not to do partial knee replacements, but I would like to add my experience.

In November 2000, I had a PKR, using an Oxford mobile bearing implant. I was 59 years old. I made an uneventful recovery and have had eleven good years out of that PKR. I could do just about everything I could do before my knee got arthritis.

I was told to expect 10 to 15 years out of that PKR and I had eleven very active years before the spacer failed. It’s only now tha I am needing a revision to TKR.

I just wanted to present the opposite perspective!

jerseychick

post-grad

Hi Debbie, It sounds like you have a great job, welcome to BoneSmart! I also can’t speak to the partial vs a full knee. I had a full knee in June 2010 and hiked up the Catalina Mountains in Tucson, Arizona in August, 2011. We did 6 miles and went up 4,000 feet. It was actually like rock climbing and my knee did just fine. I know that I would have definitely not been able to do a hike like that six months out. My knee took about 9 months to feel like normal. Not sure if it would be the same with a partial.

referee54

Former BoneSmart staff member

United States

Joined Dec 21, 2007 Messages 17,881 Age 68 Location Northern Part of the Buckeye State Gender Male Country United States

I canKR vs. a TKR, but I had a BTKR four years ago, and I am doing anything I want—umpiring over 100 baseball games a year, teaching, working part-time on a produce farm, and cutting down trees and splitting the logs that will be used to heat our home. In addition, I cycle 120-140 miles a week in the summer time.

My point is this—after your PKR, you should be able to do almost anything you wish—skydiving and bungee jumping are out, but we have runners, cyclists, hikers, snowboarders, skiers, and other very active people who have reclaimed their lives after having the procedure done.

I would say that you should be able to hike as long as you want wherever you want—but your recovery may take some time. Recovery can be slower and longer than you would like, so if you have the surgery in December, you will most likely be able to be ready in late April or May—this will give you time to recover from surgery, rehab and strengthen your knee, and give you a tiime period for some leeway.

I had my BTKR in November and the first week of baseball season—the first week in April, I still had a slight limp, but it went away in a few weeks. You can never forecast how long recovery will take—it may be relatively quick, but some can take quite some time. It has been said that it can take upward to year to return to “normal.”

I do believe that you should have no trouble hiking with a pack, etc. The question is simple—will your knee have enough time to recover?

Jamie

OneStep AMBASSADOR ..Staff member since Feb, 2009

Joined Mar 24, 2008 Messages 69,323 Age 74 Location Kansas Gender Female Country United States

Hi, Debbie. welcome to BoneSmart.

The hiking might be possible for you, but I have some concerns about the situation you described. At less than 6 months out from surgery, in my opinion you would not be in a position to carry or support a person who had problems during a hike.

You’ll just have to see how you do after your surgery, but we have had members go back to really demanding jobs like police work and firefighter. So, once you get through the healing phase of recovery, you should be able to start rebuilding the strength you need for that job.

Does your surgeon do both partials and full TKRs? It’s usually a good idea to have someone who does doing your PKR. Sometimes things don’t appear on the xrays or MRIs. Arthritis can ony be seen once they are in your knee. Usually a good surgeon will tell you that he’ll try for a PKR, but he will want the option to do a full replacement if it turns out that you have arthritis in 2 of the 3 compartments of your knee. If this is the case and an PKR is done, the chances are increased that the arthritis will soon spread to the other compartment and you’ll be back in for a conversion to a TKR.

The bottom line is that you must put your trust in your surgeon’s recommendations, though. If you have researched him fully and he does at least 250 PKR/TKR surgeries per year, then you should be confident that this is right for you.

Source https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667980/

Source https://www.healthykneesclub.com/can-i-run-after-knee-replacement/

Source https://bonesmart.org/forum/threads/knee-replacement-and-long-distance-hiking.12477/

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