Life After Knee Replacement: Some Sports are Best Avoided
April 27, 2000 -- Despite the increasing number of total knee replacements
being performed in the U.S., few studies have looked at which sports activities
are best -- and which are best avoided -- after surgery. But, after measuring
the stress load placed on knee replacements, Swiss researchers have determined
which activities are safest and which can be harmful.
"Patients should alternate activities such as power walking and cycling,
which place less stress and pressure on the knee, and they should avoid
high-stress endurance sports such as jogging and sports involving running,"
lead author Markus S. Kuster, MD, PhD, tells WebMD. Kuster is an orthopaedic
surgeon at the Clinik Für Orthopädische Chirurgie, Kantonsspital, in Gallen,
Kuster also advises staying away from downhill mountain hiking or "at
least using ski poles and avoiding heavy backpacks." Mountain hiking
involves ascending and descending steep trails, and walking uphill has been
shown to produce minimal force on the knee. But, when Kuster and his
researchers recorded the stress placed on knees during downhill walking, they
found it to be quite high. For downhill hikes after total knee replacement
surgery, they suggest walking slowly to reduce the burden on the knee joint.
Their research was published in the April issue of Medicine & Science in
Sports & Exercise.
According to experts, one of the reasons that more knee replacements are
being performed today than ever before is that physicians have found it's much
better to intervene early rather than late. "In the past, the doctor
typically would not operate until the person had a foot in the grave,"
Jerry L. Cochran, MD, FACS, tells WebMD.
By waiting, he says, "people would get out of shape, lose muscle tone
and cardiovascular endurance, and gain weight. We don't want that to happen
because it brings on aging and loss of motion. We know today that it's better
to do the joint replacement early to keep the person active. A person should
not trade their health for time." Cochran is director of the Midland
(Texas) Orthopaedic Clinic and was not involved in the study.
"Usually, when a patient gets a total joint replacement, they think,
'Now I'm an old person.' But if a joint is put in appropriately, it will be
like taking 20 years off your age," he says. "You will be able to do
the things you enjoy again, and that's very important because it reconfirms our
existence as a human being -- it's good for our psyche." Cochran speaks
from experience; he recently underwent a successful joint replacement
Kuster agrees that patients should remain active for overall general health.
"If patients want to perform endurance sports after total knee replacement,
they should alternate power walking and cycling and [avoid activities] like
stepping," he says.
"This is good news for the patient," Patrick Meere, MD, tells WebMD.
"[Researchers] are now in the final stages of perfecting the [total knee
replacement,] and we're offering it to younger patients." The downside,
Meere says, is that "joint replacements offering greater range of motion
may result in patients placing too much wear and tear on the mechanisms.
Patients should be reassured that [walking and cycling] are very important
after total knee replacement, but contact sports should be banned forever."
Meere is a clinical assistant professor of orthopaedic surgery at NYU Hospital
for Joint Diseases in New York.
Cochran's advice to prevent the need for hip or knee replacement is to
"avoid the extremes of any sport. Hips and knees were meant to bend, but
don't overdo it."