Will a knee replacement end your running career?

Many people would assume getting a knee replacement would put an end to your running career, but according to a literature review published in the Journal of Musculoskeletal Surgery, that may not be the case.

A total knee arthroplasty (TKA) is the replacement of damaged knee joint with an artificial one to improve function and alleviate pain, and typically, patients are told to steer clear of high-impact activities, even after recovery. New studies contradict the standard recommendations from surgeons, and suggest that running post-TKA is feasible, or possibly even beneficial.

Although the procedure boasts a high success rate, it can greatly impact the quality of life for runners, who are typically advised to avoid running entirely and instead focus on low-impact activities, like swimming, walking and cycling.

Running is on the table

Using statistics from existing studies on runners who underwent TKA surgery, this literature review addressed the limited information on the subject of running after a knee replacement. The paper sums up six studies, all pointing to running as a feasible goal and lifestyle for active individuals after a TKA.

These three studies stood out as the most compelling and inspiring of the group:

1. Running is not a risk factor for revision surgery: The first study investigated the revision rate of TKA surgery (the need to redo the procedure) at two years post-operation. Researchers found that patients who were highly active, doing activities like running two to three times a week, had the lowest revision rate. In contrast, patients who had lower activity levels had the highest revision rate.

2. Runners can regain their fitness post-surgery: This study investigated the return to activity for runners post-TKA surgery, showing that only 35 per cent returned to running–and demonstrated similar function to their preoperative fitness levels. The primary reason for others not returning to running? Advice from their surgeons.

3. Runners can run just as much post-TKA: Another study analyzed the activity levels of 494 patients five-years post-surgery, where after 31 patients were back to running and 18 were back to marathon running. None of these runners required revision surgery and 93% of them “maintained or increased their [activity] level after surgery.”

The critical timeline

Researchers also emphasized the rapid and very critical timeline for rehabilitation to ensure patients regain ROM and knee function to facilitate their return to running. As with any healing process, the timeline is subjective and patients should be careful to not overexert themselves.

1. Before leaving the hospital

Physical therapy should begin immediate following surgery, before leaving the hospital. These exercises include quadriceps contractions, leg elevations, ankle flexion and extension and knee flexion. The patient also must be walking and ascending and descending stairs before being discharged. Pedalling backward on a stationary bike is also recommended.

2. One month post-surgery

At this point, patients should be proceeding gradually to bodyweight exercises including squats, lunges, step-ups, wall sits and leg extensions. Swimming is encouraged but high-impact activity is not advised.

3. 6-8 months post-surgery:

The patient is allowed to gradually return to running over the span of two months.

Weeks 1-2: Fast walking for 20-30 minutes up to three times per week.

Weeks 3-4: Alternate between a one-minute jog and two-minute fast walk for 20 minutes.

Weeks 5-8: Gradually increase working time, not exceeding 40 minutes of continuous activity.

Week 9+: Patient should be able to run with no time limitations.