Will a knee replacement enable you to resume the sports and activities you loved before osteoarthritis struck? Prof. Nick London shares his report to the European Knee Society.
Go back 20 years and the ambition post-knee replacement wasn’t to pick up your golf clubs and get back on the fairway. It was to be able to walk pain-free. Quality of life was very much a secondary issue to relieving or eliminating the grinding pain of osteoarthritis.
Fast forward two decades and that’s no longer the case. Today’s 60, 70 or 80-somethings are likely to be far more active than their parents were at the same age and expect to be able to retain the lifestyles they enjoy for much longer. There’s a corresponding recognition amongst knee surgeons that we need to be able to meet that expectation.
Active with implants
So it is that we now have many partial (and some total) knee replacement patients skiing, playing doubles tennis, fell walking and more. I hear reports from patients undertaking activities that we as knee surgeons may not recommend, but which they are doing anyway. I’ve treated football or rugby referees who are now pounding up and down their respective pitches every week. Extreme skiers are attempting serious off-piste stuff. I have a patient who’s desperate to climb Everest (again). And we have lots of people who tell us about their return to jogging and distance/endurance running.
But which of these activities are safe to undertake with a knee implant, and which are the ones that should come with a large ‘at your own risk’ warning? For knee surgeons, the answer is complicated by the fact that there’s little real data, and what research there is tends to be old and based on aging implants or techniques. What’s left is conjecture (there’s plenty of that) and the feelings of surgeons and engineers about what is safe.
So at the closed meeting of the European Knee Society in Megeve recently, I attempted to pull together the information we do have to reach a consensus about what is and what isn’t currently recommended.
Getting away with it
The consensus appears to be this: although some people ‘get away’ with returning to repetitive impact activities such as jogging, the overwhelming majority of knee specialists continue to recommend you avoid such activities. Just because some patients appear to be able to return to high level sporting activities doesn’t mean they should. Even if your partial or total knee replacement is performing well, the recommendation at present remains to avoid repetitive impact sports, contact sports and activities that put you at risk of a heavy fall.
The sports you can enjoy post knee replacement
Effectively, we are making a distinction between the social, the moderate and the non-competitive (doubles tennis, cross country or modest downhill skiing, fell walking etc) and higher impact, more unpredictable activities (competitive singles tennis, off-piste or moguls skiing, fell running etc).
There will always be those people who push themselves further and you will always read tales of knee replacement patients doing extraordinary things. One of my younger patients is seven years into a total knee replacement, plays high level, competitive singles tennis regularly and (so far) gets away with it.
But there’s a big difference between such anecdotal examples and consistent, measurable evidence. At present, I don’t know of any knee surgeon who would be willing to risk placing knee replacement patients through some form of impact trial.
So the advice is that low impact, social sport should be absolutely fine – especially with a partial knee replacement. Beyond that, you’re very much going beyond the recommendations and participating at your own risk.
If knee pain has stopped you taking part in the sport you love, talk to the knee specialists at Yorkshire Knee Clinic on 03453 052 579.
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Prof. Nick London
Specialist Knee Surgeon & Visiting Professor to Leeds Beckett University
“An excellent knee surgeon. He probably does as many partial knee replacements as anyone in the country.”