Sport is healthy. All doctors say so, without exception. It’s beneficial for the heart, for maintaining weight, for mental health and for a lot of other things. You have played sport for as long as you can remember and you’ve always felt great…until now.
For some time now your knee has been hurting, so much so that you’ve had to stop running. The orthopaedic surgeon has told you that you have osteoarthritis. The cartilage is worn down and, sooner or later, you will have to have a prosthesis. A prosthesis! Granted, you’re not as young as you used to be, but you’re fit, you like sport and you want to keep doing it. The idea of a prosthesis sounds like “I’ll only be able to go for walks”.
Is that really the case? Do knee prostheses mean the end of sporting activity? What kind of physical activity can you do and how long after the procedure? In this article we talk about osteoarthritis, sport and recovery time after knee surgery. And, above all, we answer the question that’s been tormenting you: “Will I be able to play my favourite sport after surgery?”
The dilemma: benefits and disadvantages of sport
As we’ve already said, sport is good…for almost everything. Many of the ills of the 21st century, such as obesity and diabetes, can be combated through physical exercise. On the flip side there are, for example, injuries or the shorter longevity of prostheses with certain sports.
Physical exercise, the source of life
It’s been known for a long time that a sedentary lifestyle shortens life expectancy while physical activity lengthens it. It is also known that the benefits are related to the intensity, frequency and duration of the activity, although any degree of physical exercise already provides health benefits, both physical and mental. And it’s never too late to start: did you know that there are studies that show that very old and frail people improve their physical fitness and, even, longevity, despite starting to exercise at such advanced ages?
Studies have shown that physical activity is good for all of the following (be prepared, it’s a long list!):
- It improves strength, coordination and balance in older adults, so it decreases the risk of falls and promotes independence for everyday activities.
- It reduces the risk of cardiovascular disease.
- It prevents and ameliorates type 2 diabetes.
- It helps to lose weight, even if it is not accompanied by diet (although, of course, the combination of physical exercise and diet is more effective to lose weight).
- It improves bone health, since it increases mineral density and prevents osteoporosis. In people who already have osteoporosis, studies show that physical exercise reduces the risk of hip fracture.
- It helps prevent cancer of the colon, stomach, esophagus, breast, prostate, bladder, kidney, pancreas, endometrium and lung. Also, in people who have had cancer, life expectancy increases.
- It has a positive effect on mental health: it helps sleep, decreases stress and anxiety, prevents depression and improves intellectual performance.
- It lengthens life: you live longer and better.
And you might not believe it but we’ve almost certainly omitted several other benefits…
Although most of these effects are common to the two major types of exercise (aerobic and endurance or strength), the latter is especially useful for increasing muscle mass and strength, as well as bone mineral density. This is crucial in elderly people and also in those with osteoarthritis, where muscle mass is frequently lost.
For example, knee osteoarthritis is associated with a decrease in the tone and strength of the quadriceps, which worsens pain and further limits activity. The same happens after a procedure (including an arthroplasty or a procedure where the joint is replaced by a prosthesis). Therefore, strengthe exercises are fundamental in these situations.
The disadvantages of sporting activity
In contrast, doing physical exercise also carries risks (relax, this list is short):
- Logically, the most frequent disadvantages are injuries (sprains, tendonitis, fasciitis, etc.), especially in people who are not used to exercising.
- The risk of arrhythmias, heart attacks or sudden death is very low, but it exists.
- Rhabdomyolysis (muscle destruction) is also rare, but it can occur when you exercise very intensely in extreme heat and humidity.
As for the effect of sport on knee prostheses, it is thought that in high-impact sports they can be damaged and worn down prematurely and need to be replaced. We say “think” because there are hardly any studies on the subject and existing ones are controversial.
What does seem clear is that physical activity, in general, is positive for postoperative recovery and longevity of the prosthesis, since it improves the quality of the bone and the implantation of the prosthesis.
A little bit of history: old age is not what it used to be. And nor are prostheses.
Nowadays, people live longer than before and reach old age in better shape. Quality of life has improved and habits, too. Before, it was strange to see people running down the street, whereas now it is commonplace. Gyms proliferate and are not only full of young people, but also people older than 65 (which is defined as elderly). All these physically active people want to continue playing sport for a long time and do not want their osteoporosis to be a hindrance.
In keeping with people’s expectations and with medical advances, prostheses have also evolved. In the last century, knee prostheses were an alternative in elderly people with very advanced osteoarthritis. The aim was to alleviate pain and allow them to walk again and to carry out everyday activities, which, in most cases, did not include sport (because people did not play it).
Now, prostheses are an option for ever-younger people who want to continue to lead an active lifestyle without pain. There are numerous therapeutic advances for knee osteoarthritis, and procedural techniques and the materials used are getting better. Even so, not everything goes. There are sporting activities that are harmful because they wear out the prosthesis faster or can dislodge it. Below, we’ll tell you about recommended sports and what is best to avoid after knee arthroplasty.
So, what sport can I do with my prosthesis?
From what we have seen, it is clear that sport is beneficial and should continue to be performed after knee surgery, but activities must be adapted to avoid damaging the prosthesis. That said, what activities are allowed and which ones are not recommended?
Playing sport again depends on several factors
The type of sport activity that you can do in your particular case is a subject that you will have to raise with your orthopaedic surgeon. The type of sport and the intensity with which you can practice it will depend on many factors, such as the type of procedure and prosthesis, age, weight and physical fitness, motivation and, above all, sporting experience prior to the procedure. It is not the same for a 60 year-old who trains daily and runs marathons as for someone who is 75 who goes to pilates twice a week. Therefore, please take this post as for guidance only.
Furthermore, orthopaedic surgeons do not completely agree, since there is a lack of scientific studies on the effect of different sports on prostheses. Many recommendations are based on surveys of orthopaedic surgeons and other health professionals related to sports, that is, on opinions (based on experience, but ultimately only opinions). So much so that, for example, if you had a hip arthroplasty in the United States, only 21% of surgeons would allow you to return to high-impact sporting activity, while, if you had the same operation in Denmark, 55% would “give you their blessing”.
With that said, let’s get straight to the point. The first thing that we have to distinguish is the degree of risk on the prosthesis that each sport presents. Depending on the impact, they are classified as low, medium and high impact sports. You also have to take into account the risk of falls or of being hit.
Low impact sports: allowed
These types of sports are suitable for practically all people after knee arthroplasty, once the relevant recovery time has passed. They are beneficial activities for health and have a very low risk of damaging the prosthesis. The following sports fall under this category:
- Exercise bike
- Swimming and water gymnastics
- Ballroom dancing
- Table tennis
- Gentle gymnastics
Medium impact sports: allowed if they were practiced before
These are sports that require previous experience to ensure that they are practiced with minimal risk to the prosthesis. That is, if you practiced any of them before your operation, you can continue them. However, if you did not, it is better not to start now. They are the following:
- Doubles tennis
- Horse riding
High impact sports: better to avoid them
Although, as we have said, studies are lacking which supports evidence that this type of sport actually lessens the longevity of the prosthesis, prudence and logic make most orthopaedic surgeons recommend you stop playing these sports. Contact sports increase the risk of injury and are also not recommended. They are the following:
- Singles tennis
- Intense gymnastics
- Water skiing
When can I go back to playing sport after my knee surgery?
The minimum recovery time before playing sport again after a knee prosthesis procedure is 3 months. The usual time period is 3 to 6 months, although many people will need more than 6 months, especially if the prosthesis is total.
This time is approximate, since it will depend, once again, on the type of sport and other factors related to both the procedure and the individual. It’s logical that it is easier and quicker to resume less intense sporting activities than those with greater impact, and that someone trained and highly motivated will most probably recover sooner.
Of all the factors that influence recovery time after knee surgery, there is one that, to a large extent, depends on you: postoperative rehabilitation. The more effective it is, the sooner you will return to playing sport. If you follow your doctor’s instructions and are disciplined with the exercises they provide you, recovery will be faster and more successful.
In this respect, rehabilitation exercises seek to work on muscle power (especially quadriceps), mobility, balance and coordination, and will be adapted to the postoperative phase you are. In turn, resuming sporting activity should also be a gradual process.
The most important advice: talk to your doctor
Remember that everything said here is for guidance only and cannot be applied to all cases. Surgical techniques are becoming less aggressive and prostheses are becoming more resistant, and the tendency is for specialists to allow more and more types of sporting activity. Also, there are many new therapies for knee osteoarthritis that may be an option for you.
Talk to your doctor and tell him your preferences. Even in sports which are initially prohibited, in certain cases there may be the possibility of reducing the impact through adaptations with physical devices, or by changing your technique or the playing surface. Together, develop a sports plan that is acceptable to you…and to your prosthesis.
If, ultimately, you must change your sporting activity, do not be discouraged. There are many sports that you can perform and that, as well as fun and stimulating, have many health benefits (read the list at the beginning of this post to refresh your memory). And now, yes, we won’t take up any more of your time: get exercising!
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