Activity recommendations after total hip and total knee arthroplasty

Key points

1. 01More than 95% of surgeons placed no limitation on walking on even surfaces, climbing stairs, level cycling, swimming, and golf after both hip and knee replacement.
2. 02Higher-impact activities were more often discouraged, but with considerable variability between surgeons.
3. 03Recommendations after total hip replacement were generally more liberal than after total knee replacement.
4. 04No surgeon indicated that their recommendations were supported by strong scientific evidence.
5. 05Biomechanical data suggest golf is actually a high-impact activity for the leading leg, contrary to common belief.

How it was conducted

Design

Cross-sectional survey handed out to surgeons at the 2007 AAHKS annual meeting, completed before the patient-activity session

Participants

Members of the American Association for Hip and Knee Surgeons (AAHKS), who devote at least 50% of practice to hip or knee replacement

Survey content

15 specific activities rated as unlimited, occasional (1-2 times per month), or discouraged, with separate responses for hips and knees

Analysis

Spearman rank correlation and multivariate analysis (significance threshold .05) relating recommendations to annual surgical volume and surgery type

What they found

• One hundred thirty-nine surveys were returned.
• Greater than 95% of responses placed no limitation on walking on even surfaces, climbing stairs, level-surface cycling, swimming, and golf for both hip and knee replacement.
• After total hip replacement, jogging was discouraged by 71%, difficult skiing by 83%, and singles tennis by 49%.
• After total knee replacement, responses were similar except that 60% discouraged singles tennis.
• Occasional doubles tennis was recommended after total hip replacement by 71% and after total knee replacement by 66%.
• Surgeons were more liberal after hip replacement than knee replacement, reaching significance for walking up stairs (P = .045), jogging (P = .045), doubles tennis (P = .011), and singles tennis (P = .0004).
• Surgeons performing a higher volume of revisions were more liberal, reaching significance for vertical climbing (P = .028), cycling on inclines (P = .045), and singles tennis (P = .035).
• High-volume primary hip surgeons were more likely to recommend climbing (P = .032); high-volume primary knee surgeons were more likely to recommend stairs (P = .021) and walking on uneven surfaces (P = .009); high-volume revision knee surgeons were more likely to recommend singles tennis (P = .027).
• None of the respondents reported that their recommendations were supported by scientific evidence.

Limitations

• The survey queried only a limited number of activities.
• The number of respondents was relatively small, and only surveys completed before the activity session were accepted, which further reduced the sample.
• Recommendations reflect surgeon opinion rather than long-term outcome data, and no respondent claimed scientific evidence behind their advice.
• The link between activity level, surgical volume, and revision risk is correlational, leaving cause and effect unresolved.

Why it matters

For patients

After a hip or knee replacement, most surgeons will support a return to low-impact activities like walking, swimming, cycling, and golf, while higher-impact sports such as jogging or difficult skiing are commonly discouraged.

For clinicians

This survey documents current community standards for post-arthroplasty activity advice and highlights that such advice varies widely and is not grounded in strong evidence.

For readers

Surgeon recommendations for activity after joint replacement are largely consensus-based opinion, with emerging biomechanical data (such as golf loading the leading leg as much as jogging) that may not yet match common advice.