I'm an Athlete Who Needs a Total Knee Replacement, What Can I Expect?

Written By: Robert M. Shalvoy, MD Orthopedic Surgery & Sports Medicine Care New England Health System on December 19, 2022

Will I still be an athlete after a knee replacement?  
What will I be able to do?  
Will I be better or worse? 
How do I know what is best for me? 

These are the questions individuals with active lifestyles face when considering a knee replacement.

Athletes commonly experience symptoms of osteoarthritis after knee injuries and surgery from years past.  Activities that were once easy and pain-free gradually become harder and more uncomfortable - until the discomfort can no longer be ignored. At this point the athlete must make an important decision: stop/modify their present activities or seek treatment for their arthritis.  

A knee replacement or Total Knee Arthroplasty (TKA) then becomes part of the conversation. A knee replacement is a routinely successful operation that eliminates pain and restores function to a worn-out joint. But, the operation is not without risks and success is dependent upon the patient’s commitment to the preparation and recovery processes.  
How Do I Know It’s Time for a Knee Replacement?
Ask yourself these simple questions: 
  • Is my pain manageable?
  • Can I do the things I want to do? 

If your answer is “yes,” you are successfully living with arthritis. If the answer is “no,” then your arthritis is not sufficiently managed.  

You may want to explore treatment options that do not include knee replacement surgery. Alternatives include anti-inflammatory medication, injection therapy, and physical therapy. Sometimes symptoms are caused by other knee problems like torn cartilage or meniscus.  In those cases, a knee arthroscopy may be a reasonable solution.  (These alternatives are reviewed in more detail elsewhere in the article.) If, after considering and exploring these options, your pain is still unmanageable and your activities are still limited, it may be time to consider TKA.  
What Can I Expect?

In a Total Knee Arthroplasty (TKA), an incision is made down the front of the knee. The muscles and tissues are then retracted away to expose the joint. The surfaces of the worn-down bone are leveled off to a smooth, flat surface and the replacement surfaces of metal and plastic are precisely fitted and fixed to the bone.  This corrects the deformities and restrictions of the knee.  Lastly, the muscles and tendons are allowed to return to their normal position.

Now, the healing process begins.  In the days and weeks following surgery, the tissues will heal, and muscles will regain their function.  This requires time and work from the patient.  

To be successful, you must commit to taking the time to heal, working with rehab professionals, and staying within a healthy balance of healing and exercise - outlined by your surgeon.
Returning to Sports
Eventually you will progress beyond basic rehab and start to focus on more complex and athletic activities.  It takes about 3 - 4 months for patients to be able to perform all their work-type activities.

Getting back to sports can take longer – 6 months on average - with a more gradual progression. Tissue healing, restored muscle strength, and full range of motion are basic requirements to consider before returning to sports activities.

Your sport or activity may benefit from some additional “sport-specific” therapy to train the actions used in your planned activity.  This brings us to the ultimate question: What sports are ok and what sports are off limits after TKA?
What Sports Are OK After Knee Replacement?

Traditionally, surgeons have balked at patients returning to vigorous sports after knee replacement. These surgeons preferred limiting stress to promote longevity of the artificial components. (Note: there is limited data or literature outlining the outcome of patients attempting to return to sports).


Over time however, the design/quality of the component parts, improved surgical techniques, and advanced rehabilitation programs have allowed for new levels of performance and function after TKA. This coincides with changes in patient expectations and increased desires to maintain an active lifestyle - including recreational and competitive sports. 

So, the bar has been raised and the guidelines are evolving.  It is important to remember that while the function of a total knee replacement has never been better, it has not reached the level of a normal knee that has not been replaced.  

Activities That Are Always OK:
Activities that have traditionally been recommended after TKA include:
  • Walking
  • Hiking
  • Cycling
  • Swimming
  • Golf
  • Tennis


The intensity of these activities can be modified to match the patient’s level of function and do not cause high levels of stress on the knee.  
Activities That Are Sometimes OK
Activities that are more vigorous tend to involve twisting, cutting, and overall higher loads of stress on the knee. This would include: 
  • Rock climbing
  • Running
  • Skiing (snow and water)
  • Snowboarding
  • Softball
  • Basketball and more


The first thing to consider is your ability level prior to surgery.  If you weren’t able to do it before surgery, you are not likely to be able to do it after.  Research shows that what you were doing before surgery is predictive of what you will do after your recovery and rehabilitation. 

Achieving a full range of knee motion, adequate muscle strength, muscle endurance, and balance are not only necessary to meet the demands of your sport - but also serve to protect and off-load increased stress to the replaced joint that can cause it to wear out prematurely.

Be aware that engaging in vigorous activities comes with an increased risk of injury and the possibility of more surgery - including surgery to revise or modify the knee replacement.  While it is thrilling to return to a favorite sport without pain, it is wise to have an increased awareness of safety to keep you in the game.  
It Takes a Team
Not all surgeons share the same outlook when it comes to returning to sports after a knee replacement.  Make sure your expectations are aligned with your surgeon’s and your physical therapist’s before considering surgery.  It’s also a good idea to get a second opinion. Consider a sport medicine expert who is well versed in Total Knee Arthroplasty and who can work with you to determine if knee replacement is the best option for you and can help you achieve your goals.  It really does take a team to have a successful total knee replacement and like many things, the key is in the preparation.

For more information on Total Joint Replacement Surgery and to schedule an appointment click here.