Are There Permanent Restrictions After Knee Replacement?

Are there any limitations immediately after knee surgery?

Whether you have had a total knee replacement or a unicompartimental knee replacement, the answer is the same: there are no forbidden movements! And this applies from the first few hours after the operation.

Neither immediately after the operation, nor in the weeks that follow, nor throughout the lifespan of the replacement.

In theory, you can flex and extend the knee as much as you want. You can even sleep on your side or stomach right from the beginning. You can also, in theory, put the prosthetic knee on the ground and lean on it to get up from the floor or do gardening, for example.

⚠️ The only thing that should limit you is pain. You should limit movements that cause pain, especially if the pain persists even after you stop the movement.

Some people are afraid that by taking pain medication, they won’t be able to feel if they make a wrong movement. However, there is no risk of making a “wrong movement,” even while taking pain relievers.

💡 From the beginning, the knee replacement is securely in place. No particular type of movement can displace it. The risk would rather be not moving enough! This would lead to stiffness in the knee, making it difficult to get into a car, climb stairs, ride a bike, or even walk. However, rest assured, this only affects 4 to 16% of people who have had a total knee replacement.

Is it certain that there is no risk in performing certain movements? Yes, because:

• Total knee prostheses have been around for over 40 years;
• There are many clinical studies that follow patients’ progress, sometimes for over 15 years.
• Knee dislocations are extremely rare. They affect only 0.15 to 0.5% of operated individuals, which is roughly the same as in the general non-operated population. In the vast majority of cases, dislocations occur as a result of a fall or trauma to the knee, already weakened ligaments, with significant deformity, and mostly in obese individuals. Less commonly, dislocations occur as a result of hyperflexion of the knee.

As an illustrative example, in 11 years of practicing physiotherapy, I have never encountered a patient who experienced a dislocation of their knee replacement. However, I have seen dozens of people who had hip dislocations after a hip replacement surgery.

Why is it believed that there are restricted movements after total knee replacement?

There may be some confusion with the post-operative care after a total hip replacement. After a hip replacement surgery, it is indeed necessary to avoid certain movements (although even this risk should be put into perspective). Otherwise, the risk is dislocation, which can be very painful and requires consulting a surgeon who will reduce the dislocation under anesthesia.

However, there is no risk of dislocation with a knee replacement. This is because the knee joint is much less mobile than the hip joint. The knee primarily flexes and extends, while the hip can move in all planes.

Another possible explanation for this concern is the fear of damaging the prosthesis. Modern prostheses are made from durable materials and have a long lifespan. Movements are not responsible for any potential premature wear of the prosthesis.

Wear and tear, when it occurs, is primarily due to excessive weight-bearing stress on the replacement. Generally, this happens when a person is overweight or obese, or when they engage in high-impact sports (such as running) too intensely.

Which positions or movements should be avoided too frequently?

The main complication of a knee replacement is stiffness. The knee does not bend or extend enough, which can be troublesome for daily activities and sports. However, this occurs in less than 1 person out of 10, so there is a strong chance that it won’t happen to you!

👉 Here are some tips to minimize the risk of stiffness:

• Change positions frequently (lying on your back, lying on your side, semi-sitting, sitting).
• Get up and walk several times a day, even if it’s just a few steps.
• Prioritize activities that involve movement (such as walking) rather than static activities (dishwashing, DIY projects, sitting in front of a computer).
• Mobilize your knee several times a day, flexing and extending it, as your physiotherapist has likely instructed you to do.
• Avoid standing for long periods after knee replacement

Are there permanent restrictions after knee replacement?

There are no formal contraindications to participating in any sports. There is also no long-term follow-up of patients that would allow us to know if resuming certain sports leads to premature wear of the prosthesis or pain.

However, some less impactful sports are more often recommended:

• Walking, especially with poles.
• Swimming.
• Golf.
• Bowling.
• Stationary biking.

On the other hand, there are some sports that are generally discouraged:

• Weightlifting.
• Trail running.

These activities involve heavy loads or significant and repetitive impacts.

Sports are typically resumed between 2 and 6 months after the placement of a unicompartimental or total knee prosthesis. This is the time when the range of motion has been adequately restored, there is no pain at rest or during walking, and walking long distances is already possible.

Regarding available statistics on resuming sports after a total knee replacement:

• 88% of individuals who undergo the surgery return to their preoperative level of physical activity and sports.
• Ten years after the knee replacement surgery, 70% of individuals continue to engage in sports.

Is it possible to use a stationary bike after knee prosthesis? When?

The stationary bike is one of the first physical activities that can be resumed after knee replacement surgery, following walking. In some cases, it can be started as early as a few weeks after the operation.

My patients who resumed the earliest started using an adapted stationary bike around 2 to 3 weeks after a total knee replacement. However, some individuals may take several months before being able to do so.

How can you determine if you can start using a stationary bike (aside from discussing it with your physiotherapist)?

• Generally, you should have at least 90° of knee flexion.
• You should not experience a significant increase in pain when bending and extending the knee.

If these two criteria are met, you can consider trying the stationary bike in an adapted manner:

• Adjust the seat so that you minimize knee flexion.
• Start with reverse cycling (it’s easier).
• Don’t force it if it feels difficult. Simply move back and forth without completing a full rotation. It may take several days of practicing in this manner before you can complete a full rotation.
• On the first day, cycle for a few seconds. If everything feels reasonably fine the following night, gradually increase the duration very slowly.
• Avoid adding resistance.

Some physiotherapists or surgeons strongly discourage cycling, even on a stationary bike, in the first few weeks after the operation. They believe it may increase inflammation in the knee following the prosthesis placement.

While I understand this argument, I believe that by testing it in the manner I described, you can adapt and assess if there is an increase in inflammation, and adjust the intensity or stop if necessary.

Can you ever cross your legs again after total knee replacement?

Yes, of course! There are no contraindications to crossing your legs after total knee replacement.

You can do it right from the beginning as long as it’s not painful.

The prosthesis is securely fixed in the bone and there is no risk of it moving!

Are there work restrictions after knee replacement?

In general, many individuals are able to return to work after a period of recovery and rehabilitation. The ability to resume work will depend on factors:

• the physical demands of the job,
• the healing progress,
• and the advice of the healthcare and job team.

Some individuals may need to modify their work activities or have temporary restrictions during the early stages of recovery. This could include avoiding heavy lifting, prolonged standing or walking, or activities that put excessive strain on the knee joint. As the individual progresses in their recovery and gains strength and mobility, they may gradually return to their regular work duties.