Cycling After Knee Replacement: Tips from a Physical Therapist

Does cycling wear out knee replacement?

No, stationary bike, road cycling, city cycling, or elliptical cycling, whether mechanical or electric, does not damage the total or partial knee replacement.

Why do I say that? A combination of factors, which I will list here.

1. After nearly 15 years of providing knee surgery rehabilitation at least every week (recent or several years ago), I have never come into contact with a single person who had an issue with their knee replacement after cycling (occasionally or from time to time).

Of course, if you do too much at once, especially in the first few weeks, it can cause pain or increase knee inflammation. But this is the same for any activity where you increase intensity, frequency, or duration too quickly.

3. I regularly read scientific publications on the aftermath of knee prostheses (especially to enhance the site you are reading, Fonto Media), and I have never read anything suggesting that cycling is dangerous.
4. Some studies follow people for several years after knee surgery. The three most common causes of knee replacement revision (which remains rare) are (Postler 2018):
   • Infection
   • Replacement loosening for reasons other than infection, usually after 15/20 years of prosthesis wear
   • Fracture (due to a fall)

So, not cycling. Activities with impact and full body weight, such as running, are more likely to accelerate prosthesis wear.

But not cycling, which is non-weight-bearing (at least for seated cycling).

5. There are several studies on resuming cycling after knee replacement (link at the end of the article), and none report it as dangerous, forbidden, or deleterious.

A study conducted on a very small number of individuals found that those who used cyclo-ergometers during their rehabilitation recovered at least as well as others and did not experience more knee stiffness, swelling, or inflammation (Sanzo 2021).

Finally, stationary bike within 6 weeks after knee surgery is among the recommended activities by orthopedic surgeons (Thaler 2021). (And ground-level cycling at least 6 weeks after surgery.)

How long to ride stationary bike after knee replacement?

The knee is swollen after knee replacement surgery. It is also painful and stiff, and all of this can last for several weeks.

Over the days and then weeks, you will regain knee flexion. Some people achieve 90° within a few days and then progress to 100, 110, 120° of knee flexion.

Others may need several weeks (or even months sometimes) to regain these ranges of motion.

So, you can probably resume stationary bike in the weeks following the operation when you have at least 90° of “easy” flexion.

For outdoor cycling or the elliptical bike, I would advise waiting a bit longer. For example, at least until the follow-up visit with your surgeon, often 8 weeks after the operation.

How I practically suggested resuming cycling to my physiotherapy patients?

When my patients were eager to resume cycling quickly, I suggested starting with a stationary bike as soon as they had enough knee flexion.

As a home-based physical therapist, I could directly assess with my patients how they felt on their stationary bikes (many had one at home).

The quickest ones resumed after 2 or 3 weeks (starting with only 2/3 minutes, adjusting the seat high to minimize knee bending). Others needed a month or two to recover enough flexion.

Cycling is not mandatory in knee replacement rehabilitation. Some people did not want to do it, and that’s perfectly fine!

How to get on a bike with a knee replacement?

It’s true that sometimes the hardest part is getting on the bike! Here are some tips.

First and foremost: adjust the seat as high as possible, relative to your height.

The lower the seat, the more your knee will need to flex. However, that can be challenging with a prosthesis!

At the beginning, it’s perfectly fine to pedal on the ball of your foot; it will be easier.

To get on the bike, climb over the non-operated leg first.

For example, if you’ve had a knee prosthesis on the right, climb over the right side of the bike, and pass the left leg over the bike first.

And vice versa if you’ve been operated on the left.

Don’t try to immediately get on the seat. Stand on both sides of the bike first, with the bike between your legs after climbing over it.

Once standing with one leg on each side of the bike, place one foot on a pedal.

Place the foot of the good leg, the non-operated leg.

Then lift yourself onto the seat.

Next, bring the pedal on the operated side down and place your foot on it.

There you go, you’ve successfully gotten on the bike! That’s already a good thing!

I will now explain to you how to start pedaling step by step, in case you are apprehensive about it!

What to do if you can’t ride a bike after your knee surgery?

I will explain how I introduce the first sessions of stationary biking after a knee prosthesis. This will probably give you some ideas!

You can, of course, also discuss this with your physiotherapist, who can provide more personalized advice 🙂.

Step 0: As explained earlier, raise the seat as high as “bearable.”

Then position yourself more or less forward on the seat, whichever feels best for you.

Try different positions.

Also, remember not to put any resistance on the bike: pedal “empty.”

Step 1: Once on the bike, start pedaling backward! Why? Because it is easier, especially if you still have difficulty bending your knee.

Step 2: Don’t necessarily complete a full rotation right away! Go forward, backward, and farther each time.

Some of my patients need to do only that for several days before being able to complete a full turn.

It’s a very good exercise to gradually, gently train the knee to bend better.

Step 3: When you can complete full rotations backward, try forward pedaling.

Some people will also need several sessions to be able to pedal forward.

Step 4: Gradually increase the time spent on the bike.

Even when my patients could pedal forward right away, I told them to do a maximum of 1/2 minutes of cycling the first time.

To see how the body reacts, immediately after, and the night following.

If everything is fine, gradually increase the duration or resistance, over the days, or every 2 days.

Still can’t use the stationary bike after your knee replacement surgery?

You can try floor mini exercise bike. Pedal while sitting in a chair.

This often requires less knee flexion. You can find them in sports stores. This one (on Amazon) is of good value.

When to switch from a stationary bike to a ‘real’ bike or an elliptical bike?

I detail how to resume each type of bike.

Mechanical Bike

I recommend being quite comfortable with the stationary bike before switching to a ‘real bike’. With a real bike, you have balance to manage.

You need to be more responsive to put a foot down to stop. And during small inclines, you need to push more on the pedals.

Generally, my patients resumed riding a real bike several months after the operation.

Electric Bike

At the start, electric bikes often require a bit more force on the pedals. It’s better to resume this a few months after the knee operation.

Elliptical Bike

If you tolerate the movement well, you can directly use an elliptical bike during the first weeks after the operation.

Depending on the type of elliptical bike you have, it might be very challenging: some require a lot of knee flexion (over 140°). And it’s very rare to recover that much flexion after a knee prosthesis.

See my full article on the advantages and disadvantages of elliptical bikes.

Mountain biking after knee replacement 🚵‍♂️

Some people choose to resume mountain biking. The primary risk I see is the potential for falls and knee fractures, which can be a bit more concerning when you already have a knee replacement.

Now, only you can assess whether the risk is worth the well-being and enjoyment you derive from it!

Competitive cycling after knee replacement 🚴‍♂️

Some people also choose to resume competitive cycling with a knee replacement. Here again, the primary risk is the potential for fractures in case of a fall.

Additionally, if you engage in overly intense activity, there’s a possibility that the prosthesis may wear out more quickly.

This might necessitate an earlier replacement than initially expected (perhaps after 10 years instead of 15-20 years), although it’s challenging to predict as various factors come into play.

Do many people resume biking after a knee replacement surgery?

Cycling is one of the top 3 sports resumed after a knee replacement, along with hiking/nordic walking and swimming.

Out of 588 people who underwent knee surgery and were cycling before experiencing symptoms leading them to stop, 463 resumed cycling after the operation.

That’s approximately 80% of those who had knee surgery!

Source: Konings 2020

Best bicycle after knee replacement?

Any stationary bike will do the job; there’s no need to buy the latest model.

The most important feature is that you can adjust the seat more or less high. Because initially, you’ll probably need to raise the seat to avoid bending the knee too much.

Also, it’s better to prioritize bikes without resistance to start (or with minimal resistance/power, often 25 watts).