Can I Kneel After Hip Replacement? (+ How to)

Does kneeling damage the hip replacement?

No, kneeling does not damage the total or partial hip replacement.

What makes me say that? A combination of factors, which I will list here.

1. After almost 15 years of ensuring the rehabilitation of people who have had hip surgery (recently or several years ago) at least every week, I have never encountered a single person who had an issue with the replacement after squatting (except for possible temporary pain).

2. I have known several people who resumed gardening or even classical dance after a hip replacement. They were capable of squatting and kneeling, even though it remains the exception.

3. I regularly read scientific publications on the aftermath of a hip replacement (especially to enhance the site you are reading, Fonto Media), and I have never read anything suggesting that kneeling is dangerous.

4. Some studies follow individuals for several years after hip surgery. The three most common causes of hip replacement reoperation (which is still rare) are (Oltean-Dan 2022):

• Replacement loosening for reasons other than infection, usually after 15-20 years of replacement wear.
• Fracture (due to a fall).
• Infection. These reasons have no connection with kneeling.

5. There are several studies on squatting after a hip replacement (link at the end of the article), and none report that it is dangerous, prohibited, or harmful.

Most of these publications focus on people living in Japan because squatting and kneeling are much more common in daily life there than in France, for example.

Therefore, after a certain time, you can attempt to kneel with your hip replacement.

After how much time? That’s precisely what I am going to detail now.

After how much time can one kneel?

You probably won’t be able to kneel for several weeks after the operation. This is entirely normal.

During this period, your hip is stiffer. Your lower limb may be swollen and painful.

With your physiotherapist and through self-rehabilitation, you will gradually improve hip flexion over the weeks.

Generally, at the follow-up appointment with your surgeon 4-8 weeks after the operation, you will be able to flex the hip to 90°, 100°, or even 110° or 120°, or more.

You will also be able to move your leg to the side and backward: your hip will be more flexible.

At this point, you can consider kneeling, in my opinion:

• Because you will have had the follow-up appointment with your surgeon to ensure everything is fine.
• Because you will have enough mobility in your hip to squat.
• Because you will have passed the 4/6-week mark necessary for your muscles and tissues to begin healing well. (This is why some movements are sometimes “forbidden” after hip replacement.)

Consider kneeling at least 4/8 weeks after the operation, once you have regained sufficient flexion.

How to kneel with a hip replacement?

The first step is to regain sufficient flexibility in hip flexion and extension.

Normally, your physiotherapist will have shown you exercises to help you regain more flexibility in your hip.

(See also my ebook on hip replacement, containing exercises.)

Once you have at least 100° of flexion without the need to force, you can try kneeling.

The first few times, I recommend doing it:

• By leaning on something sturdy and low, like a sofa.
• By putting a gym mat on the floor or wherever it is more comfortable.”

Which knee to put on the ground? Whatever you prefer, although it’s often easier to put the knee of the recently operated hip on the ground.

Why? Because the leg that is placed on the ground is much less bent. It’s more comfortable, and it’s a position further away from the position that can cause hip replacement dislocation (rare+++) if you were operated on from the back (like most people).

Descend gently, leaning on your arms on the sofa to put little pressure on the knees.

Once the knee is on the ground, you can place the other one next to it.

To get up, lean well on your arms.

The first few times, stay only for about ten seconds.

Then gradually increase this time!

When you’re comfortable with this method, you can go down to the ground by leaning on one arm. Then, you won’t need support anymore, or you’ll simply lean on one of your knees and the ground.

I’ll show you this in the video below (I talk about the ‘operated knee,’ but it’s equally valid for the hip)!

Why is kneeling often uncomfortable with hip replacement?

Apart from children, the kneeling position is not very comfortable, even under normal circumstances!

I’ve met many people who, without any particular pathology, already had a hard time kneeling.

A hip replacement alters the anatomical structure of your joint. The flexion of your hip (and all other movements) is more limited than without a replacement. This makes the kneeling position less natural and less comfortable.

Moreover, you probably already had trauma or arthritis in the hip, which motivated the placement of the replacement. Your hip is thus ‘worn out’ and less comfortable.

What to do if you can’t kneel?

First, know that you are NORMAL if you have difficulty crouching after your hip operation: 78% of people operated on for a hip replacement report having difficulty doing it! (Wood 2020)

Many people operated on for the hip could no longer kneel BEFORE the operation (or did not have the opportunity).

From the sample of people operated on for a hip replacement that I had in rehabilitation (for this or another problem), I would say that about 30% were able to kneel.

If you can’t kneel:

1. You are “normal”; this does not mean that there is an issue with the replacement.
2. Keep hope: some people continue to recover after the operation for months or even years. You may be able to kneel in a few months.
3. Try to establish a routine by crouching, supporting yourself on a sofa at least 2 or 3 times a week, for 30-40 seconds. Over time, it is likely to become easier.
4. You can also establish a general muscle and joint maintenance routine to perform movements other than those specifically aimed at kneeling.

***

I hope this article has been helpful! Feel free to comment for further discussion if needed 🙂!

If you feel the need to learn more about the recovery period after a hip replacement, I wrote this guide in eBook format:

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 📚 SOURCES

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Min BW, Song KS, Kang CH, Bae KC, Won YY, Lee KY. Delayed fracture of a ceramic insert with modern ceramic total hip replacement. J Arthroplasty. 2007 Jan;22(1):136-9. doi: 10.1016/j.arth.2005.12.012. Epub 2006 Jun 21. PMID: 17197321.

Fujita K, Makimoto K, Mawatari M. Three-year follow-up study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty. J Orthop Sci. 2016 Mar;21(2):191-8. doi: 10.1016/j.jos.2015.11.004. Epub 2015 Dec 31. PMID: 26740433.

Zaballa E, Ntani G, Harris EC, Lübbeke A, Arden NK, Hannouche D, Cooper C, Walker-Bone K. Feasibility and sustainability of working in different types of jobs after total hip arthroplasty: analysis of longitudinal data from two cohorts. Occup Environ Med. 2022 Jul;79(7):486-493. doi: 10.1136/oemed-2021-107970. Epub 2022 Jan 13. PMID: 35027440.

Wood TJ, Petruccelli DT, Tushinski DM, Winemaker MJ, de Beer J. Nuisance Symptoms in Total Joint Arthroplasty: Prevalence and Impact on Patient Satisfaction. J Arthroplasty. 2020 Mar;35(3):661-670. doi: 10.1016/j.arth.2019.10.034. Epub 2019 Oct 25. PMID: 31735491.

Oltean-Dan D, Apostu D, Tomoaia G, Kerekes K, Păiuşan MG, Bardas CA, Benea HRC. Causes of revision after total hip arthroplasty in an orthopedics and traumatology regional center. Med Pharm Rep. 2022 Apr;95(2):179-184. doi: 10.15386/mpr-2136. Epub 2022 Apr 28. PMID: 35721045; PMCID: PMC9176300.