How do I Get Back Into Running After a Knee Replacement?

Are you wondering whether you can go back to work after a total or partial (unicompartmental) knee prosthesis ?

Will it damage the prosthesis? Is this advisable? Dangerous?

👉 Here are my physio answers to your questions!

Summary: Resuming running after a knee prosthesis is generally possible if you were already running before the operation. You should resume running very gradually, generally at least 3 months after the operation.

If you would like more information about rehabilitation period after a knee surgery, I wrote an eBook to this topic 🙂!

♻️ Last update: August 14, 2025
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

Will running damage my knee prosthesis?

Studies are trying to follow people who have undergone knee surgery for as long as possible, to see whether running a lot or playing sport increases the risk of the prosthesis wearing out faster.

In the United States (Crawford 2020), over 1,600 patients undergoing total knee replacement surgery were followed for at least 5 years.

The average follow-up was 11.4 years. The researchers found that the most active patients were less likely than others to have required re-operation. Here’s what they conclude:

Highly active patients showed better prosthesis survival at minimum 5-year follow-up compared with less active patients. The level of physical activity after knee replacement may not need to be limited with modern implants.

However, in a survey of over 4,000 people (Esculier 2022), a majority of the general public believe that running :

• increases the risk of knee pain (5 out of 10 people);
• increases the risk of needing a knee prosthesis (4 out of 10 people).

There’s a growing body of evidence to suggest that running with a knee prosthesis doesn’t damage the prosthesis any faster if you don’t feel pain.

How do I get back into running with a knee prosthesis?

Quebec physiotherapists 🇨🇦 have documented the return to running of a 55-year-old woman (a former triathlete) in a scientific publication.

She was fitted with a knee prosthesis because femorotibial osteoarthritis had prevented her from competing in triathlons for 4 years. She had already had a rupture of the anterior cruciate ligaments (operated on) and 2 menisectomies on this knee.

The patient consulted a physiotherapist one year after the operation to resume running.

Before encouraging the progressive resumption of running, the physiotherapists carried out a check-up to validate that the patient was able to perform the following activities without knee pain or swelling:

• walk for 30 minutes, several days a week;
• perform three squats on one leg to 90° of knee flexion;
• hop on one leg for 10 seconds;
• run on the spot for 30 seconds.

As everything was going well, the physiotherapists recommended that the patientalternate phases of slow running with phases of walking.

For the first two weeks, she had to train every other day. Thereafter, the frequency could be increased (symptoms permitting), as could the total running time.

He was advised to train without knee pain and at a running speed that would allow him to talk at the same time.

In the event of pain during or after the race, he was advised to reduce the duration of the race.

Here’s how it worked for her for a year after she started using:

The patient reported no knee pain during the one-year follow-up.

On the other hand, she had several mild episodes of calf contractures, both on the operated leg and on the other.

The first episode occurred in early August 2022, after a session involving 15 repetitions of 1 minute running followed by 1 minute walking. After a few days’ rest and a gradual recovery, she experienced a second episode of contracture at the end of August, prompting her to space out her sessions.

Despite this, a new episode took place in October 2022.

During the following autumn and winter, the patient focused more on cycling and skiing, with only a few occasional running sessions.

In the spring of 2023, she adopted a strategy that seemed to suit her calves better: alternate 45 seconds of running and 45 seconds of walking, over 3 to 4 km, three to four times a week, avoiding running two days in a row.

She achieved her goal of completing a triathlon (including a 10 km race) just before the one-year follow-up.

How long after the operation can I consider running?

The first step before considering a return to running is :

• good flexion (bending the knee at least 100°) and extension (stretching it completely);
• no longer feel knee pain when resting or walking;
• tobe able to walk several tens of minutes several times a week without crutches.

Once these 3 stages have been completed, running can be resumed very gradually. This usually takes place at least 3 months after the operation, and often after 6 months.

A study (Antonelli 2023) of more than 4,000 patients undergoing total knee (or hip) replacement surgery shows that :

• 9/10 went back to work in the year following the operation for those who were already running before;
• 8/10 for those who had stopped running before the operation.

Here’s what their surgeon told these patients:

• 3/10 were banned from racing after surgery,
• 3/10 were told that they could run a little but should mainly stay active with low-impact activities,
• 1/10 were allowed to resume the same running volume as before surgery,
• 3/10 did not receive any recommendations regarding resumption of racing after TJA

Can all patients have recourse after a knee replacement?

No, not all patients can run again after a knee replacement.

As in everyday life, there is a great disparity between people.

For example, among the 24,855 participants in 5 editions of the Ultra-Trail du Mont-Blanc®(UTMB®) (Rochoy 2020) :

• at least 4 riders had a total knee prosthesis;
• and 3/4 completed the 150km race.

Conversely, only 2 out of 10 patients returned to running after total knee replacement in over 2,000 patients followed (Antonelli 2020).

What should you do if you are unable to resort after knee surgery?

If you can’t run again after the operation, identify the cause:

• pain?
• Apprehension?
• Feeling a lack of stability?

You may want to consider physiotherapy to help you get back on track.

In most cases, this happens because you’re resuming too intensely for your body to handle.

Try running for shorter periods (alternating with walking), less often, or at a slower pace, and build up gradually (over weeks or months).

***

That’s all I wanted to say on the subject! Any questions or comments? See you in comments!

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📚 SOURCES

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Esculier JF, Besomi M, Silva DO, Passigli S, Rathleff MS, Van Middelkoop M, Barton C, Callaghan MJ, Harkey MS, Hoens AM, Krowchuk NM, Teoli A, Vicenzino B, Willy RW, Hunt MA. Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey. Orthop J Sports Med. 2022 Sep 30;10(9):23259671221124141. doi: 10.1177/23259671221124141. PMID: 36199830; PMCID: PMC9528027.

Antonelli B, Teng R, Breslow RG, Jamison M, Hepinstall M, Schwarzkopf R, Moschetti WE, Chen AF. Few Runners Return to Running after Total Joint Arthroplasty, While Others Initiate Running. J Am Acad Orthop Surg Glob Res Rev. 2023 Apr 19;7(4):e23.00019. doi: 10.5435/JAAOSGlobal-D-23-00019. PMCID: PMC10118379.

Esculier JF, Lalande JF, Lauzier A, Dubois B. Return to Running after Knee Arthroplasty: A Case Report. Physiother Can. 2024 May 8;76(2):175-180. doi: 10.3138/ptc-2023-0084. PMID: 38725598; PMCID: PMC11078252.

Lester D, Barber C, Sowers CB, Cyrus JW, Vap AR, Golladay GJ, Patel NK. Return to sport post-knee arthroplasty: an umbrella review for consensus guidelines. Bone Jt Open. 2022 Mar;3(3):245-251. doi: 10.1302/2633-1462.33.BJO-2021-0187.R2. PMID: 35300532; PMCID: PMC8965786.

Crawford DA, Adams JB, Hobbs GR, Berend KR, Lombardi AV Jr. Higher Activity Level Following Total Knee Arthroplasty Is Not Deleterious to Mid-Term Implant Survivorship. J Arthroplasty. 2020 Jan;35(1):116-120. doi: 10.1016/j.arth.2019.07.044. Epub 2019 Aug 6. PMID: 31471181.

Rochoy M, Six J, Favre J, Lagrange N, Lefebvre JM, Rollier JC, Girard J. Does hip or knee joint replacement decrease chances to complete an ultra-trail race? Study in participants at the Ultra-Trail du Mont Blanc®. Orthop Traumatol Surg Res. 2020 Dec;106(8):1539-1544. doi: 10.1016/j.otsr.2020.07.011. Epub 2020 Nov 12. PMID: 33191172.

Meena A, Hoser C, Abermann E, Hepperger C, Raj A, Fink C. Total knee arthroplasty improves sports activity and the patient-reported functional outcome at mid-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):905-913. doi: 10.1007/s00167-022-07025-z. Epub 2022 Jun 11. PMID: 35689683; PMCID: PMC9957844.

Lawrence KW, Bloom DA, Rajahraman V, Cardillo C, Schwarzkopf R, Rozell JC, Arshi A. Return to athletics after total knee arthroplasty: a survey study of 784 recreational athletes across 12 sports. Arch Orthop Trauma Surg. 2024 Sep;144(9):4115-4124. doi: 10.1007/s00402-024-05364-9. Epub 2024 May 22. PMID: 38777908.

Written by Nelly Darbois

I enjoy writing articles that answer your questions, drawing on my experience as a physiotherapist and scientific writer, as well as extensive research in international scientific literature.

I live in the French Alps☀️🏔️, where I enjoy the simple pleasures of life (+ I’m a Wikipedia consultant and the founder of Wikiconsult).