Hiking After Knee Replacement Surgery

Hiking After Knee Replacement Surgery

How does knee replacement surgery affect your ability to hike? How painful is the recovery? When can you resume hiking after surgery? What advice would you give to hikers with arthritis of the knee? As a frequent hiker, I’ll share my first-hand experience with you.

When to Seek Medical Advice

I can still remember a hike up Mt Moosilauke in June 2017, when I felt like I’d injured my knee. I haven’t always had the greatest knees for hiking, but this felt really off. I’d done a long loop over the mountain, coupled with a few bushwhacks. Initially, I just brushed it off as overuse, and things gradually improved but never returned to where they had been before that hike. That hike had somehow suddenly broken me.

The hikes continued because it’s what I do, but I quickly found that I couldn’t do what I did before. Mileage and difficulty were all lowered. Instead of climbing 4,000 footers in the White Mountains, I was leaning more on the 52 With A View, lower peaks in New Hampshire’s Lakes Region, and walks on Concord, New Hampshire’s local trail system.

Initial x-ray of my right knee. There’s no much cartiledge in there.
Initial x-ray of my right knee. There’s not much cartilage in there.

I eventually sought out an orthopedic doctor and to make a long story short, was diagnosed with osteoarthritis in both knees, with the right one being more advanced. Those initial x-rays were eye-opening: I didn’t have much cartilage left.

Obviously, osteoarthritis doesn’t just appear out of nowhere. The progression was largely unknown to me until it finally roared up and got my attention on that Moosilauke hike.

Initial treatment included anti-inflammatories and bracing the bad knee. However, these efforts didn’t provide much relief due to the bones clanking together in there. With much consideration and thorough discussion with my ortho doc, the decision was made to go ahead with a unicompartmental (partial) knee replacement at the age of 51, which is a young age for this type of procedure.

Do I Really Want Knee Replacement Surgery?

So here I was, a person who’s never had surgery for anything about to have one of the most complex joints in the body broken apart and repaired. Would this work? Would it get me back to “normal”?

Fortunately, I live in the modern era where this surgery is fairly commonplace, although less common than a full replacement I would later learn, performed by skilled surgeons. No stick to bite on or whiskey to swig in this scenario.

As far as surgeries go, I didn’t feel a thing! I recall being quite anxious beforehand, but that’s what the anesthesia is for. I remember being wheeled into the OR, seeing the familiar face of my Physician’s Assistant, then going to sleep. The next thing I knew someone was waking me up but things were fuzzy after that.

From what I understand, most knee replacement surgeries require an overnight stay, and that was certainly the case for me. This is probably a good place to say that there is a choice of anesthesia method beforehand. I went with general anesthesia and hoo boy that was not fun. General shuts everything, and I mean everything, down in the body which resulted in a quite unpleasant experience.

The next morning resulted in being awakened by staff who want you to get your butt up out of bed when the last thing you want to do is stand on your new bionic parts. But stand you do. And walk up and down steps. And back and forth in the hallway. And get in and out of a wooden car. If you can do all this, then you’re sent home, usually the day after the surgery.

Once home, it’s a regimen of physical therapy to strengthen up everything around that shiny new metal and plastic. For me, it was in-home PT for a few weeks or so, then on my own with a home routine with the option of seeing a therapist in a clinic. I got to know my neighborhood pretty well with all of the crutch-assisted walks around the block.

First steps out of bed, the morning after surgery. (Photo: Christine Welsh)
First steps out of bed, the morning after surgery. (Photo: Christine Welsh)

When Can You Resume Hiking?

As is probably the case with most hikers, I find it difficult to sit around and not be active. But I knew I had to deal with some forced downtime here. Driving was out for several weeks and a constant rotation of DVDs and laps around the living room helped to pass the time.

Everyone’s recovery time is different and your doctor will advise you as to when you can start getting back on your feet again. For me, I took my first steps onto a flat trail about a month after the surgery. A whole half mile! It wasn’t much but it was a beginning.

Eventually, those half miles turned into miles, which turned into longer hikes, which turned into some actual hill climbing. By late summer 2018, I had hiked a few White Mountain 4,000 footers and was feeling pretty great.

In retrospect, my activity level was probably ramped up a bit too soon. It can take up to a full year to completely heal, and I was just going on a partial replacement here — a full knee overhaul can take longer. Unfortunately for me, I had setbacks regarding pain and limited movement. The prosthesis itself was fine, it’s just that my mind had gotten ahead to a place that my body wasn’t ready for yet.

As active people, hikers can likely expect to recover a bit quicker than the average joe, but if you are considering undertaking knee replacement surgery, the key to a successful recovery is really sticking with the PT, if you feel “nah, I’m fine”. This is an invasive procedure that requires intense strengthening of the area around the knee. Do what the physical therapist tells you over and over and over again.

I was also told that because of the increased activity from hiking, we can expect our replacement parts to wear out a bit quicker than those of folks who are not as active. In the case of a partial replacement, it may have to be later replaced fully. A full replacement may need to be completely redone.

Knee replacement surgery definitely leaves a mark. I ended up with a slight keloid scar which is a bit more pronounced but most incision scars fade nicely in time.
Knee replacement surgery definitely leaves a mark. I ended up with a slight keloid scar which is a bit more pronounced but most incision scars fade nicely in time.

Advice for Arthritic Hikers

I’m still going, although maybe not as strong as I once was. While I’m definitely slower, I get there. These days, the replaced knee is fine, but it’s the other knee that’s the issue. It’s in the same boat and will need to be replaced, but after a difficult recovery and lessons learned the first time around, I’m in “maintenance mode” and am trying to put it off as long as I can.

If you’re dealing with arthritic knees, I feel your pain. But hiking with replaced knees can be done. Heck, look at long-time White Mountains uber-hiker Ed Hawkins. He is in his 70s, has had both knees fully replaced, and has completed the White Mountains grid eight times. That’s a staggering 4,608 four thousand footers climbed, with close to eight million feet of elevation gain.

A few caveats do apply though. Jumping off a ledge, for example, ain’t a good idea due to potential damage to the joint. Also, be mindful of twisting. It took me a while to consciously walk a bit differently to make sure I was keeping the leg straight. And for hikers that downhill ski during the winter, your doctor is probably going to say you won’t be able to do that anymore. One surgery is traumatic enough and having to do a second one to repair damage to the prosthesis isn’t a fun thing.

Trekking poles are even more important after knee surgery.
Trekking poles are even more important after knee surgery.

My advice for arthritic hikers is to stay small if needed. Hike smaller peaks, which can be just as rewarding as the big ones. Listen to your body. In time, you’ll become in tune with how far you can go and what types of terrain may aggravate things. Unfortunately, when we climb up things we also have to come down them, so using trekking poles is essential for offloading some of the effects of gravity. Anti-inflammatory medications are ok to use in moderation, but be aware of the potential side effects from long-term usage.

It’s also important to strengthen everything around that knee, including quads, glutes, hamstrings, and core. The less stress you can take off the joint itself the better. A good physical therapist can recommend a regimen of exercises to keep you going as long as possible before surgery is needed.

Some days it will be really difficult. Pain really sucks and it can wear on your mind as well as your body. But those days won’t happen all the time. If you’re passionate about being in the woods like I am, I think you’ll find that the mental benefits of being in nature will counter the physical symptoms somewhat.

With patience, a strict physical therapy routine, and mental determination, you can get back to what you love to do after knee replacement surgery. I was reminded of this when I returned to climb Mt. Moosilauke, four years after my knee replacement story began.

About the author

Ken MacGray is a freelance writer and guidebook author. He's written New Hampshire's 52 With A View - A Hiker's Guide (2nd Edition), AMC's Southern New Hampshire Trail Guide (5th Edition), and is currently working on the 31st Edition of the White Mountain Guide, also for AMC. He lives in southern New Hampshire and can usually be found wandering throughout the state's forests. You can learn more at kenmacgray.org

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35 comments

  1. Glenn A Roberts

    I realize that you’re talking about hiking and its effects on the knee, but I was wondering if you have any thoughts on backpacking. Specifically, after knee replacement, do you find that you need to switch to ultralight gear/minimal gear, or is pack weight (within reason) of no particular concern to a properly-rehabilitated knee?

    • Hi Glenn, I am primarily a day hiker and can’t speak too much to backpacking, but some of the same advice mentioned in the article would likely apply. Everyone will heal differently, but it can’t hurt to lighten up your gear as much as you can. One aspect of post-surgery life that I neglected to mention in the article is the importance of keeping excess weight off — both your body and gear. Excess weight can put more strain on the surrounding structures of the knee as well as the implant itself. That said, I’ve seen accounts of folks backpacking just fine after surgery.

    • I had a partial knee replacement 5 years ago I’m happy to report that I’ve had no issues backpacking with it. In fact, it’s a loss less painful than it was before surgery. I did my first backpack trip 7 months after surgery. Since then, I’ve backpacked the JMT, Teton Crest, sections of the PCT, and AZT plus many other routes averaging 10-20 miles per day. I had already converted to lightweight gear, and highly recommend it. Every person has a different experience, and I’m very grateful mine has gone so well, but there’s reason for optimism is you need knee replacement. I even took up downhill skiing last winter!

      • Totally agree with Marla! I had my knee replaced 2 years ago. Prior to the knee replacement, hiking was incredibly painful on the downhills. The knee replacement has been amazing. I now hike 4000 footers every week, have completed the 48 4000 footers and then again in the winter – and most of them with the new knee! I hike with others who also have had knees replaced. I ski in the winter and cycle all year round. So very glad I listened to the doctors (and some hiking friends).

  2. I just passed the one year mark after a total knee replacement. I worked daily on my rehab for six months. Excercising and walking daily was my regimen, under a physical therapist for 6 weeks and on my own there after. After 6 months I was back to normal activity. Your mileage may vary.
    Back to hiking as I did and am able to carry up to 30 pounds for camping and other hobbies. No running, no heavy carries, have not gone over a ten mile day…but I keep moving on giving me me tests of my self since surgery.

    • Mark, glad to hear you recovered quickly!

      • Hi I am going to be 70 in 3 weeks , I had Bi – lateral full knee replacements 16 1/2 years ago also have had 4 hip replacements . Life goes on , I still hike , climb mts , x- c ski , backpack ; just not as fast . After the knees I did intense PT for 10 weeks , skiing in 8 weeks with Dr. OK . Enjoy and go for it , also PT’s rock !

      • Ah…how many *legs* do you have? Just kidding.

  3. Paul Glazebrook

    And now on to Hip Replacement.

    My new Knee is great but the range of motion is about 10-15 degrees less then pre-surgery.
    The new hip is not as strong as I had hope. It also limits the range of motion.

    I second : Scaling back your climbs for the first year and recognizing/accepting you will be slower is key….
    Strengthening the upper leg and core is critical.

    • Hi Paul, absolutely good advice and sorry to hear you’re having issues with the new hip. Hope it improves for you. I still have close to the range of motion in my knee that I had pre-surgery, but I’m definitely mindful about bending or hyper-extending it too far. The body will definitely let you know when you’re hitting that limit!

  4. I am a year out on a total knee replacement and am working on backpacking again. I have always tried to lighten the load but still want creature comforts so would consider myself light but not quite ultralight.
    Go slow and build up your strength and follow your PT’s advice. I pushed to get all the movement I could and still push the envelope on movement but am starting to get to the mechanical limits. Low tarp type tents are no longer for me, they just have too much crawling around. A pyramid though still works.

    • Yes, crawling around and crouching have been difficult, even with a partial replacement. I used to rest my bad knee to the ground when taking photographs, but that doesn’t happen anymore. As you say, you start to hit the mechanical limits of the implant at a certain point.

  5. I had double knee replacement in the summer of 2015. I spent a year rehabing and walking in my neighborhood. Since then I’ve been backpacking in New Mexico two or three times, hiked Guadalupe Peak (3000′ climb) in Texas five times, and Truches and Wheeler Peak in New Mexico, both over 13,000. I never think about my knees anymore unless someone asks about them. The new knees gave me a new life.

    • Berry, that’s amazing, glad it worked out so well for you!

    • Bill in Roswell GA

      Berry, I’ve heard of a few double replacements. Does insurance allow for that? Does the Ortho surgeon have to write a special request? I ask because osteoarthritis has laid both knees to waste. I’m doing PT which does help, but hikes went from 15 mile mountain day hikes to 3 mile creekside hikes knowing I will suffer afterwards. I just came off 1.5 years of PT and don’t relish the thought of two replacements with a year each of PT.

      • I had both knees replaced the same day in 2012. The only way to go if you need both in my opinion. I pretty much do what I want, I joke and backpack. I am always trying to lighten my pack as much as possible. It’s a life changing surgery.

  6. Fourteen years ago, my wife had total replacement of both knees a couple months apart. Eight days after the first knee replacement, I found her out front mowing the lawn. We read her the riot act about overdoing it when she had her second knee replaced and it wasn’t until the ninth day afterwards that I caught her mowing the lawn. I guess she was taking it easier! She had a doctor visit this week to check on her knees and he says they are holding up very well. She doesn’t hike but she’s having no problem with her knees whatsoever.

    As we get older, we have to make adjustments in the way we do things because we can’t do them like we could when younger, however we can still enjoy many of the same activities, just at a different level. After a joint replacement or other major surgery, we just have to adjust and set our sights on amended goals. I’m facing a four level fusion in my low back late this summer. I know it will change how I do some things but I still plan on doing what I enjoy, just at the level and pace my new circumstances allow. It beats living in constant agony.

  7. I have had both knees replaced and one re-replaced and 1 hip replacement. PT is the key to successful surgery. At the time of my surgery, I was pretty much a couch potato and very overweight. After the hip replacement, I worked to lose 100 pounds and joined a great gym and monthly PT appointments. I am much stronger and have better mobility than I did. I am just beginning to do some hiking. So far I have stuck to local trails but desire to try some easy mountain hikes in NH. My suggestions are to put up with all the PT you can get post-op. Find a good trainer who will be able to pick up slight mistakes in your form so that you can correct them and not get injured. Use your replaced joint. If you don’t use it, you will lose mobility. Have fun!

  8. Ken, great article. I’ve had both hips replaced and had an ACL surgery prior. I may be an exception but I still backpack and dayhike.

    I do less winter hiking than I used to and I also go through a specific workout regime during shoulder season (prior to my hiking season) and all is okay. I do occasionally suffer from ITBS in my right knee (the ACL knee) but it’s manageable with two ITBS bands.

    I do start small and work higher/longer each season and I hope my knees hold on. I have heard that knee replacements take longer to recover from than hip surgeries?

    I’m just so happy to hear about others who keep going!

    Take care (of your bionics). Good luck going forward. Peace and out!

    • Steve, yes, I have heard that hip replacements these days are so much easier than the knees, due to the complexity of the latter. There’s just so much going on in there. Glad you are still getting out there!

  9. Ken, a timely article for me as I have been diagnosed provisionally with a lateral meniscus tear in my left knee. Poor side to side agility and stability as a result. I’m already on physio exercises to strengthen everything around the knee. While it is not a knee replacement, I still need to follow similar steps to get my mobility back. Whether it requires intensive physiotherapy or possible surgery, I’ll find out soon enough.

    I would say it is better to get one’s knee issues dealt with earlier rather than later as they can be easier to fix and come back from. Independence becomes more important as one gets older and allows for a better quality of life. Mobility is a big part of that. I’d also suggest relying on your pharmacist for both prescription and non prescription remedies/information as they should be knowledgeable about both and willing to answer any questions you have.

    Thank you, Ken!

    • If this helps, I had a meniscus repair on my right knee in 2008. Then twice in 2013 prior to going with my son to Philmont in 2014. After the second meniscus repair my doctor said I had arthritis in the knee and eventually I would need to have it replaced. He was right. I was attempting a thru hike of the Laurel Highlands trail at the end of last September and as I was taking the access trail down to the shelters on the first day I managed to get the leg caught on a vine and hyperextended my knee. Ibuprofen did not cause things to settle down so the next day I came off the trail and headed back home to see the doc. After much deliberation I had my right knee replaced in November (the day before Thanksgiving). It has been a long road back but I have been able to day hike and walk quite a bit. Rehab and the gym are my friends (even if they don’t feel like it at the time). I am 58 and already planning my next attempt at the Laurel Highlands this Fall. A meniscus tear does not have to lead to replacement, but it does put more wear and tear on your knee. Take it a little easier and you will get plenty of miles on it. For reference I am 58. Good luck!

    • I hear you about wanting to get the issues addressed earlier than later. My surgeon balked a little bit because of my age at the time (53) but I was pretty insistent that I have things I want to do NOW, not in 20 years.

  10. This is pretty remarkable timing for this article. I just had total knee replacement surgery on my left knee on 7/6. I wasn’t hiking a lot before the surgery, but I was doing 300 squats every few days (in sets of 75) for 5-6 weeks immediately before the surgery. I tapered off the last 4-5 days. I went home the next day with a walker and exercises from my physical therapist. I got a machine that stretches my range of motion in both directions: I’m already down to 4 degrees from being able to straighten it out completely and up to 93 degrees bending it back. Goals are 0 and 125. I will be adding formal physical therapy soon: starting with 2 weeks at home and continuing with going to PT after that for as long as I can get it. I live in the Catskills and hike most frequently here and in the Gunks. I have 9 summits remaining to become an Adirondack 46er and hope to be able to complete that before too long. I’m 73, so I don’t have forever left anyway. Friends who have had knee replacements are uniformly doing well – a bit slower and more cautious than before, but still out there. Their most common complaint has been that they shouldn’t have waited so long. Best wishes to all of you with your new joints, and thanks so much for sharing your stories. They are an inspiration for me! This is an amazingly fantastic newsletter! Thanks for that.

  11. As the person above said, excellent timing with this article. Thanks, Ken. Thought about it many times yesterday, all the way up Webster and all the way down! In addition to using poles, folks might want to uses their a$$e$ as well. I sat down and lowered my 4’11 self from one ledge to the next all the way down! Will probably need one, if not two, eventually; but I will be 64 next month and the women in our family (as long as they stay away from their smokes) live into their 90s. So I don’t want to have it wear out and need a second one.

    I never knew you had knee replacements. Thanks for your words of wisdom.

    • Beckie, just one so far, and am trying to put the other off as long as possible. From your trip reports, it sounds like you and Prema are doing just fine out there. :)

  12. Greetings Mark, Your experience is like mine 2 years after a TKR. I just want to emphasize PT. My rehab was cut short by Covid. I started my home program. I hiked a few overnights with my son carrying 30 lbs and some extra depending on water needs. I Started riding my bike indoors on a trainer during the winter. I felt l had plateaued. I got a new PT referral after Covid lightened up. I told my therapist l needed to be able to hike better. She was amazing. She attacked my weak spots like a laser. Things like balance (small muscles), flexibility and simple strengthening. I did the last hike over again with my son and the difference was noticeable. So now l am on my own again. I have just finished my home PT program and read this article. I had to reply. My PT is now a daily routine. My son and l are planning a multi day hike for August. One last thing. Trekking poles are a must. I have lost proprioception around the knee. But the poles have saved me from excessive wobbling on river crossings. Plus they ease the strain on my other knee. When it finally gives up, l have no concerns about getting it replaced. Then onward and upward.

    • Hi Rick, PT was definitely the hardest thing for me, especially on my own. When someone is there to make you do it, it’s a different story. I had a fantastic therapist who unfortunately relocated for another job. I still go the same office for tune-ups, but when you connect with your therapist and they push you a bit, and they get WHY you want to stay active, it’s a great thing.

  13. I had a total knee replacement, it had bee more than a year . My new knee is stronger than my old one. . I still can not kneel on my knee without pain. I am upset about this since I have dreamt about a long distant hike. Without my knee working I can not get into a ?

    • I haven’t been able to kneel on my left knee without pain since my ACL surgery 29 years ago. I just kneel on my right knee. Can you kneel on your other one? Can you pack a soft pad to kneel on? Can you use a hammock when you hike? You may have to adjust where you wish to hike to make sure there are trees. Don’t give up. Think of other options.

  14. As a word of advice to older hikers who are beginning to feel the effects of osteoarthritis, strength is your friend. My knees began to ache several years ago. My Dr. advised me to increase my exercise with a focus on legs. To someone who has always maintained an athletic weight and fitness that sounded like strange advice, but good advice it was. I began using Kettlebells and following the regime recommended by Strong First. Swings, squats, getups and carries. I also started walking every day with a 30lb pack. Not much weight and not far, just 2.5 miles, but it adds up. The result was a lot of mass increase in my legs especially in the calf. My knees stopped hurting entirely. They used to get worn out and if overused, accumulate fluid. Now it takes considerably more overuse to cause swelling and require rest. My knees, endurance and strength are as good as at any time in my 66 years.

    I know it sounds strange, as it did to me, especially to someone who is already fit, but my Dr. was correct. Strength, and lots of it, can provide the support to keep joints at high function. Try it before opting for the knee replacement. (Same advice worked on my shoulders a decade ago).

    And by the way, the X-ray and MRI reveal that my days on these knees are limited so I’m exploring my options and getting ready for the replacement that I know is coming. This article came from a request I made to Phillip (thanks Phillip). My Dr. has one more piece of advice for me. Make a list of the three things that are most important to you that require knee function. When you are able to do only one of them, its time to replace the knee.

  15. Hi Ken, thanks for your story. I had a Total Knee Replacement 3 months ago at the age of 50. Was slow going at first due to the pain and swelling. However, I am now hiking up to 15km and have recently started pack walking in prep for a multi day hike in 2 months time.

    I find that I still cant bend it as good as I did pre surgery, but at least there is no pain in the joint. Same cant be said for all the other “old” bits attached to the knee

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