The American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons advise against running after a total hip replacement. In contrast, guidelines from the European Hip Society recommend both jogging and running.
Although older studies found increased wear and revision rates with high-impact activities and high-activity levels, patients in those studies had conventional polyethylene liners. More recent studies of patients with highly cross-linked polyethylene (HXLPE) liners have not shown greater risk associated with high-impact activities.
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A 2023 study found that 16.7% of people who ran prior to undergoing a total hip replacement (THA) ran afterwards. It also found that 1.6% of those who were not runners prior to replacement took up running afterwards. There’s even a website where people who run after THA share their experiences. So, clearly some people do run after THA — but should they?
I consulted six surgeons, and only one said that running after a total hip replacement would be okay. The other five said they would not recommend it, with three of them strongly discouraging it. Those views align with the recommendations from relevant U.S. medical associations.
The American Academy of Orthopaedic Surgeons (AAOS) states:
In general, lower impact fitness activities such as golfing, bicycling, and doubles tennis put less stress on your hip joint and are preferable to high-impact activities such as singles tennis, jogging, racquetball, basketball, and skiing.
Similarly, the American Association of Hip and Knee Surgeons (AAHKS) states:
Low-impact sports are recommended, medium-impact sports should be approached with caution, and high-impact sports should be avoided. These recommendations are based on our knowledge that the wear rates of the hip replacement materials are a function of patient activity level and joint loading. Running, for example, places a large amount of stress on the implants and may lead to implants loosening over time.
Here’s the full list of activities labeled “Do not recommend” by the AAHKS: singles tennis, racquetball, squash, jogging, snowboarding, contact sports, baseball, softball, high-impact aerobics, and martial arts.
These current recommendations echo the guidelines published in 2007, which were based on a survey of more than 500 surgeons from the Hip Society and AAHKS. (Full text available here.) For jogging, the survey reported:
Based on those results, jogging was given an overall classification of “Not Allowed.” (“Jogging” wasn’t defined, and running wasn’t included in the survey’s list of activities.)
A separate survey of members of the AAHKS, published in 2009, found that:
More than 95% of the responses placed no limitations on low-impact activities including level surface walking, stair climbing, level surface bicycling, swimming, and golf. Higher-impact activities were more commonly discouraged, although there was considerable variability. Higher-volume surgeons tended to be more liberal in their recommendations.
However, the punchline was:
No responder indicated that there was strong scientific evidence for their recommendations.
Looking at the recommendations of the surgeons I consulted and the U.S. guidelines from 2007 to present, I wonder whether there’s a vicious circle: opinions shaped the guidelines, which are now shaping the opinions.
The results of a 2021 survey of members of the European Hip Society were far more permissive:
Thus, both jogging and running were classified as “Recommended.” The recommendations for both jogging and running were for 6 months after surgery. Jogging was defined as a pace less than 6 miles per hour — i.e., more than 10 minutes per mile.
There are at least two plausible explanations for the difference between US and European recommendations.
The 2007 US recommendations were based on the assumption of a metal-on-polyethylene bearing. In contrast, the 2021 European survey asked surgeons to state their preferred bearing. While 78% did choose a polyethylene liner paired with a ceramic or metal head (66% ceramic, 12% metal), 17% chose ceramic-on-ceramic, <5% dual-mobility, and <1% metal-on-metal.
It’s possible that some European surgeons would allow running only with non-polyethylene bearings, like ceramic-on-ceramic. If the European survey had stipulated polyethylene liners as the US survey did, perhaps jogging and running would have lost support, such that the overall recommendation might have shifted to “Undecided” — at least for running, if not jogging.
A second possibility for the difference between US and European recommendations is timing. The 2007 US guidelines reflect outcomes from earlier generations of polyethylene liners, whereas the 2021 European guidelines came after the widespread adoption of highly cross-linked polyethylene (HXLPE) — which significantly reduces wear and related complications.
For instance, a 2012 study of patients who underwent THA using ceramic on conventional polyethylene between 1995 and 2000 found higher wear in the high-impact group and a higher revision rate in the high-activity group. The study is frequently cited as evidence that THA patients should avoid running and other high-impact sports.
This excerpt from a 2014 narrative review details the mechanistic reasoning that likely contributed to the 2007 US recommendations:
One of the main concerns of resuming regular high‐impact physical activity after conventional total joint arthroplasty is mechanical degradation of the polyethylene spacers that are used in most traditional joint arthroplasties. These materials are built to withstand large cyclical forces, but the wear rate of this plastic is related to the amount of use, which has been established by in vitro[34] and in vivo studies.[35] As the polyethylene wears, it creates particulate debris that can remain localized within the joint or spread to adjacent tissue. This can lead to sensations of pain and instability,[36] osteolysis and subsequent aseptic loosening,[37], and regional granulomas and cysts.[38] Polyethylene wear and the associated prosthetic loosening are the most common causes of post‐operative failure and the need for revision surgery. Therefore, activities that potentially expedite the wear through increased frequency or magnitude of loading (such as high impact sports) is a primary concern.
But the issue of high wear seems to have been solved. In fact, the first study cited in the paragraph above is an in vitro study showing that HXLPE had an 80% lower wear rate than conventional polyethylene. In vivo studies, like this one at 10+ years follow-up, this one at 20 years follow-up, and this one involving participants in high-impact sports, show similar reductions.
Studies of patients with HXLPE have found no increased wear or risk of revision with high-impact activities or high-activity levels. I did not cherry-pick these studies. This list includes every relevant study I found searching Google, PubMed, and Consensus AI. I did not find any study reporting higher wear rates or adverse outcomes in HXLPE with increased activity levels or participation in high-impact sports.
Let’s begin with three early papers:
Here are more recent papers, ordered by increasing postoperative follow-up time:
Many recently published articles rely on outcomes from outdated conventional polyethylene.
One example is this 2025 review from researchers at McGill University which states, “… in 3 studies including 2068 participants [which represents 66% of all participants covered by their review], increased physical activity was associated with lower rates of implant integrity at an average follow-up of 6.3 years.” The authors conclude, “Patients undergoing THA should be counselled to participate in moderate physical activity and may benefit from avoiding sports that exert an excessive load on their implants.”
Setting aside the circularity of the claim (if a load is excessive, then by definition it should be avoided), the problem is that the three studies cited involved conventional polyethylene liners, not HXLPE, and thus are outdated and irrelevant to surgeries in 2025.
Similarly, a 2024 Swiss study of THA patients found that increased activity level was associated with an increased risk of revision, at both 10 and 15 years follow-up. Revision rates at 15 years were 3.9% for the low-activity group, 7.2% for medium, and 12.2% for high. The study abstract concludes, “...intensive and moderate PA may be associated with an increased risk of revision.”
But the patients studied underwent THA between 1996 and 2012. The study thus captured a wide mix of bearing surfaces, including metal-on-metal (MoM), ceramic-on-ceramic, ceramic-on-conventional-polyethylene, metal-on-conventional-polyethylene, as well as ceramic-on-HXLPE. The authors did divide the patients into MoM and non-MoM groups for further analysis, but that still left HXLPE grouped with conventional polyethylene.
Finally, consider this 2026 systematic review and meta-analysis. The authors analyzed 20 studies involving more than 500,000 participants. In their discussion, they write:
Multiple studies have established a link between elevated physical activity levels and increased rates of aseptic loosening [36,37], though some reports found no significant association Malik et al [38]. Our study corroborates these findings, demonstrating that smoking combined with high physical activity more than doubles the risk of aseptic loosening (OR = 2.198, 95%CI: 1.048-4.611, P = 0.037).
There are several problems here.
First, the two studies they cite as evidence that “elevated physical activity” increases loosening rates were both conducted in the era of conventional polyethylene, not highly cross‑linked polyethylene (HXLPE) — which dramatically reduces wear, debris, and failure from aseptic loosening.
Second, the Malik study they cite as showing “no significant association” has nothing to do with physical activity. Malik examined smoking and non‑steroidal anti‑inflammatory use as risk factors. And the material studied was once again conventional polyethylene, not HXLPE. It is unclear why the authors present it as a counterpoint to physical‑activity research, and it is outdated regardless.
Third, the authors claim their meta-analysis “corroborates these findings.” Which findings? That elevated physical activity levels increase rates of loosening, or Malik’s finding that neither smoking nor NSAID use is associated with aseptic loosening?
Finally, the authors claim that “smoking combined with high physical activity more than doubles the risk of aseptic loosening.” But that’s not an accurate characterization of their own findings. In fact, the authors combined smoking, alcohol use, and physical activity levels into a single factor called “lifestyle.” Lifestyle is the “factor” that more than doubles the risk of aseptic loosening. To be clear, the meta-analysis does not isolate physical activity as an independent variable.
On the upside, some recent systematic reviews are highlighting the issue with old data.
This 2024 systematic review, for example, states: “4 of 5 studies showed improved survivorship in high-activity patients, while one showed lower survivorship. However, the study that showed lower survivorship assessed patients who were operated on between 1995 and 2000 and had conventional polyethylene liners, which may not be reflective of modern day prostheses.”
Similarly, the discussion section of this 2023 study states,
One study reported higher revision rates 10 years after THA with a history of high-impact sports than the low-impact activity cohort. Similarly, revision rates were higher in patients who were more active after THA (28%) compared with those who were not (6%).
A few sentences later, however, the authors qualify the relevance of those findings:
It is notable that several of the reported studies [including the one mentioned above] assessed patients who received first generation polyethylene liners while highly cross-linked polyethylene may withstand increased wear and kinematics of high-impact activity.
It’s probably obvious, but I still feel that I should state the following:
The fact that I could not find published evidence that running is harmful after a THA with HXLPE does not mean that such evidence does not exist or that running is safe.
That said, my review of the literature suggests that the current US recommendations are probably not evidence-based.
Maybe the U.S. recommendations will be updated soon, and maybe they’ll align with European recommendations. Maybe future research will conclusively establish that running and other high-impact activities are not riskier. That would be great.
My own decision is complicated. I need to consider the overall stress on my new hip. I hope to resume some form of weightlifting, and the kind of hiking I want to do involves steep and substantial elevation changes, which might already be pushing into the “high-impact” activity range. I’ve also torn the meniscus in my left knee twice and never had it repaired. I have to admit that my knee feels better now that I don’t run.
But I still dream about running and still feel a strong sense of loss, even though it’s been more than a year since I last ran. Maybe my desire will fade over time and hiking will become enough for me, mentally and physically.
I’m still undecided, which is fine. I’m only three months post-op. If I do resume running, it won’t be until one year post-op to maximize osseointegration.
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Posted May 2026.