T Nation

Total Knee Replacement and Squatting Again

I’m 51 years old 6’ 6" 380# man and power lifted all my life. Had 2 total knee replacements this past year. (rt is 12 months old) (lt is 9 months old). was squatting 600# for sets of 8 up to 3 weeks before first replacement. Dr says NO Squatting. (He says squats are evil even before replacements) I have not been able to strengthen my left knee fully with normal PT etc. the leg gives out when walking. the head of physical therapy said that’s because all the years of heavy squats, my quads wont respond to “Straight leg raises and light rehab”… He says squats are necessary for me. I’ve squatted 5 weeks now, light weight, 5 sets working up to 335# 10 rep set with reverse bands, and knee is feeling awesome. Any experience with this among lifters, Dr’s or therapists? still afraid to wear out the joint prematurely.


I’ve rehabbed hundred of knees. Only patient I have ever had with a total knee that was wanting to be activity was much older than you and all his activity had to do with running, and competing in senior olympics. As far as heavy squats I’ve personally never dealt with that with a TKA patient. I’m not recommending you do them as a therapist however no one can stop you and I’d say do this to protect your knees.

  1. Go wide stance. Takes more off the knees.
  2. Use box squats (maybe above parallel even)
  3. Use reverse bands and other methods to take tension off the bottom.
    4.use knee wraps of course

Most of these methods are going to accent the posterior chain of course and I know you’re asking about quad development. However typically the more you accent the quads, the more the knee is involved and subject to injury. I hope this helps a little and hope you have good progress. I’d be interested to know how things go for you for the future for personal knowledge if I ever encounter this personally in my career.

Not the same issue but I have a rebuilt knee. I too have difficulty getting muscle back in my quads avoiding the squat. My ortho surgeon makes no sense, he want more quad muscles but no squats, no weighted leg extension.

The sport physio mention once about not being the normal patient as most can’t get off a chair before the surgery anyway.

I do full bw weight squats and starting to add weight on box squats but I destroyed my tibial plateau in an accident.

I just want to say that I’d be pretty damn proud of myself if at 50+, II squatted 600 for a single, let alone repping it for sets.

I’d take that now haha

Nice work and good luck on the rehab

Crazy as it sounds I’d try contacting Vlad Alhazov. If anyone knows how to come back squatting from knee replacements he does.

1 Like

Destroyed my ACL and MCL in a dirtbike accident almost 15 years ago. I say squat. Honestly, unless my form gets sloppy, squatting feels great compared to other stuff. Single leg work feels terrible and most machines hurt. I’ve always felt that since everyone squats differently, it’s the most natural way to keep everything working the way it’s supposed to (if that makes sense).

I only went to physical therapy once 2 weeks after the surgery. I remember walking in without crutches and the PT freaking out. They put electrodes on my knee and had me do a bunch of goofy drills. That was enough for me to realize it was going to be a useless circle jerk and I did my own physical therapy at home.

I’m an Orthopaedic Surgeon. Not giving medical advice.
If your set on squatting.

  1. Don’t flex knee past 90. Use a box or something at parallel
    2.Sit back so your knees don’t go forward.
  2. I would use Front squat or Zerchers if you want to squat for quad development.
  3. I would definitely recommend SINGLE LEG use of a leg press with your foot low on the plate and fairly pointed straight. Working sets of 15-25 for hypertrophy ,again don’t flex past 90.
  4. My squat routine is sets of 5, the some Zerchers for sets of 10.
    On my bench day( 2 days after squatting I do leg press).
    I am 60 still training with some OA in my right knee
1 Like

Remember, it’s not a new human knee. The poly tibial component will wear with stress and use. It’s a man made material that can wear out with use.
380 +600 is a lot of load on the component. If your knee arthritis was not post traumatic but degenerate in nature, I would be careful with trying to make this last. Revision surgery is not fun for anyone.
Good luck and enjoy your training,

Lastly, obviously you are very strong at 6’6 380, if you are looking for a new training challenge, see what you can squat at a BMI of 40.
There are evolving new guidelines for joint replacements and BMI under 40 will probably be a hard stop. I don’t make the rules, but that’s where we are heading.

Reverse bands are great idea or just squat to a above parallel box, 3/4 squats. No shame at 50+ with bilateral TKRs

1 Like

I’m not sure if I’m allowed to post a link, but I’d also check out the bonesmart forums to see what folks there have to say about this.

Interesting stuff.

I still have my non-artificial knees but they are beat up like a lot of folks’ knees after 50 years on this planet. I thought my squatting days were done b/c of all the damage, but found squatting to parallel or just slightly past, sitting back and loading the posterior chain and not letting the knees drift too far forward, and driving the knees outward, my knees are happy even with a 500 lb squat. I’m not as big as OP at around 200 lbs, but have a replaced ACL and both have been beat up with skiing and motocross back when I was young.

1 Like

Agree with your approach,adapting with age.