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Although participation in pickleball and other sports is growing, data on returning to play after total joint arthroplasty (TJA) is limited – until now.

A new study presented at the 2025 Annual Meeting of the American Academy of Orthopaedic Surgeons found that most patients who played racket sports were able to return to play at a similar skill level, and without an increase in re-operation rates, within 6 months of undergoing TJA. Patients who returned to play also had higher physical function scores after surgery compared with those who did not return to play.

Racket sports are incredibly popular in the United States, fueled by pickleball, which has seen a 159% increase in participation since 2019. [1] Many who play racket sports are over the age of 60, an age group that’s more prone to hip and knee osteoarthritis (OA) than younger patients, creating an overlap in racket sports players and patients seeking TJA. [2]  There is no clear consensus on which activities are safe to resume following surgery. [3]

Survey-Based Study

For this study, an online survey was sent to 7200 patients who had undergone at least 1 primary TJA at a single academic center between January 2014 and October 2023.

The survey asked patients about their prior and current racket sports participation, including ability level, expectations, limitations and reoperations. Demographics, patient-reported outcomes, and reoperations were also captured through chart review.

All surveys included Patient-Reported Outcomes Measurement Information System v2.0 Physical Function and Short Form v1.1 Global Health (PROs), regardless of playing status.

Study Findings

The average follow-up time among the 1284 respondents was 3.6 years, and the average age was 66.9 years at the time of the survey. The researchers found that:

• 61.7% of total respondents (n =792) had never played a racket sport, 25.3% (n = 325) had last played a racket sport more than 2 years before TJA (remote players), and 13.0% (n = 167) had played a racket sport within 2 years prior to TJA (recent players).
• 71.9% of the recent players returned to play after surgery, compared with 30.2% of remote players.
• Patients typically returned to play 4 to 6 months after surgery – 44.4% of pickleball players, 36.2% of tennis players, and 39.1% of other racket sport players returned to play during this time period.
• When compared with remote and never players, recent racket sports players had the highest PROs across physical function, physical health, and mental health.
• The majority of patients who returned to play after TJA reported an increase or similar level of enjoyment in playing their desired racket sport and reported being very satisfied or satisfied with their procedure because it allowed them to return to their desired sport (90% of tennis players, 77.2% of pickleball players, and 86.9% of other racket sport players).
• Among the recent players, no difference was reported in return to play based on preoperative self-reported skill levels, with 72.5% of beginners, 76.2% of intermediate, and 65.6% of advanced players returning.
• The most common reasons for recent and remote players to avoid returning to play were fear of injury among tennis players (29.7%) and loss of interest among pickleball players (35.3%).
• Rates of reoperation were not significantly different between patients who did and did not return to play.

The study has some limitations. These included being survey-based and susceptible to biases; relying on participants to self-report skill levels, which could lead to inaccuracies; and having no objective mechanism for tracking racket ability changes over time.

References

1. Akabas L. Americans More Active Despite Team Sports’ Decline: Data VIZ. Sportico. Published Feb. 22, 2023. Accessed March 13, 2025.
2. Loeser RF. The role of aging in the development of osteoarthritis. Trans Am Clin Climatol Assoc. 2017;128:44-54.
3. Swanson EA, Schmalzried TP, Dorey FJ. Activity recommendations after total hip and knee arthroplasty: a survey of the American Association for Hip and Knee Surgeons. J Arthroplasty. 2009;24(6 Suppl):120-6.

Source

Taylor AJ, Braathen DL, Blackburn B, Peters CL, Pelt CE, Gililland J, Archibeck MJ, Anderson L. Return to pickleball and other racket sports after total joint arthroplasty. Presented at the 2025 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 10-14, 2025, in San Diego, California.