I started cycling after meniscus surgery eliminated running as an option for me. The ortho doc at the time advised me to never ride out of the saddle and I cycled in a reasonably hilly area like that for multiple years. Fast forward many years and post total knee replacements, the surgeon also cautioned against riding out of the saddle because of the higher forces on the hardware parts. I am accustomed to climbing while seated and while I may give up some power in some places, it mostly works just fine. On occasion I get out of the saddle just to change position, but I am a seated climber and I have had some challenging climbs the past couple years without feeling compromised.