Knee Replacement - Anyone else?

Hi,

Around 28 years ago I suffered a knee injury playing rugby and ever since then have always had some sort of knee problem. I’ve seen various consultants over the years and had two arthroscopes but I haven’t been able to run for years without pain, so landed on cycling as just about the only thing I could do without too much pain. Over the last couple of years I got into Time Trialling and have been using Zwift and then TrainerRoad to train. I PB’d at 40km back in May (50:58) but slowly my bad knee has been getting worse and worse until in July it became simply too painful to cycle or walk for more than 10 minutes. Having seen a orthopaedic surgeon and had an X-Ray and MRI scan I’ve been diagnosed with severe osteoarthritis in all three compartments of my right knee with the only real option is a total knee replacement which is likely to happen around the end of November / early December.

Whilst I always knew this would be the likely end point after the original injury, at 48 years old it’s a bit of a blow, particularly as I’ve had to watch my fitness slide as the last few weeks go by. Just wondering if anyone else out there has had a TKR and what worked for you pre and post-op?

Thanks

John

Yeah, same kind of thing: rugby => increasing pain => various minor operations => (after a brief respite) more pain => TKR at age about 55. So a bit older than you. But I still have the same new knee, 20-odd years later.

There’s not a lot to do beforehand. Just limit the pain. You will lose a lot of muscle mass and it will be painful during initial rehabilitation. But then you won’t know yourself: pain-free. It’s then a matter of weights and cycling to rebuild the muscle mass.

The critical post-op thing to concentrate on is range of motion. People report various ranges of motion, the ability to bend the knee, from 90 degrees to 120/130 degrees [measured on the outside of the knee] or 90 degrees to 70 to 60 degrees [inside angle of thigh and shin]. The more the better.

A range of motion of 90 - 100 degrees will not really affect your cycling. So just aim for more than that. [The worst thing about limited ranges of motion is that it creates difficulties in kneeling and in having a crap outside in the woods.]

Good luck. Just recognise that this will put a serious short-term dent in your cycling measurements. But with gradual increases in post-operation workload, the long-term gain is tremendous.

2 Likes

Really encouraging to hear that you have got that kind of longevity out of your replacement knee. Does seem like getting moving from day one is the key.

What kind of activities have you been doing other that cycling? I know running is not recommended on replacement knees but I am hoping to get back into walking longer distances and maybe even a bit of village cricket.

Basically, cycling, JonnyBike. I was already in my mid-50s, and with a high stress/time commitment job. I did a bit of pool swimming, but basically it was cycling. As you note, running is contra-indicated, and I walk only grudgingly [but that’s preference, not really capability]. Still, I do ride 150 - 200 km / week, plus 10 - 20 day tours.

1 Like

I’ve no personal experience but I cycle with a number of people who have knee and hip replacements. Most of them are going strong into their 70’s and put some younger riders to shame.

My dad (64) has now had both knees done in the last 3 years after years as a rower/squash player.
He actually used TR as part of his pre and post surgery rehab work. Surgeons/docs will tell you this, but the better shape you are going in, the better your recovery will be. Dropping excess weight is key to assisting in this, but generall all-round body strength will assist too. Your leg is going to suffer muscle atrophy, so just be prepared for that. The more muscle you start with the more you have to work with.
While walking long distances can prove difficult in rehab, pedaling with minimal resistance (less than 50w) in flat shoes (no cleats) will allow your leg to get range of motion back and get used to the movement.

I had a TKR at 48 a couple years ago and it went really, really well for me. I suffered for years from bad knees and severe arthritis (from HS football, bad genetic luck, and poor rehab on my part). I was a really avid cyclist (4K miles a year across gravel, MTB, fatbiking, road) and i was freaked out that my days as a cyclist were over after the TKR, even though there are testimonials on the web of others that got back on the bike.

I got my TKR on Feb 1. I was on a trainer in 7 days, moving slowly, but getting full rotation. I was outside on a fat bike on dry roads 3.5 weeks after the surgery (my dr would not have approved) going slowly, but damnit, i was back on the bike. I did a 39 mile gravel/mtb race in June (the Lutsen39er), a 75 mile road ride in August and a hard 25 mile MTB race in October. The next summer i was doing 100 mile gravel rides. In 2018 I did the Leadville100 ride.

I feel like i got super lucky and maybe i’m an edge case. I got the right Dr (an avid roadie) who made sure my surgery was minimally invasive and my family was very supportive before and after. I was aggressive about rehab and i worked really hard to stay positive, optimistic and focused on the future (i’m a big believer that recovery starts with your attitude) as i took a measured, slow, safe and patient approach to getting back onto the bike. Finally, the point about being in good shape going in is true, i think. You’ll have an advantage due to your fitness, but also spend a couple months working on your flexibility, your core strength, and any weight you can lose will only help.

The science and medical technology is amazing. Truly incredible. I’ve got to replace my other knee in the next year (hopefully after Leadville 2020), and if it goes 1/2 as well as the first one, i’ll be over the moon. Happy to chat via email or phone if you have more questions. You’ll be glad you did it.

Thanks very much for taking the time to reply. I’m going in for the operation this Saturday, so it was a really well-timed message. To be honest, I’ve found it a tough few months and it’s so good to hear positive stories about the process of having a TKR. The psychological side has probably been the hardest to deal with. To go from doing the mid volume plans and racing to being unable to pedal or even walk without pain has been difficult and unfortunately, I have lost an awful lot of motivation. I’m just about keeping on top of my weight (+3kg) since I stopped training about five months ago but that’s about it. It’s been drummed into me by doctors, physios and anyone with any experience of a TKR that getting the knee moving and doing all the prescribed exercises is essential for a good result so that must be my focus.

I have a very well-regarded orthopaedic surgeon who is a knee specialist, so it all bodes well for a good result. Best of luck with your second knee when you get it done and thanks again for sharing your story.

All the best

John

2 Likes

Good luck, John. Come back and give an update when you’re back on the bike!

I followed this late last year. Hows the rehab going? Will most likely need a TKR in the next couple years.

Mike

I’d like to know too. I’m having my left one done Sept 10. I asked the question on the Cyclists over 50 on Facebook and got nothing but great responses, no horror stories at all. Everyone said it was the best thing they ever did.

1 Like

Wow, great to see this thread pop back up. I’m scheduled for Sep 8 so @craigmanning, once we’re coherent enough to post here would be interesting to track our respective recoveries. I did find some good threads on forums.thepacelineforum.net

My question is about the next 4 weeks on the bike. Don’t think Plan Builder has knee surgery as a planned A event :smiley: so just finishing a build phase (not stock but custom by plan builder for events I’ll no longer be doing) so likely won’t try to reprogram that way.

What would the collective wisdom be on how to spend the next four weeks on the bike? Will also be doing kettlebell swings and get ups plus goblet squats. What else?

Spend it carefully for sure…my doc told me not to shave my legs 4 weeks prior…if you were to cut yourself you would have to postpone the surgery due to infection risk…I was thinking of only riding the trainer from here on out, hate to crash on the MTB. I have a good friend who is also my PT, I see him today, I will ask if there is anything I should be doing before the surgery.

I hear you. Hadn’t actually thought about limiting my outdoor riding, but now you have me thinking… I am thinking of hitting the bike stress fairly hard for at least 2 weeks, and then going into recovery mode so my body is “tanked up” for the surgery itself.

My surgeon is a stickler on infection prevention too – which is a great thing. If I get any cuts/scratches etc in the two weeks prior to surgery he wants to see photos, and he is targeting me going home same day to avoid additional hospital exposure overnight. That last one has me and my wife a bit apprehensive, but he assures me he’s judicious in whom he considers for that, and he’ll flag that off right away if anything isn’t as he wants it to be.

My PT is a personal friend/cyclist/nordic skier and we are already are planning post-surgery stuff. Interestingly, we were talking about strength training down the road and he asked one of his colleagues to come over. Turns out the colleague has a TKA by my surgeon a year ago, and he’s now doing a lot of strength work including serious deadlifts and Turkish Get Ups, so that was optimism-inspiring.

Mine is being done outpatient as well, I had to pass a screening with EKG, bloodwork, strength tests, and minimal pre existing conditions. Supposedly in at 5am and out around noon. My wife is a bit freaked out as she can only drop me off and pick me up due to covid, she isnt allowed in the building.

I talked with my PT, he said I have good strength in that knee currently, he wants me to just keep riding and training as I am, no special exercises needed.

This is right around the corner…are you still on for Sept 8? My surgeon pushed mine back two days to Sept 12, he must have been offered a tee time or something he couldn’t turn down :-). I’m ready…its been getting pretty painful these last two weeks…I know its going to get worse before it gets better but I am eager to start the process.

Still on for a week from tomorrow. When I had my preop the PA said “I suppose your knee is feeling better these days” and I “said, as a matter of fact, it’s not so bad…” she laughed and said that happens a lot. I’m still going forward as both knees are letting me know they’re not really happy, although not as acutely as a few weeks back. Sounds like you’re going the other direction and confirming that you’re really ready.

Last outdoor ride was yesterday – a good two hours with a long warmup, Carson, plus two more self-inflicted intervals, and a nice endurance pace back. With my surgeon being so fanatic about infection prevention (which I’m pleased to see) I don’t want to have to send him photos of road rash…

Had drinks (outdoors) yesterday with a friend and her husband; he’s an anethesiologist and he gave me some good counsel on what to anticipate with the surgery prep and how to altenate acetominophen and ibuprofen post surgery to avoid using the opiods more than a couple of days post surgery.

This article came through my news feed yesterday re: same day discharge.

I had moved to 170 cranks last season, and just picked up a set of 165s for my fender/CX/rain bike so I’ll put those on this week and get the portable Omnium trainer set up in my garage so I can start some more rotational movement as soon as my PT gives me the OK

I read that article this morning, she didn’t look to be a “great” candidate, a little overweight but gave some good insight. I don’t think I will be riding outside again before the surgery, its too risky and we have been getting all of Northern California’s wildfire smoke here in Reno, so indoors it will be. I bought some flat pedals for my trainer bike as well as a cushy seat, my PT says I will be spending a lot of time on it.

Do you know which implant you are getting? Im getting a Smith & Nephew Journey