Fifty Plus (50+) - Cycling after a TKR (Total Knee Replacement)

Yes, I already searched this topic, but wanted to start a fresh thread on it. My cranky ass right knee has been sustained with stretching, ice, and Synvisc (today I'm having the third shot of the latest round of shots) but osteoarthritis is a degenerative condition and I fear I am sailing towards a knee replacement. My knee surgeon, Larry Livingston (Montvale, NJ) is the best, he's operated on my right knee twice (in the 1980's). He says his TKR's can get 130º+ range of motion. I believe what he tells me, I've known him for almost 25 years.

What's it like cycling after this? Could I ride 10K+ miles annually? Could I ride hard (i.e., TT's, races, etc.)? He seems to think so, I am skeptical.

In any case I hope to put this off for another couple of years, and hoping the Synvisc will kick in, it probably will. Larry seems to think I can be sustained with what I'm doing now until age 60+ (I just turned 53), or that I may never need a TKR. My knee is starting to hurt at times, in addition to the stiffness, so that's not a great sign.

I do know that TKR success is highly dependent on the rehab phase and how aggressively you approach physical therapy. My guess is that I'm considerably more athletic than 95+% of TKR subjects, and my motivation to get this knee working would be much higher than most of those patients.

Sorry to hear bout the knee pcaddy, I have a knee that gives me some fits as well - had surgery some 15 years ago. All I can tell you is a story about I guy I met a Killington about 8 years ago. He was about 85 then, had both knees replaced. He was skiing and we were ridding the Gondola to the top.When we got to the top I asked him where he wanted to go, thinking some easy way down would be his choice. As I turned to face him he already had snapped in and was pushing off down a steep expert trail, as he started rolling his response to my question was "DOWN", we spent the day skiing harder than I usually do. Being of the older ski generation, I asked him if he could still do a royal christie - he popped off a few as he bombed down the hill, amazing fellow, all on two artificial knees.

So I hope that helps you at least realize that an active life doesn't end with a TKR.

Killington is the only place I've ever ridden a chairlift in the hammering rain when it was 20ºF.

Skied with an 84 year old who had one knee replacement. He said he skiied fewer moguls because of the knee replacement. He skied them very well on telemark skis.

Skied with an 84 year old who had one knee replacement. He said he skiied fewer moguls because of the knee replacement. He skied them very well on telemark skis.

That's encouraging.

A couple of thoughts.

1) TKR should be done with a "minimally invasive surgery" (MIS) technique. Sometimes older surgeons are not clued into the newer technologies, as I discovered with my recent L4-L5 fusion and discectomy - where, with MIS, I was walking the evening of surgery, walked a mile the next day, was swimming in 2 weeks and bicycling in 17 days. This while others with the non-minimally-invasive technique were still using walkers at 6 weeks.

2) My wife (now 73) had a MIS TKR about 3 years ago. She worked hard - as you do - to be in the greatest shape possible prior to the surgery, and followed the rehab regimen exactly. You would never, ever know she has had a knee replacement. Synvisc did not help her. She bicycles, wlaks, etc. all the time.

I don't know about the hard bicycling, but I sure don't know of any reason why you could not. Also, I have read recently about TKR appliances designed to last 30 years. I know nothing more, but be sure to check it out. New techniques and appliances are being perfected all the time.

A couple of thoughts.

1) TKR should be done with a "minimally invasive surgery" (MIS) technique. Sometimes older surgeons are not clued into the newer technologies, as I discovered with my recent L4-L5 fusion and discectomy - where, with MIS, I was walking the evening of surgery, walked a mile the next day, was swimming in 2 weeks and bicycling in 17 days. This while others with the non-minimally-invasive technique were still using walkers at 6 weeks.

2) My wife (now 73) had a MIS TKR about 3 years ago. She worked hard - as you do - to be in the greatest shape possible prior to the surgery, and followed the rehab regimen exactly. You would never, ever know she has had a knee replacement. Synvisc did not help her. She bicycles, wlaks, etc. all the time.

I don't know about the hard bicycling, but I sure don't know of any reason why you could not. Also, I have read recently about TKR appliances designed to last 30 years. I know nothing more, but be sure to check it out. New techniques and appliances are being perfected all the time.

Valuable info, and thanks.

I know an older guy that kept putting his knee surgery off, because it was going to be the end of his sports life. He did a lot of golfing and a little running. At the age of 80 he couldn't take the pain anymore and decided to get it done. After he got it done, he said he's kicking himself in the ass for not having it done sooner. About 6 months later he had the other one done. He was back to his old self again and very happy. He died at the age of 85. Personally, I don't know if I want to live that long.
He had all this done about 15 years ago and I know they've come a long way with the procedure since then. I do know a few others that had knee surgery, but I don't know if it was complete knee replacement or not, but they said it was a piece of cake as well.
Good luck with the Synvisc, but I don't know if I would be to worried about the surgery either.
By the way do you still squat 400#. If so I think I would forget about that for a while. Have a nice Christmas.

I have two stories - one very good and one not so good.

A 67 year old team mate, who races track, had a knew replacement a couple of years ago. He was back to riding in a few weeks and set a new World record in the flying 200 meter last year in Masters Track Natz that he held for two minutes until another guy beat him by .1 seconds. This year he was best all around rider at Masters Track Natz in Frisco, Tx and was 6th in the 500 meters at track worlds. His knee does not seem to bother him.

A younger guy in his fifties and a trainer at our gym had his done and it did not turn out well. I was talking with him last night and he had to have it redone.

I have yet to talk with someone that has had a bad doc per se. It appears the outcome depends a lot on the individual but having a doc with a great track record of success is mandatory.

Good luck and hope your knee feels better.

A guy I know had knee and hip replacement after a bout with MRSA. He's in his 50s and has started riding again. He's not yet up to his former speed or distance but the last time I saw him he was very happy to be on the bike again.

One of my riding buddies is 58 yrs old and has had both knees replaced. He says that cycling is easier now than before since he does not have to deal with any pain before or after the ride.

Last March at the start of the first Master's 50+ race I was talking to some of the racers, including my buddy with the new knees. I was telling them about the ankle fusion surgery I had done on December 1st. One of the other racers then stated that on Jan 13th he had a hip replaced. He had also won the State Masters 45+ cyclocross championship in Dec. The three of us all laughed at our cobbled up bodies and racing at our advanced ages. A 4th rider laughed and said that he was feeling macho riding with a broken finger but would not mention it to any others.:D

Sorry to hear PCad. Sorry I can't offer any additional information but just wanted to be supportive. I am avoiding getting my knee scoped but it's only a torn meniscus and hasn't been affecting my riding.

Why don't you post this question over on the road forum? I'm sure you'll a lot of good, helpful, and sincere suggestions over there.

Why don't you post this question over on the road forum? I'm sure you'll a lot of good, helpful, and sincere suggestions over there.

I figure there are older farts over here, and if anything it's even more Fredly.

I have two stories - one very good and one not so good.



Very encouraging. I'm not worried about finding a guy who won't eff up the knee surgery. The guy I have now is the best and if he retires or moves to Florida, I'll find the current guy who's the best. That I know how to do. In going through rehab for this knee twice I kept meeting people who had one surgeon eff up their knee procedures, including TKR's - and my guy Larry fixed them. Finding the right guy is easy, you ask around, particularly ask the physical therapists. They are the ones who really know which surgeons get it right.

My knee's not toast yet however. I look forward to Synvisc shot #3 tonight. Oddly, I'm actually starting to enjoy the pain of the injections. I am utterly insane.

My Mom had it done a few weeks ago, she's 76. This was her second one, her first around Thanksgiving last year. About 3 weeks after the surgery her therapist put her on a stationary bike. This last surgery she was more prepared, she borrowed a Airdyne from a friend. After the initial pain goes away its probably gonna make your bike riding a lot better.

I figure there are older farts over here, and if anything it's even more Fredly.

I have more good news and bad news.... Your knee is going to be fine with or without replacement but you will always be a Fred. I used two coaches who formerly coached the Belarus National team. They divided cyclists into pros and touristas (Freds). The P/1/2s were pros and the rest of us touristas. You and I will always be a tourista.

My knee's not toast yet however. I look forward to Synvisc shot #3 tonight. Oddly, I'm actually starting to enjoy the pain of the injections. I am utterly insane.

I wonder if I could use those shots in my elbows.

My Mom had it done a few weeks ago, she's 76.

Is she racing yet?

I wonder if I could use those shots in my elbows.

Good question. Synvisc will work on other joint capsules. It has been approved for such use in Europe, currently undergoing FDA trials for likely approval for shoulders, elbows, ankles, etc. here in the USA. So probably within a couple of years. Or go to France on vacation and get a shot there.

Good question. Synvisc will work on other joint capsules. It has been approved for such use in Europe, currently undergoing FDA trials for likely approval for shoulders, elbows, ankles, etc. here in the USA. So probably within a couple of years. Or go to France on vacation and get a shot there.

Docs have a lot of latitude in using drugs for off label purposes. Drug companies cannot advertise a drug and label it for a particular purpose until it passes FDA approval. George, do some research on the subject and you may find a doc that is using Synvisc for elbows.

I just checked it out. $1000 to $1500 per injection and you have to get 3. Some say cortisone works just as well, but you can only get 3 shots of cortisone a year. For some people the Synvisc doe's not work at all. I guess it's just like anything else, you have to keep trying until you find out what works for you. They say it's best used with Depo-Medrol and Synvisc
together.
http://www.ehow.com/about_6472436_depo_medrol-synvisc_.html

I just checked it out. $1000 to $1500 per injection and you have to get 3. Some say cortisone works just as well, but you can only get 3 shots of cortisone a year. For some people the Synvisc doe's not work at all. I guess it's just like anything else, you have to keep trying until you find out what works for you. They say it's best used with Depo-Medrol and Synvisc
together.
http://www.ehow.com/about_6472436_depo_medrol-synvisc_.html

I pay $1350 for three Synvisc injections in my knee (not guided by radiology, he just tries to hit the spot) and this is in pricey North Jersey. Insurance usually pays about $900 for them, unless they can weasel out of paying with their unfathomable deductible co-pay scam formula, which they love to employ to fark us.

I figure there are older farts over here, and if anything it's even more Friendly.

Fixed it for you!

He says his TKR's can get 130º+ range of motion. I believe what he tells me, I've known him for almost 25 years.


Pcad, I just had my left done (6 weeks from surgery), I just finished PT with 132 degrees (I am 54 years old), and it will get better as the swelling goes down. I had my right one done in 2003, I have 140 degrees in that one, and 5 months after surgery carried my daughter on my back on a 4 mile trek uphill to a local rock formation (Delicate Arch, UT)


What's it like cycling after this? Could I ride 10K+ miles annually? Could I ride hard (i.e., TT's, races, etc.)? He seems to think so, I am skeptical.

I'm not.


I do know that TKR success is highly dependent on the rehab phase and how aggressively you approach physical therapy. My guess is that I'm considerably more athletic than 95+% of TKR subjects, and my motivation to get this knee working would be much higher than most of those patients.

This is a double edged sword, I trained really hard this summer getting ready for my surgery (Lost weight, built up my leg muscles). But then I kept blowing it during PT by doing too much, too soon. Patience and steady progress is what you want to shoot for. You do your PT, you have a goal to shoot for and you will do fine. I went out and bought a new Giant Defy 1 a week before surgery and that was my goal (It is sitting in my office), to be in top shape to ride that rocket when the ice thaws.

My Dr. told me before I went in the first time that I would go through 3 stages:

1. It would hurt so much that I would curse myself for having it done.
2. Pain level would be about the same as pre-surgery
3. My life would be so much better, I would curse myself for not having done it sooner.

Hope this helps

Terry

Pcad,
I have several friends with both single knee and both knees replaced. To the letter everyone has said it was the smartest thing they had ever done. As with most orthopedic surgeries the quality of the surgeon makes the difference as well as the mind set of the patient. You are still young and pretty fit. the core strength and musculature of your legs will help tremendously when, if ever you do have the replacement should you choose. One thing that really can get to my knees is cleat or clip placement and causing the foot to turn in, even a small amount.

Best of luck and it is nice to see you here at 50+.

Bill

So I see my orthodpod tonight for the last shot and I'm discussing all this. He thinks I am very far away from a TKR. Then on the way out, I tell him the Meloxicam (NSAID) I take when my knee flares up doesn't work for me anymore. I tell him maybe he should prescribe something different, he agrees. He gives me two samples in his office, one is Celebrex (I've taken that before, years ago). I take ONE Celebrex on the way out the door. Within an hour my knee feels 200% better. So that's encouraging. I really need an effective NSAID, and maybe between those and the Synvisc (now I may have to go twice a year) I can keep this under control for a long time. He is the most experienced knee guy on the planet (THOUSANDS of TKR's, reconstructions, scopes, he is the best) and he is rather insistent that I can function this way for a long time. He must know something about evaluating patients with bad knees. More than any of us at any rate.

Let's hope he is right.

Thanks for all the input, VERY encouraging. My doctor, with all his thousands of patients, hasn't done a TKR on an avid road cyclist.

Had mine done in October of 1999 so I've got a little over 11 years of experience.

I got back into cycling in March 2009 as cycling was one of a few things I could still do. Running and any sport that involves jumping or quick changes in direction are not recommended.

I've had good luck with cycling and haven't had any issues with the knee.

Definitely hold off until the next generation of replacement knees hits the market. You know, the ones with the same little motor they put in Contador's bottom bracket. You'll be the next Lee Majors.

If it will help I've had both knees replaced one in 03, one a few month later in 04. My doctor told me two things were forbidden if I wanted the implant to last. 1.) I can not get down on my knees for any reason 2.) I can't hammer when I ride my bike anymore. I can ride my bike from here to the moon but I can't hammer for the speed anymore.

My doc told me that he want's me to keep riding as long as I can 'cause that's great low impact activity that I can do for years even if I just toodle around the neighborhood.

Now one point to be fair: since there are millions of baby boomers getting TKR the tech behind the implants is getting better by leaps and bounds. Heck, my implants are now considered old school to the newer implants! Work with your doctor to time the TKR just right to get the latest tech implants at just right time for your body.

Oh yes, not everybody heals the same and how well you heal depends on your grit to do ALL the after surgery therapy. The surgery therapy is no time to be a wuss. Nope, no time at all...........

There are some of us for whom placing a chunk of metal inside the body is just not a good idea. I hope Pcad isn't one of them (us). I first found out about this when I had some crowns replaced. After two years of having the hygienist telling me I wasn't flossing enough as evidenced by the swollen gums where the crowns were (I was flossing four times a day), I switched dentists. My new dentist found that the crowns had a surgical stainless base metal instead of gold. I replaced the crowns with porcelain-covered gold and the swollen gums were no longer a problem. Twenty years later I found my right leg in need of a bit of bolting back together. I found that my previous poor reaction to surgical stainless was still intact. Fortunately, the bolt only needed to stay in for a month.

I can't imagine the horror of getting a TKR and then finding out that I am allergic to the base material. It is highly unlikely that you will have any issue with the TKR materials, but you might check into it. Of course, like bikes they don't use steel anymore. Maybe by the time you need the procedure they won't even use Ti anymore, it will all be done with plastic.

Good luck with the injections and the new NSAIDS. The longer you hold out the better the materials/techniques get, balanced against the misery of constant pain. Getting old ain't for wimps (said my uncle, who also insists that 80 isn't old).

2.) I can't hammer when I ride my bike anymore. I can ride my bike from here to the moon but I can't hammer for the speed anymore.

My surgeon, who has done thousands of knee replacements, didn't think riding hard would be a problem. It's not high impact. Weight bearing, but no impact to speak of. Prosthetic knees apparently handle that well.

The Synvisc appears to be kicking in. He does think I can get by with Synvisc shots for a long time to come. I sure hope he's right about that.

I have more hardware in my body than Lowe's has on aisle 7. Two back fusions and a knee reconstruction. Giant screws show up on my leg xrays, it's pretty strange. Brackets in my back.

Had TKR a little over three months ago - the best decision in a long time. I spent 4 years in significant pain trying to put it off - what a waste! Walking with a walker the day after surgery, home at three days. Walking with a cane at 12 days. Without a cane at 14 days. Golf at one month, bicycling again (after 4 years) in two months. If my other knee decides to go, I will not wait.

The key, however, as everyone has said, is a positive attitude and working very hard at PT. I may be an exception, but at 70 years of age and 70 pounds overweight, one would think it recovery would have been a lot slower.

So - go with the synvisc, but don't discount getting TKR when you really need it. My bet is you won't regret getting it done.

Hoping to avoid a TKR, but if it gets to the point where it hurts to ride the bike and walk, I wouldn't hesitate too long. I get some pain, but not too much of that yet, even when it's bad, more stiffness and discomfort than anything else. Rode hard again today, knee feels pretty good, so hopefully the Synvisc is working, it does seem that way.

I would be trying to ride hard and race (at least do TT's and rides like Nyack with the racing boys) after a TKR, so if it comes to that I hope it's possible to do that. I'm hearing mixed reviews on that.

A couple of thoughts.

1) TKR should be done with a "minimally invasive surgery" (MIS) technique. Sometimes older surgeons are not clued into the newer technologies.

Be aware that MIS is not applicable to all knees. If the knee has had a prior incision, MIS techniqures are usually not applicable because of the scar tissue and possible tears of old incisions that could occur when the MIS incision is S-T-R-E-T-C-H-E-D to make room for the doc to work. That's the case of my right knee, which will soon require a TKR (I've pushed it back from age 42 to 59), but it has had three incisions and two scopes over the years.

One other new technique involves a "Custom knee" built specifically for you.

http://www.texashipandkneecenter.com/whats_new.html

They use MRI and scans to build a replacement knee specific to your body, rather than using an "off the shelf" joint.

In my opinion you can learn as much or more about replacement results by visiting with a few physical therapists as you can talking to the doctor. If you know one I would try to visit with him before deciding who and where.

That's just my two cents, but I've had a lot of knee surgeries.

My surgeon, who has done thousands of knee replacements, didn't think riding hard would be a problem. It's not high impact. Weight bearing, but no impact to speak of. Prosthetic knees apparently handle that well.



My doctor said that he DID NOT want me standing to pedal faster (hammer) since that placed a shock load on the implant that could loosen it in the bone or either spit the plastic bearing or at least add lots of extra wear. Other that that he ok'd all the SITTING riding I can stand!!!

Now my right knee is all stiff and swollen. Apparently that's a rather common side effect of Synvisc, particularly if you've had multiple applications of the drug. Temporary. Hopefully it will just subside. I really don't want to get the knee drained (ouch). I don't think I'm even willing to undergo that procedure. Eff that action. I can limp around for a week. Not sore, just stiff and uncomfortable. I'll call him tomorrow.

Yes, I already searched this topic, but wanted to start a fresh thread on it. My cranky ass right knee has been sustained with stretching, ice, and Synvisc (today I'm having the third shot of the latest round of shots) but osteoarthritis is a degenerative condition and I fear I am sailing towards a knee replacement. My knee surgeon, Larry Livingston (Montvale, NJ) is the best, he's operated on my right knee twice (in the 1980's). He says his TKR's can get 130º+ range of motion. I believe what he tells me, I've known him for almost 25 years.

What's it like cycling after this? Could I ride 10K+ miles annually? Could I ride hard (i.e., TT's, races, etc.)? He seems to think so, I am skeptical.

In any case I hope to put this off for another couple of years, and hoping the Synvisc will kick in, it probably will. Larry seems to think I can be sustained with what I'm doing now until age 60+ (I just turned 53), or that I may never need a TKR. My knee is starting to hurt at times, in addition to the stiffness, so that's not a great sign.

I do know that TKR success is highly dependent on the rehab phase and how aggressively you approach physical therapy. My guess is that I'm considerably more athletic than 95+% of TKR subjects, and my motivation to get this knee working would be much higher than most of those patients.

I had mine done when I was 63 and have averaged 5-7K per year since. Your last paragraph is true beyond true. I could kick myself for suffering for the 3 or 4 years before I had it done. Feel free to pm me about this if you like.

My right knee is stiff, swollen about as bad as it has ever been, and somewhat sore. I'm reasonably sure it's just a Synvisc reaction, that it will calm down and I'll be on the bike again by the weekend. But this is nasty. Hope I don't have to get it drained off. This side effect is not unusual with Synvisc, particularly after repeated courses with the drug (this is my fourth round of shots). Usually temporary and self-resolving. No particular sign of infection or allergic reaction so far.

I know it would be tough to stay off the bike for 6 weeks, but I think I would get the surgery, rather than take steroids for the rest of my life. That's easier to say, than to do though.Good luck.

Knee is 25-30% better today. Swelling is down, pain is much better. Hope to be back on the bike by Monday.

I'm not worried about time off the bike to recover from TKR surgery, more about whether it's a long term solution. Steroids? I'm not getting steroid injections. Synvisc is not steroids.

Knee is 25-30% better today. Swelling is down, pain is much better. Hope to be back on the bike by Monday.

I'm not worried about time off the bike to recover from TKR surgery, more about whether it's a long term solution. Steroids? I'm not getting steroid injections. Synvisc is not steroids.

No steroids is good to hear.
I wish I had a quick fix for this arthritis.

Pcad,

I had one of my ankles fused with 9 screws and a plate last December. It had osteoarthritis resulting from college sport injuries. 15 years ago I had to give up basketball and softball and found cycling. I could ride my bike all day but couldn't take a 1 mile walk with my wife. I had last been to the doctor 10 years ago when he suggested the fusion surgery since there were no artificial ankles that would have sufficed or cartilage injections. I went a new doctor in October of 2009 and got the same answer. The doctor said that I would be the one to make the call on the fusion surgery. I scheduled the fusion that day based on completing the last cyclo cross race, finishing the “honey do list” and being recovered somewhat for the holidays. Imagine my wife's reaction when I got home from the doctors with the news.

In my case I knew it was time to get the fusion and give up the pills that I needed to take for inflammation. I was able to think back a few years about things I could do that I longer would, due to the pain or aggravation of working around the pain. Just pushing a wheelbarrow was a painful endeavor that took much concentration. If your injections give you the quality of life and mobility you desire then why would you have a TKR? If a new knee will give back mobility and no pain then why not have the TKR? That will be your call alone since you will live with the results.

You made a wise decision to post you question on the geezer forum. Many of us have some new replacement parts, parts from someone else, animal parts, shiny screws and plates, and even some with a few parts missing.:D

I had a TKR in October, 2008. After rehab I have no issues. it feels like the real thing except it doesn't hurt. I rode 5,921 miles this year on 3 different recumbents and expect to do more next year since I just retired. You have to work at the rehab but it's worth it.

If your injections give you the quality of life and mobility you desire then why would you have a TKR? If a new knee will give back mobility and no pain then why not have the TKR?

It's not that simple. The Synvisc injections will work for a while, but they may well lose efficacy at some point (which may already be happening) and then you're on drugs all the time, then the TKR starts looking more urgent. I don't want to ride a recumbent bicycle with a TKR, I'd like to RACE a regular bike, and that's weight bearing (if low impact) and much more stressful on a TKR. I'm getting mixed signals on whether this is possible. Again, I suspect that it is, but some doctors warn you against it to err on the side of caution. My doctor seemed to think once I was rehabbed that I'd have the range of motion and I could hammer my bike.

Oh well. I'm not there yet. Knee is 20% better today, that's a great sign, hopefully I'm back on my bike by Monday.

Thanks for all the responses, keep them coming, this is really about the only place I'm going to get this informed feedback. But don't get the idea I'm as old as you guys.

It's not that simple. The Synvisc injections will work for a while, but they may well lose efficacy at some point (which may already be happening) and then you're on drugs all the time, then the TKR starts looking more urgent. I don't want to ride a recumbent bicycle with a TKR, I'd like to RACE a regular bike, and that's weight bearing (if low impact) and much more stressful on a TKR. I'm getting mixed signals on whether this is possible. Again, I suspect that it is, but some doctors warn you against it to err on the side of caution. My doctor seemed to think once I was rehabbed that I'd have the range of motion and I could hammer my bike.

Oh well. I'm not there yet. Knee is 20% better today, that's a great sign, hopefully I'm back on my bike by Monday.

Thanks for all the responses, keep them coming, this is really about the only place I'm going to get this informed feedback. But don't get the idea I'm as smart as you guys.

Corrected for accuracy... And I am glad your knee is better and I am sure it will be fine.

But don't get the idea I'm as smart as you guys.


Corrected for accuracy... And I am glad your knee is better and I am sure it will be fine.

I believe the correct formula is

SMARTNESS = 100 + your age.

Smartness is realizing how dumb you really are.