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Knee replacement in my future - Questions

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Knee replacement in my future - Questions

Old 08-27-16, 04:41 AM
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DaveQ24 
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Knee replacement in my future - Questions

Left knee is bone on bone. Right knee has moderate cartiledge loss. Left knee has a couple of bone spurs on the back of patella.

Yikes, I'm only 51 - my goal in the next 2 years is to get several tri's, a couple of marathons and finally do at least a half IM. This news kinda sucks, but OTOH severe osteo and rheumatoid are rampant in my bloodline - I'm in much better shape than siblings, aunts and uncles. They all end up with various joint replacements eventually.

Right now I only get mild to moderate twinges of pain with high intensity load-bearing movements, especially those where my foot strike isn't aligned, when there is a twist or bend in the joint. But it sometimes buckles and gives out with more pain and then stiffness.

So, in discussing this with the orthopedic surgeon, he said TKR is my long-term option. I want to put that off as many years as possible. Not currently doing any significant running, just a few miles a week as part of boot camp.

Right now, aside from cycling, roughly 100-120 per week, I swim usually twice a week and do a mixed resistance/cardio boot camp 3 days a week.

Dr gave me a prescription for NSAID Mobic, just gonna watch it for now.

It's osteo, rheumatoid factor test was negative. Bone density was actually very good.

My plan is: NSAID daily for inflammation,joint supplement to try and protect my other joint, get on the thin side of my ideal weight but maximize muscle mass and minimize body fat. Clean eating, higher P, moderate F and C. Bone supplement Ca, Mg, P etc.

I guess my question is what should I be doing to strengthen the muscles of the leg so I go into this thing -eventually - in the best shape possible? More cycling with moderate resistance training? Moderate weight but more reps/time doing resistance training? More stretching, foam rolling, balance and plyometric exercises?

Thoughts?
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Old 08-27-16, 09:39 AM
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Originally Posted by DaveQ24 View Post
Left knee is bone on bone. Right knee has moderate cartiledge loss. Left knee has a couple of bone spurs on the back of patella.

Yikes, I'm only 51 - my goal in the next 2 years is to get several tri's, a couple of marathons and finally do at least a half IM. This news kinda sucks, but OTOH severe osteo and rheumatoid are rampant in my bloodline - I'm in much better shape than siblings, aunts and uncles. They all end up with various joint replacements eventually.

Right now I only get mild to moderate twinges of pain with high intensity load-bearing movements, especially those where my foot strike isn't aligned, when there is a twist or bend in the joint. But it sometimes buckles and gives out with more pain and then stiffness.

So, in discussing this with the orthopedic surgeon, he said TKR is my long-term option. I want to put that off as many years as possible. Not currently doing any significant running, just a few miles a week as part of boot camp.

Right now, aside from cycling, roughly 100-120 per week, I swim usually twice a week and do a mixed resistance/cardio boot camp 3 days a week.

Dr gave me a prescription for NSAID Mobic, just gonna watch it for now.

It's osteo, rheumatoid factor test was negative. Bone density was actually very good.

My plan is: NSAID daily for inflammation,joint supplement to try and protect my other joint, get on the thin side of my ideal weight but maximize muscle mass and minimize body fat. Clean eating, higher P, moderate F and C. Bone supplement Ca, Mg, P etc.

I guess my question is what should I be doing to strengthen the muscles of the leg so I go into this thing -eventually - in the best shape possible? More cycling with moderate resistance training? Moderate weight but more reps/time doing resistance training? More stretching, foam rolling, balance and plyometric exercises?

Thoughts?
The short answer no tri,marathon or Iron man.Running and jogging are high impact on your knees.They will only get worse.Swim,golf,walk, hike ,bike more low impact exercise on the knees.As far as prep for the operation consult the doctor.My opinion,not what you wanted to hear.Good luck!
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Old 08-27-16, 10:18 AM
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One of my hiking and backpacking friends had both knees replaced. After the rehab was over, he was ecstatic about the results. His comment was that if he'd known how well it would turn out he would have done it long before. The procedure is well understood. The only part needing attention is selecting an orthopedic surgeon with a good rep.
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Old 08-27-16, 12:17 PM
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CliffordK
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Dad had bilateral knee replacement. Had them both whacked off at the same time. At least initially he did very well, although nearing the end of life, he was using a cane again.

One thing. In Dad's case, he had lost a lot of knee flexibility pre-surgery. The surgery itself doesn't lengthen the tendons, so he had a lot of stretching to do after the surgery. So, perhaps the one thing you should consider is to try to maintain joint flexibility.

I'm not sure if a small amount of impact exercise (jogging) is bad for knees that aren't already toasted. Maybe a short jog once a week. However, as Shamrock mentioned, you should cross the Marathon and Iron Man competitions off of your bucket list. Bone on bone, however, you may already be beyond the place where moderate impact exercise would be of any benefit.

Anti-inflammatories (NSAIDS) seem to be important for the reduction of inflammation within the joint. However, they also have an effect of potentially limiting healing, especially with tendons and tendon stress. You will have to weigh the two effects. But, again, your current problem (and family problems) are related to joints, so the NSAIDS are an important part of treatment. Take them regularly as prescribed.
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Old 08-27-16, 11:20 PM
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My knee's where pretty much bone on bone and running only made things worst for me, so 8 weeks ago i had bilateral knee replacement great decision on my part, but running is not allowed for me now which is fine cuz I'm pain free now.
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Old 08-28-16, 12:09 AM
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Folks I know who've had total knee replacements (titanium) during the past decade did very well. Much better than the older procedures done for my grandparents and my mom's first knee surgery during the 1960s.

The real key to recovery is physical conditioning before and after surgery. One of my good friends (in her early 70s) had double knee replacement this summer and recovered remarkably quickly. But she's very conscientious about getting regular, moderate exercise, including tennis and weight lifting. She was doing incredibly well immediately after surgery and was discharged from rehab much sooner than scheduled.

At the other end of the spectrum, my mom and granddad were very poor patients. They didn't get any pre-surgery exercise, other than walking as little as possible. And my granddad refused to cooperate with post-surgical rehab. His knee never healed properly and often popped out of joint. The connection tissues were too atrophied. He was a big guy and I just about blew out my back lifting him over his last couple of years when he'd fall and couldn't get up again because that knee never healed properly.

My mom's connective tissues weren't bad, but she does have both osteo and rheumatoid arthritis, which she tends to wield as an excuse for avoiding any exercise, at all. Ever. Her only exercise is to walk to the mailbox and back a few times a week, a round trip of maybe 400 yards. And she was a bear regarding physical therapy. I stayed with her 24/7 at home to ensure she did the exercises, which included the auto-knee-flexing doodad. She doesn't do pain, at all, or even mild discomfort, without melodrama. But I'd seen her go through this when I was a kid and her first knee surgery in her 20s never healed properly. By the time of her second knee surgery I'd already been caregiver for two older relatives and had worked in nursing for several years. So I just shrugged off her complaints and howls of protest. Her second knee surgery did much better. While her balance is poor her leg strength is good in the later knee replacement leg. Her first leg never got any better and she can't lift herself from the floor or tub without help.

So by being active you're already way ahead of the game compared with lazy folks who won't exercise before surgery or won't cooperate with physical therapy afterward.

I refuse to let myself get into such poor shape, so I bicycle, walk and stretch no matter how much it hurts. But I no longer jog or do any impact exercises. I have the same predisposition toward arthritis, and have a permanent C2 neck injury, so I'm trying to conserve and exercise.

I take a couple of 200 mg ibuprofen most days for pain, or sometimes magnesium salicylate (Doan's pills and generics) for back and neck spasms. Occasionally I'll take one aspirin before exercising, or at bedtime. Usually that's good enough. I soak in a hot bath with Epsom salts after most longer rides. Usually after a 10 mile or longer ride I need the hot soak for back and neck spasms. Seems to help a bit with the knee and hip pains too.
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Old 08-28-16, 07:13 AM
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Thanks for all of the good advice. Of course ... I mostly wanna hear what I wanna hear. I'm basically gonna play it by ear for a while. If I can run a little fine, if not I guess I'll deal. There are a few aqua bike events in my region as well.

However - this is the part when you all get to say "Dumbass" - it isn't all quite as cut and dried as medical experts originally thought. There is a body of literature out there that says people in good overall shape can do moderate impact running if they are careful. There is a body of literature that shows running places too much stress on the joints - and most of those cite a study done in 1999 and published in 2000 - implant technology has upgraded a lot in 16 years.

We'll just have to see what happens.

I know, I know ... Dumbass
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Old 08-28-16, 07:35 AM
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I serve on a board with a number of doctors. The quite consistent recommendation from them is generally:

1) Wait as long as possible before surgery. There are risks to the surgery and while most turn out very well not all do. The prosthesis and bone connection don't last forever and a second surgery isn't always possible. Synvast works well for some people to prolong time before surgery. Personally I prefer Naproxen over Meloxicam for my knees but I think some people have GI problems from Naproxen. I'm currently doing Naproxen daily for a week and then taking a week off (I really dislike using any meds).

2) Avoid high impact sports like running, football, racquetball, etc.

3) Stay in good health. An hour per day of moderate physical activity and healthy diet. This both for immediate term and more importantly to aid in a good outcome from surgery and a faster and less painful recovery.

Every person is different though. My brother had a knee replacement in 1972 that served him 31 years and the second is still doing well. He's 72 and plays tennis once or twice every week (and has most of his life).

I hope whatever you do turns out well for you.

Last edited by CrankyOne; 08-28-16 at 07:42 AM.
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Old 08-28-16, 09:11 AM
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If you're headed for a TKA anyway, NSAIDs are at best a palliative treatment and long term can cause other issues (e.g., kidney damage)...
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Old 08-28-16, 09:56 AM
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I've gone through this... being young (for a TKR), my ortho did not want to do it. Basically, you can figure 10-15 years of use out of a replacement and you have enough bone for about 2 replacements. We got around it by doing a partial knee replacement to takeout the worse side (inside). When the outside of the knee gets bad enough, we go to the first TKR... this has bought me a number of years. Its been 4 years since my surgery and it still feels very, very good (not 100%... some limited bending still). Every now and then I see people running and I wish I could run again, but I'm in this for the long haul, so I resist. I do however put a good amount of mileage on a bike, pain free.

You could look at a partial and see if its a viable option....
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Old 08-28-16, 12:09 PM
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Just my personal story here: 54 yo, runner until my knees gave out. Bone-on-bone, chewing Ibuprofen like candy and finally unable to drag myself into the fire engine when I had the first one replaced at 50. Second replacement - required after an accident on a fire scene and a collapsing knee post-scope- is a year old now. Youngest one in rehab by 20 years, although they tell me they're starting to see a larger wave of 50+ who have been athletic all their lives, now coming in for TKR on worn-out knees.

Surgery is hard; rehab is much harder, but the 3+ yo knee is 100% and the newer knee will get there. I was back to full duty as a firefighter in 90 days. I ride my HT with complete confidence and road cycling is all that much easier. No meds. None. Life expectancy of the prosthesis is 10-15 years on average; doc says in my case, as active as I am, might have to trim that down to 8-10 years before a revision is necessary (new plastic pad is inserted. Not as terrible a surgery as the TKR).

The down side is no more running. I can snow ski, ride, swim, MTB; Ortho says anything but running- the pounding ruins the joint. I hike, but I miss the trail running. But it's worth having my life back...

Get it done sooner than later: your life will thank you.
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Old 09-05-16, 09:45 PM
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I am nearly 6 years post left TKR. I was bone on bone and wearing grooves. I waited way to long to see an orthopede. My surgeon is well regarded locally, and had no issue at my age, then 47. His biggest suggestion of what I shouldn't do was snow skiing... Running, as long as I had no pain was allowed. I am the oddball, at 7 months I jumped off an ATV just to see how it felt... Felt fine. My suggestions beyond finding a surgeon. Work to strengthen the quad muscles, do a lot of standing from knees on the ground, that will be important later. STRETCH the other leg too. I spent some time after surgery recovering from a MCL injury to the other leg. So work them together. DO all your post surgery therapy. Even the work they give you to do at home. I have excellent Range of Motion. Nearly 6 years after replacement. 146* and the knee is designed for 150*. Bottom line, is, the knee no longer holds me back. Plenty of other things have... But not the knee...
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