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Old 07-15-17, 09:26 PM   #1
TCR Rider
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Riding after a Knee Replacement

I think my lucks just about run out and I'm looking at the prospect of needing a knee replacement. I've had a gamy knee for quite a few years but I've been able to manage it to the point where it hasn't affected my riding. In the past two weeks things have taken a big turn for the worst. I've tried everything I can think of to quiet it down including massage, working trigger points with a foam roller and manually. I've been taking anti-inflammatories and icing it without much improvement. In the past I've had prolotherapy and PRP injections.
I went to the Ortho on Friday and had x-rays and a CT scan. Based on the x rays, still waiting for the results of the CT scan, he seems to think the only real fix is with a knee replacement. He's calling me on Monday after he looks at the scan. I've already got a hip replacement and that doesn't limit my cycling at all but the hip is a much more stable joint than the knee.
Has anyone had or know someone who's had a knee replacement who's an avid cyclist and if so how has it affected your cycling? Thanks for reading this.
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Old 07-16-17, 06:39 AM   #2
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Knees

Had both knees replaced about 4 years apart and after each one got right back on and got going, Dr. said ride away. So it's been 3 1/2 years since last one and i put on 80-100 miles a week.
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Old 07-16-17, 02:20 PM   #3
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Had both knees replaced about 4 years apart and after each one got right back on and got going, Dr. said ride away. So it's been 3 1/2 years since last one and i put on 80-100 miles a week.
That's good to hear. I plan to do just that.
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Old 07-16-17, 04:09 PM   #4
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One of my skiing friends was an avid amateur cyclist as a young man. Several years ago his knees gave up and had both of then replaced. He said the rehab was really painful but necessary. Today he rides a mountain bike and still skis.

I have a cranky knee that complains now and then. My treatment so far has been knee exercises and kinesiology tape, After a few days the troubled knee subsides and it is business as usual. https://www.protherapysupplies.com/S...ent=SpiderTech
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Old 07-16-17, 04:46 PM   #5
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I've tried Kinesio Tape but never had much success with getting it to stay on. I've been using a Vantelin Kowa knee brace which is based on the principle of kinesio tape. It give me some relief but it's not the solution I'm looking for. https://store.kowahealthcare.com/product/knee-support/

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Old 07-16-17, 05:23 PM   #6
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I nursed two arthritic knees from 2010 to 2015 using PT, cortisone shots, and hyaluronic acid injections (synvisc type stuff). In 2014 my right knee was affecting cycling substantially and I had it replaced in January 2015. I began cycling about 8 weeks after surgery, but my left knee, which had more severe arthritis but was less painful, began a steep decline and i decided to have replacement surgery in August of 2015 for my left knee. I rode about 6000 miles in 2016, the first half mostly on flats and the second half with a mix of hills and flats at a more normal pace.

While there is a lot of literature that says cycling is great after a TKR, if you look carefully at what they mean by "cycling" it is more like recreational bike riding, not lots of miles, climbs, and faster pace. I don't think there is as yet a definitive study about the effect of robust cycling on TKR, but there are lots of anecdotes out there that show that some folks have a great range of motion after surgery and others do not and are compromised in their cycling. I became convinced that if surgery resulted in a limited range of motion, there were still options for custom cranks that would allow me to cycle, just maybe not as aggressively as I would like. Fortunately, my range of motion is 135+ in my right knee and about 130 in my left. I do have some soft tissue issues in my left leg that keep recurring, but otherwise I can ride as normal, 3-5 times a week, 130-180 miles a week, and 6-10k climbing, depending on the week. Sometimes I cannot push as hard on climbs as I did before surgery, but that is just in my left leg and I think it has to do with muscle imbalance issues that I am working on. My right leg is just fine and if that had been my only surgery, then there would be no compromise at all.

I have friends who had less range of motion after surgery and other swelling and pain issues that have limited their rides and climbing, but they still ride. Predicting what will happen for any given surgery is a tough one, but finding a doc that understands your expectations for cycling and doing the physical therapy after surgery helps considerably.

Good luck with your surgery and I am sure you will do fine.
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Old 07-16-17, 08:01 PM   #7
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Thanks for the reply metalheart44. I know when a lot of references to cycling after TKR are made they are talking about riding a bike and not CYCLING. Great to hear that you are cycling at the level you are.
When, if, I have it done it will be at the Hospital for Special Surgery and plan on going to a rehab after to get a solid start on my recovery. The way I look at it is find the best surgeon you can and after he or she does their job it's the patient's job to make the most of the surgeon's work and kil the rehab.
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Old 07-20-17, 10:22 PM   #8
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Once you have the surgery, do all the therapy and then some. Seek a therapist before you have surgery. My knee was done in 2010. I don't ride as much as many of you. But I did run on it before breaking my back. Again. DO THE THERAPY. I have 146* Range of Motion, I kneel on the ground with it and play with my grandkids...
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Old 07-21-17, 02:56 PM   #9
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Once you have the surgery, do all the therapy and then some. Seek a therapist before you have surgery. My knee was done in 2010. I don't ride as much as many of you. But I did run on it before breaking my back. Again. DO THE THERAPY. I have 146* Range of Motion, I kneel on the ground with it and play with my grandkids...
When it comes to doing the therapy you're preaching to the choir. I fully intend to totally throw myself into my rehab. I'm seeing the Doc on Tuesday to set up the surgery. In the meantime I'm still riding and exercising. Taking anti inflammatories and icing to get me through. It's walking and stairs that are killing me so I just keep riding. The way I see it is the more fitness you have going into the surgery the faster you should recover.

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Old 07-22-17, 01:00 PM   #10
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When it comes to doing the therapy you're preaching to the choir. I fully intend to totally throw myself into my rehab. I'm seeing the Doc on Tuesday to set up the surgery. In the meantime I'm still riding and exercising. Taking anti inflammatories and icing to get my through. It's walking and stairs that are killing me so I just keep riding. The way I see it is the more fitness you have going into the surgery the faster you should recover.
That's the way to do it. There is a lot of truth to being in the best shape before surgery. But the body will tell you exactly how long it will take regardless...
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Old 09-13-17, 10:41 AM   #11
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I just had a total replacement on my right knee Aug 21, and back at work 3 weeks to the day later (ran out of sick/vacation time).
The therapist had me on my trainer in the third home session. Walking and stretching is leaving me sore and still pretty stiff but better than I was before. I'm shooting for next spring for my bike camping trip so fall/winter will be my 'reconditioning' time.
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Old 09-13-17, 11:26 AM   #12
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I had my right knee replaced last Thursday, 9/7 and came home Sunday 9/10. I really wanted to go to an inpatient rehab but for whatever reason I was deemed not qualified and sent home.
At this point I'm getting intensive at home PT which is five times a week for two weeks followed by outpatient rehab. I have quite a bit of swelling, operated knee measures 46 cm as opposed to 40 cm for the good knee. Pain is significant but manageable with meds. At first this was an issue until I realized they cut the dosage from 15 mg of oxy every 3 hours to 5 mg every 4 hours at home. That was just not working. I'm no fan of opiates but managing post op pain is what they are designed for and if the pain is too great I can't do the exercises properly. I plan to talk this over with my surgeon when I see him on Monday.
Took my first walk outside this morning and am about to go out for another short walk with the wife.
Interesting that you were on the bike after 3 sessions. With that in mind I'm going to show my therapist my indoor bike setup tomorrow even though I know my ROM is not ready for a pedal stroke yet. I did however get flexion to a painful 95 deg today so I'm stoked about that.
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Old 09-14-17, 03:04 PM   #13
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I'll add my 2 cents about using a trainer for rehab work. My in-home therapist came 2x week for about 4 weeks before I went to outpatient rehab. About the second week I asked about using the bike on a trainer (Wahoo Kickr) and she was completely supportive and we did the regular routine of rehab work then I got on the bike. I had raised the saddle to make it easier for the range of motion I had at the time and at first I just rocked back and forth with no intention or ability to do a full revolution. But, doing the back and forth rocking seemed to help and it gave me a focus mentally: I was back on the bike. It took some time to do a full revolution and the first one came unexpectedly: I kept rocking and rocking and then on day on one forward motion momentum just carried me over. It was a bit painful, but worth every bit of it.

The limiting factor for making progress in doing a full revolution was swelling. Ice and compression helped with that as well as doing enough PT to make progress but not so much as to cause more swelling. The first few weeks, as you very well know by now, are challenging because it hurts, it is swollen, sleeping is difficult, you wonder if everything is going to be ok, and progress can be slow and full of setbacks. But, progress will happen and your flexion and extension will improve and being on the bike, even just for rocking is useful work.

Keep up the good work!
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Old 09-14-17, 04:01 PM   #14
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............. I got on the bike. I had raised the saddle to make it easier for the range of motion I had at the time and at first I just rocked back and forth with no intention or ability to do a full revolution. But, doing the back and forth rocking seemed to help and it gave me a focus mentally: I was back on the bike. It took some time to do a full revolution and the first one came unexpectedly: I kept rocking and rocking and then on day on one forward motion momentum just carried me over. It was a bit painful, but worth every bit of it.

The limiting factor for making progress in doing a full revolution was swelling. Ice and compression helped with that as well as doing enough PT to make progress but not so much as to cause more swelling. The first few weeks, as you very well know by now, are challenging because it hurts, it is swollen, sleeping is difficult, you wonder if everything is going to be ok, and progress can be slow and full of setbacks. But, progress will happen and your flexion and extension will improve and being on the bike, even just for rocking is useful work.

Keep up the good work!
I showed my therapist my set up today on the Neo and he pointed out and I just knew that I wasn't ready for it yet but then again today is one week since the surgery so that's to be expected I suppose. Question - when you got on the bike did you clip in from the start?

Thank's for mentioning what the first few weeks were like for you since that is my life at the moment The swelling is really significant from the foot to the upper thigh. Tomorrow he wants me to leave the wrist crutches home and go with the cane. I realized that I was making a dumb mistake. He wants me to do my exercises three times a day and for some reason I heard three sets of each exercise three timed a day duh. And I'm worrying about swelling.

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Old 09-14-17, 04:41 PM   #15
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TCR -- I did not clip in for a long time, I just used tennis shoes because it did not feel right to clip in. My therapist was encouraging me to get on the bike as soon as it felt comfortable, but you do need to have just enough range of motion and if the rocking causes any swelling, then it is too early. One thing I learned from my experience and from talking with a number of folks who have had this surgery is that no two knees are alike and your experience is going to be driven by your own post-surgical condition and your particular biological processes. With my second knee I was impatient, well my wife says I am impatient period, but I pushed it too soon and had extra swelling that caused several setbacks, i.e. loss of flexion. Patience now pays off later with a quicker recovery is my experience.

I kept the circulating ice machine -- I used a Breg brand machine
and kept it on most of the time when I was not up. Elevation also helped, so I was often on the couch with the Breg machine and my leg elevated and that helped to control the swelling, but early on swelling is a ***** to deal with because of the trauma from surgery and PT. It will get better but it will not be fun.
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Old 09-14-17, 07:43 PM   #16
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There's a big difference between passive and active ROM (range of motion). What I mean by 'passive' is you warm up, do all the preparatory workouts, get massaged and bent by the PT and then do what you can by sitting on a chair or ball with your foot on the ground and scoot forward as far as you can go (mumbling and cursing at the pain) with the PT measuring your performance and assistants egging you on...

I was at 110° yesterday (into 7th week post op surgery). But, that is not 'active' ROM.

By comparison, what I mean by 'active' would be, e.g., laying on my back and bending my leg by using my leg muscles to slide my heel as far back towards my hips as humanly possible– that was 101° yesterday; and, I can tell you, that's only almost good enough to ride with a mid-foot riding position and turn the pedals over on my upright with its 165 mm cranks.

So, be prepared: it is 'gonna take a lot of work. I am shooting for 120° of 'passive' ROM (which is a little bit optimistic in my situation) and it sometimes seems impossible on a daily basis but little by little (as the swelling goes down), it may happen sometime in the next 2-3 weeks– who knows?
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Old 09-15-17, 09:10 AM   #17
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There's a big difference between passive and active ROM (range of motion). What I mean by 'passive' is you warm up, do all the preparatory workouts, get massaged and bent by the PT and then do what you can by sitting on a chair or ball with your foot on the ground and scoot forward as far as you can go (mumbling and cursing at the pain) with the PT measuring your performance and assistants egging you on...

I was at 110° yesterday (into 7th week post op surgery). But, that is not 'active' ROM.

By comparison, what I mean by 'active' would be, e.g., laying on my back and bending my leg by using my leg muscles to slide my heel as far back towards my hips as humanly possible– that was 101° yesterday; and, I can tell you, that's only almost good enough to ride with a mid-foot riding position and turn the pedals over on my upright with its 165 mm cranks.

So, be prepared: it is 'gonna take a lot of work. I am shooting for 120° of 'passive' ROM (which is a little bit optimistic in my situation) and it sometimes seems impossible on a daily basis but little by little (as the swelling goes down), it may happen sometime in the next 2-3 weeks– who knows?




Hows the swelling in leg at 7 weeks post op? Am I understanding you correctly that you are not back on the bike yet? Today my therapist graduated me to walking with a cane which went well although it was only for 2 blocks. He got me to 100 degs of flexion so he's happy with my progress and I suppose I am as well at 8 days post op but the pain is a beotch as is the swelling especially at night.
I have a Tanita Iron Man scale that gives a measurement of body water. Prior to the surgery I generally came in around 68% and post op I've been at 84% body water which I'm attributing to the fluid causing the swelling. It amounts to about 11 lbs of body weight. I know I haven't been riding but I have adjusted my calories to take that into account. No matter what I know I haven't eaten enough to put on 11 lbs in a week. That's a lot of fluid
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Old 09-15-17, 11:11 AM   #18
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Hows the swelling in leg at 7 weeks post op? Am I understanding you correctly that you are not back on the bike yet? ...

:
You could lose weight and still have a swollen knee– that's my situation. Based on my experience and from what I've read, I am thinking that an average cyclist pedaling with ~170mm cranks on an elevated seat (leg nearly straight on the down stroke) and peddling on the ball of the foot will require ~112-114° of what I'm thinking is an 'active' not 'passive' ROM. If so, with 165mm cranks I might be getting by with 110° or less of active ROM which looks to me like achieving a passive RPM of nearly 120°. In other words, I think I need another ~9-10° to avoid having to think about playing around with shorter cranks (e.g., 145s) and foot positon.

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Old 09-18-17, 09:28 PM   #19
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We sometimes ride with another tandem team who are just a bit older than us. The captain has had bilateral TKR's. Stoker has had a hip replaced. Don't know about degrees of ROM but they move along pretty well.
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Old 09-19-17, 03:44 PM   #20
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Today is 12 days since my TKR. While the swelling is still significant it's starting to come down a bit. The PT got my flexion to a painful 110 deg. I got on the trainer today just to get an idea of how far away I was from being able to get the knee over the top of the pedal. Lots more work to do but as I was sitting rocking the cranks back and forth I actually got a full revolution backpedaling - shocked myself.

The biggest change I have seen in since my last surgery is the difference in rehabilitation and pain management. Not only couldn't I get into an inpatient rehab as I had in the past but sent home after four days but the dosage of my pain meds was cut by over to 60%. So while my pain was well managed in the hospital when I got home I had to endure a level of pain that was unnecessarily brutal. Once I realized the difference in the dosage I evened it out and could think again. I know everyone is rightfully concerned with opiate addiction but the intended purpose of them is to manage post operative pain. I'm not looking to sell them down on the corner I just want to get past the early acute pain so I can do my exercises and sleep.
I see the surgeon tomorrow for the first follow up and I'm waiting to hear what he has to say about it. Aside from that I think early progress has been good.

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Old 09-20-17, 04:45 PM   #21
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I hope it goes well. I agree on the opioids. Why does anyone think one size fit all?
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Old 09-21-17, 02:02 PM   #22
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Today is two weeks since the surgery and I had a follow up yesterday with the doc. He's happy with the way things are looking. Got to see my x ray with the implant and the best part is the leg is straight again. The knee had been collapsing in due to the lack of cartilage.
I have my last day of in home PT tomorrow and he's gotten my flexion up to 111 deg. which I'm happy with. The one thing that I'm almost giddy about is that I was on the trainer just rocking the leg back and forth and I started to get all the way around the pedal stroke while backpedaling. I went back to rocking and lo and behold I got over the top and was able to do some honest to God pedaling. I never expected to be doing that at two weeks. I am psyched! Now it's time for some ice.
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Old 09-21-17, 02:09 PM   #23
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Good news and great progress. Keep it up!
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Old 09-21-17, 02:59 PM   #24
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Thanks metalheart. It's a start.
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Old 09-24-17, 11:36 PM   #25
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I have had both knees rebuilt 3 and 4 years ago ( right and left respectively). I had my wife pushing me from the first day home after surgery ( 28 hours after I got over anaesthesia) She had picked up my new bike Speclized Roubaix pro. and had it sitting in the living room. My Ortho Dr. is a tri guy and he wanted me to be riding soonest. I sat on the bike with flat pedals at 2 weeks. The hard part for me was getting my leg around the bike just to get on the saddle. Long story short... I rode my first century post surgery, at 4 months. 10 1/2 hours and only 1200 feet of climbing, but a full 102 miles. Dr. said I will never run again unless a bear is chasing me. That's OK with me. This summer we did a hike across Scotland, and had only muscle pain. I did have to go for a new fitting on the bike as my legs are now the same length and about 1cm. longer than before. It is all good. Ride On.
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