gif4445

Observations, with questions for you wise people out there. A short time ago, two people close to me have had knee replacement surgery. Now both are bothered more by back, or sciatic pain, than by knee pain. I am wondering if this is a result of waiting too long to have the knee replacement and other areas of the body are compromised by compensating for the bad knee? I have been told in many cases, the strategy is to delay the replacement until an age when the artificial joint will last for the rest of the recipients life. Trying to be proactive on this, as the last year has brought some various knee pains my way during training and touring. ( https://www.crazyguyonabike.com/doc/..._id=11208&v=G3 ) Sure would appreciate your input!!

DnvrFox

Technology on knee replacements is changing rapidly. My wife has had two, with no related back pain.

If I were younger I would go ahead for the best life possible, gambling that in 15 years (life of a knee replacement today????) or so, the technology would be so more advanced that fixing it again would be no problem. Also, there are new alternatives to total knee replacement. And, who knows when one is going to die? Enjoy life to the fullest when you can, IMHO.

I have (had) atrial fibrillation, for which the current ultimate cure is a heart ablation - burning some of the tissue in the heart. I had it fixed within a year of 24/7 occurrence. Others I know are waiting and waiting and waiting for something better. In the meantime I have enjoyed almost 7 years of normal sinus rhythm. They are still waiting.

I also have Trigeminal Neuralgia (extreme pain), which is best cured by a near-brain surgery. I made the same decision regarding the TN as the AFib. I now enjoy almost a pain-free life -with the help of some minor meds - while others are still waiting for something better. If, at 73, I die today, I will have lived the fullest life possible.

GeorgeBMac

My first thought when I read your post was that maybe they developed the back pain BECAUSE they had the knee replacement. I have not had one -- but my understanding is that the surgery may be major surgery but it is still fairly routine. The REAL work comes AFTER the knee replacement with diligent, prolonged and painful therapy as well as ongoing exercise.
... is it possible that the surgery was a success but the therapy was less so -- which would leave them with a shuffle and a limp that could put undo strain and pressure on the back?

BTW, contrary to popular belief, many/most back pains are NOT due to nerves and bones but to nerves and muscles because the muscles are irritated, inflamed and tend to go into spasms...

When I was having back & neck pain I asked my physician for a referral to an orthopedist. He replied: "Stay away from those guys -- all they know how to do is cut you. Here's the name of my chiropractor". I went to his chiropractor and sure enough they took away the pain. I continued with them for several years until I realized I could do as well or better on my own with daily stretching and strengthening. Since then I have not needed either a chiropractor or an orthopedist -- as long as I remember to do my daily stretching and strengthening exercises. But, I don't have to work very hard at remembering: My back is happy to remind me whenever I forget for more than a few days.

Steve B.

My wife developed sciatica after her knee replacement.

As note, she is very heavy and does not exercise, so lack of fitness and weight are major contributors to both her knee and back issues.

As I understand it and having witnessed the progression, the recovery from the knee surgery was lengthy and more difficult then it might have been for a more fit and/or less heavy person and the result of the pain and recovery from the surgery caused an imbalance in walking as she favored the new knee. The gait issues can result in strains to the back and leg muscles with sciatica resulting. She probably had disc issues prior (as is common as we age), but it developed faster and more severely as a result.

The pain in the knee was certainly more severe then the sciatica, so the knee replacement was mandatory in her case, but with attending complications.

essiemyra

I had my left knee replaced back in aug of 2008 with great results. At the time I was having pain in both knees so much so my walking was severly limited. After the left knee was replaced i was able to walk much better with no pain in either knee. I am having the right knee replaced in Feb of 2013. The doctor told me both times that I would make the decision on when to have the knee surgery. And what he meant is when I could no longer live with the knee and how it affected my life. So at this point in time I can no longer walk and bend the right knee without pain so I made the decision to have it done. I never experienced back or sciatic pain due to the knee replacement. I also waited from the time I was 35(to young a different doc said) till I was 49 when I had the left knee replaced. I would have done it earlier as it gave me my life back. Good luck in whatever you decide.

Nashzel

I had both knees replaced on 7-23-12. So far, no sciatic pain and have worked up to rides of up to 35 miles. Wouldn't have it any other way. If yu need it, do it. But realize you will get out of it what you put in on the therapy. Incidentally, had the cardiac catheter ablation for A-fib back in January of 2011,also a resounding success. If you are thinking of either, don't hesitate, but get specialists that do tons of them, nothing substitutes for successful repetition.

Monoborracho

I had my right knee replaced in July, 2011. That was my seventh surgery on that knee, four by arthro, two by incision back in the day, and an ACL replacement in 2000. This year I did five triathlons, including two Olympic distance. But I walk the run part. I ride several times a week, and my wife and I have a brand new tandem (our second one) that we ride once or twice a week.

My farthest walking/race distance to date has been 8 miles in a bit under two hours. I'm hoping to get a half-marathon this year.

Here's a big key to knee replacement that most therapists won't tell you........if, after surgery, you can't get the leg to zero degree extension, or even better is a few degrees of hyperextension........YOU CAN NEVER WALK WITHOUT A LIMP. You have to be able to get that leg fully straight or else it will always be shorter than the other when you walk. If you walk with a limp, the rest of the muscular and skeletal system starts trying to compensate. That is the cause of the resultant back and sciatic pain for most folks.

Ever see someone who had a knee replaced and when they walk it looks like they have a spring in their shoe?

As to the timing...the time to do it is when the bad knee keeps you from living a normal life, or else you can't stand the pain.

Before surgery, take a few months with a trainer and get the weight down and the leg as strong as possible. You can generally do squats with a bad knee once you get the strength up. How is this possible? When the knee is bent, as in squats, generally the "good part" of the knee joint around the edges of the femur-to-fibula joint is doing the work rather than the core of the knee.

Here is the BEFORE, looking from the front. That's the right knee that's crooked, and you can see the ACL transplant screw.




Here are the after shots.

dbg

I've always found it interesting how problems in one area of the body start reverberating around to other areas. You limp to avoid pain in a leg and it creates extra load on the back, etc. I approach it as a fitness issue. I've had two facet rhizotomy procedures and immediately had problems elsewhere in the back until I slowly exercised it away. I attributed the problems to the fact that I could now move in ways I couldn't before and quickly irritated areas that had weakened from lack of exercise.

gif4445

In one replacement case, the back pain started a couple months or so post-surgery. In my mother-in-law's case, she had the sciatic pain well ahead of the surgery. Thinking that in her case, the surgery was put off for much too long of a time. Another lesson that should be learned: She was very faithful to her long-time doctor. Never doubted his diagnosis or decision-making. Definitely a big mistake IMO.

Denver Fox, I love your attitude! I get the feeling as the years count up, that there is a "box" that some in society and even within my own family, want to place me in. Not necessarily a coffin, but a way that you act and what you do when you get older and grey. Thankfully I have cycling and people like you to prove otherwise!

ModeratedUser150120149

One of my observations is that those who First take care of their physical fitness do the best with their surgery. The other is that attitude is very important. People who either are or become physically fit have already demonstrated their willingness to do what is necessary for rehab and to make the replacement last. It isn't a matter of doing it now, or doing it later. It is a matter of having the physical fitness and attitude to make it a success.

When to do the procedure depends on when the two keys are taken care of.

I know this doesn't directly answer the question. But, the result of getting ready for the procedure will produce the answers.

Lastly, find someone you trust who can be your advocate.

Nashzel

Monoborracho

The best thing about those knee shots is the space at the joint. That's what us BTKRs love to to see! Live strong, ride hard. Happy New Year!!!

Nightshade

Do these people that have the back/hip pain sit a lot?? If so tell'm to get outta the chair and start walking a bit.

Bluetail

Gotta jump in here, having had both a total knee replacement (October 2012) AND subsequent sciatica:

The TKR has been successful; the orthopedic surgeon surmises that the sciatica may have been due to his having corrected about 4 degrees of valgus (knock knee) and as a result, my hip, back & soft tissue needed to adjust and adapt, ergo, pressure on the sciatic nerve. It was extremely painful--more so than the knee pain--at about 6 weeks, but with a lot of PT and some gabapentin, it was completely gone by week 11.

I am slim and fit and was biking up until a few days before surgery; someone who would say, while the sciatic pain was most severe, 'get outta the chair and start walking a bit,' has obviously never had either a TKR or sciatic pain.

ModeratedUser150120149

+1

The body is a unit in which each part depends on several other parts. In today's age of extreme specialization that interrelationship is seldom, in my experience, fully explained to patients. Surprise and needing to deal with other issues after a structural surgical procedure is, I suspect, not an unusual thing.

Glad your fitness, Bluetail, set you up to deal with the situation and allow you to overcome.

Yumadons

Upon losing his job at the end of 2008, my husband took the opportunity to see a surgeon about his longstanding bilateral knee pain. The surgeon took knee x-rays, then looked at some CTs on file from Don's cancer bout. He told Don that he indeed needed new knees, but first, a new left hip. Don didn't even know the hip was bad and at surgery, they not only replaced the hip, but lengthened the leg by 1 & 1/2 inches. A year later, he had both knees replaced on the same day. Hip & both knees a success. Moral of the story: be sure they check your hips before surgicating your knees.