Anyone riding with knee replacement(s)?

[makoti]

A good friend is looking at getting a knee replacement, but is worried about how it would be riding afterwards. I came across a thread that had a couple of responses that didn't sound hopeful. All the descriptions of recovery on websites say "riding" is good for that, but I'm guessing they don't mean the same thing we do by "riding".
Anyone have a "long term review" of theirs? How has it impacted your riding? Are you able to ride at nearly the same level? She's 61 & still does 150 miles a week & week long tours. She was hoping to put it off a few more years, but the knee is still swollen from a tour that ended a month ago.

[Elefantino]

https://forums.thepaceline.net/showthread.php?t=61657&highlight=knee+replacement

Also, contact SoCalSteve. His bionic knee rips on his Pinarello.

[metalheart]

I had serial knee replacements in 2015, the first in January and the second in August. I am riding 5-6k a year post replacements and climb 200-300k. I have one issue with the second replacement, a sometimes troublesome Popiteus tendon that will slip over the hardware and become inflamed. It is an unusual outcome, but it mostly happens when I have been off the bike for a bit. Otherwise, my experience is that I can cycle just as well now as before surgery, only with less pain.

I know several other cyclists with knee replacement and most have had few issues. The one exception is a triathlete/cyclist whose knees were in pretty bad shape prior to surgery. This cyclists had a prolonged recovery and has not had a full return to cycling. She thinks it is related to the amount of damage prior to surgery. Physical therapist I have worked with post-surgery describe a minority of serious cyclists who have significant issues post-surgery, but it happens.

The literature about physical activity post-replacement identifies cycling as a preferred form of exercise, but close examination of this definition of "cycling" is very casual biking, not 150 miles a week and long tours. My surgeon, a fellow cyclist, commented that those of us who are riding higher and more intense miles post-replacement are a relatively new cohort and the literature is incomplete about the knee replacements and this type of cycling.

That's my two cents.

[zlin]

My father had both replaced a couple years back and now rides every day and tours on weekends with my mom. 150ish miles min would be my guess for them.

He lost around 75lbs between both replacements by getting and staying active again. Only thing I remember is him saying the recovery from the first one hurt so bad he was determined to find a way to drop weight before the second. I said ride a bike and they haven’t looked back.

I think your friend will be just fine and much happier after the replacements. Just one ex but a favorable outcome.

[mbrtool]

I had a knee replacement a year ago at the age of 71. Prior the surgery I rode 7K miles per year. After surgery it took a few months to get back to the usual weekly mileage. Last winter my knee was sore after a ride but was less sore as the winter dragged on. My surgeon said it would take 8 to 13 months before the knee would completely heal....he was right. Most important advice I can give...go to the most reputable hospital for the surgery...do the range of motion exercises daily. If your friend lives near Chicago, I'd check out Rush.

Ray

[Dave]

Your friend's doctor should have told him that cycling is a great thing to do after knee replacement. I've had both replaced and resumed cycling last year, after 8 years off the bike. What you can't avoid is the effects of old age. At 66, I don't ride nearly as fast as I did at 56. I do still ride a lot of steep climbs, but I've geared down appropriately. I usually don't ride quite as long and may rest longer between hard rides.

I had one knee that took 3 weeks to get enough range of motion to turn over the pedals, while the other only took a week. That knee took 16 weeks to get the knee to fully straighten.

[kramnnim]

I just got back from a ride with a retired friend who had a knee replacement in 2012. He has been averaging 100 miles per day for every day in July. His normal schedule is four 100 miles rides per week. Usually 18-20mph, 3k-5k of elevation gain per 100 miles. The joint is a Striker Triathlon 3.

[mnoble485]

I had both knees done the same day (crazy right?) when I was 62. That was 8 years ago and for me it’s not the knees that slow me down. My Ortho doesn’t usually do both at the same time but he agreed partly because I was a cyclist and in decent shape. Post surgery physical therapy and getting back range of motion were the keys for me.

Mike

[CanyonDweller]

I had bilateral knee replacement in 2008 when I was 55. I rode a bicycle some at that time to rehab. I had no problems during rehab and I was back working(farmer) by the end of the second week. No riding until last year after retiring. My knees don’t bother me one bit and I ride from 50-120 miles a week. I had a really easy recovery, but others I know have struggled in recovery. What I’ve learned is PT,PT,PT and then some more PT. Those who do the therapy do better, and my knees were worn out, not injured, previous injury complicates recovery.

[2LeftCleats]

Had a knee done 7 mos. ago and worked really hard at the rehab. Zwift was helpful especially in the colder mos. Have some tendinitis sometimes but I’m back to full cycling and no problem with hills. I bought a larger cassette, and my goal is not to install it. I was slowed by needing a hip replacement on the same side about 3 mos ago, but I’m back to full activity, though strength isn’t quite equal yet. As others said, I’ve been told to expect full recovery in about a year.

[buddybikes]

Key is to go to a good hospital with surgeons who will look at the whole, my sister went in with knee issues (from other surgeons) and NE Baptist Hospital found her hip mucked, and that needed attention first.

think there is a lifespan for these appliances, great people are pushing themselves, but could come back to haunt them later, that needs solid communication with PT and surgeon.

[2metalhips]

I will echo the above. The most important factor is the surgeon and hospital/center. Surgeons are not all created equal, pick the wrong one and it could be a world of hurt. You want a surgeon that has done hundreds preferably thousands of TKR's and has a solid track record of positive long term results in the high 95-99% range of success. The hospital or facility should have an extremely low infection rate, very important. I had bilateral hip surgery 10 years ago in my mid 50's. Complete success.

[SoCalSteve]

https://forums.thepaceline.net/showthread.php?t=61657&highlight=knee+replacement

Also, contact SoCalSteve. His bionic knee rips on his Pinarello.

Not quite sure it “rips”, but my knee does feel better after I ride. If I take a couple days off the bike, it gets achy.

The knee replacement was painful, but the physical therapy was even worse. I now have total range of motion, but it took some painful time to get there. And yes, cycling was recommended. Actually, my ortho surgeon sold me his trainer.

[makoti]

Not quite sure it “rips”, but my knee does feel better after I ride. If I take a couple days off the bike, it gets achy.

The knee replacement was painful, but the physical therapy was even worse. I now have total range of motion, but it took some painful time to get there. And yes, cycling was recommended. Actually, my ortho surgeon sold me his trainer.

Steve, how far past the surgery are you?

And thanks to all for the responses. She isn't a member, so I gave her the link to this thread so she can read the responses. Encouraging stuff, for the most part. She's going to be one of those who does what the PT tells her (used to be a massage therapist, so she knows how important that is) so I'm hopeful.
As a follow up, have any of you discussed wearing the new joint out? Any sort of a timeline laid out? Something like 15 years with normal use, 12 with heavy use? She is worried about having to get a second because the first wears out quickly.

[metalheart]

Steve, how far past the surgery are you?

And thanks to all for the responses. She isn't a member, so I gave her the link to this thread so she can read the responses. Encouraging stuff, for the most part. She's going to be one of those who does what the PT tells her (used to be a massage therapist, so she knows how important that is) so I'm hopeful.
As a follow up, have any of you discussed wearing the new joint out? Any sort of a timeline laid out? Something like 15 years with normal use, 12 with heavy use? She is worried about having to get a second because the first wears out quickly.

To get an answer to the wear question will take some digging in the academic literature. My surgeon is not too concerned I will wear out the hardware --- it is usually the polyethylene part of the device that wears -- but he and another ortho surgeon I discussed this with both agree "we just don't know." At one point I tried to find information in the literature about the loads placed on the knee during more intensive cycling and how that might affect prothesis wear, but I didn't find much.

There is at least some recent information that suggests that polyethylene wear is less of a concern that it was thought to be in the past, although there is also other concern about the metal parts wearing long term (+15 years). Note the following from the first abstract below:

Resumption of daily living activities is a basic expectation for patients provided with total knee replacements. However, there is a lack of knowledge regarding the impact of different activities on the wear performance. In this study the wear performance under application of different daily activities has been analyzed. In vivo load data for walking, walking downstairs/upstairs, sitting down/standing up, and cycling (50 W & 120 W) has been standardized for wear testing. Wear testing of each activity was carried out on a knee wear simulator. ...... The largest wear particles were observed for cycling. Walking based on in vivo data has been shown to be the most wear-relevant activity. Highly demanding activities (stair climbing) produced considerably less wear. Taking into account the expected number of loads, low-impact activities like cycling may have a greater impact on articular wear than highly demanding activities.

The modeling done in this paper also uses some assumptions that do not match what might be called moderate cycling among Paceliners:

Cycling with 50 W or 120 W corresponds to a moderate speed of approximately 15 km/h and 20 km/h, respectively. We assumed a moderate cycling activity of 2500 km/year (average 6.8 km/day). Splitting this into two separate measurements of 1250 km cycling with 15 km/h and 20 km/h would result in 0.23x106 cycles at 120 W and 0.30x106 cycles at 50 W.

When I considered the wear issue just before surgery I decided that there were plenty of other issues that might affect cycling post surgery and given the lack any definitive answers to how much and how intense, more frequent monitoring of the hardware is the best approach for me and I am just going to keep cycling as much and as hard as I want.

Your friend might want to spend some time with the literature and her surgeon -- preferably one who is sports aware -- and consider the wear issues as part of her cost/benefit assessment of TKR and cycling.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123155

https://journals.lww.com/jbjsjournal/Abstract/2015/05060/Current_Failure_Mechanisms_After_Knee_Arthroplasty .3.aspx

https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0039-1677816

https://link.springer.com/article/10.1007/s40279-015-0421-9

https://www.sciencedirect.com/science/article/pii/S0883540316301413

[palincss]

A good friend is looking at getting a knee replacement, but is worried about how it would be riding afterwards. I came across a thread that had a couple of responses that didn't sound hopeful. All the descriptions of recovery on websites say "riding" is good for that, but I'm guessing they don't mean the same thing we do by "riding".
Anyone have a "long term review" of theirs? How has it impacted your riding? Are you able to ride at nearly the same level? She's 61 & still does 150 miles a week & week long tours. She was hoping to put it off a few more years, but the knee is still swollen from a tour that ended a month ago.

I've got a partial replacement. Impact my riding? Better than at any time in the 50 years prior to the surgery (that's how long I lived with the injured knee). You'd never know it's there. It's just your knee, only without the pain. It helps if it's done by the best, as mine was. Around Metro DC, that's Anderson Orthopaedic & Dr Fricka. https://andersonclinic.com/directory/people/show/kevin-b-fricka/

[Plum Hill]

I guess I’m the anomaly here.
It took three years after the first TKR before I could ride almost pain free.
In two days it’ll be one year since the second. I’ve had swelling, fluid buildup, and abnormal pain since. Riding and exercising causes more swelling and pain. Second and third opinions have found nothing; both said mechanical aspect of replacements is good. I can bend both knees past 130 degrees. Very good PT can’t figure it out. He claims I was doing things for him that he’s never had a TKR recipient do.
Original surgeon called me a “slow healer”. Other docs said that could be a viable diagnosis.
Perhaps 35 years of trashing my knees in construction is working against me.
While not a competitive rider (realized my competitiveness wasn’t great chasing Craig Virgin around in high school), I was a better than average climber. Rides now are essentially shady rides on a trail system of around 40 miles in length and I stay out of the river valley hills.
On the plus side, a fellow rider had his knee done before my first. He had it redone later. He’s never been back on the bike.
I always say when it comes to any kind of surgery ‘your miles may vary’.