TKR 2nd TKR

[Eddy]

Hi all
I'm 3 weeks after my op. Feeling good and looking towards the future. My question is directed to active cyclists: are you back to a reasonable level of onthe bike fitness? Can you complete long rides without pain? Can you climb big hills...I want to ride some time trials again and I have an ambition to try some TDF climbs at some point.
Grateful for your feedback

 

[Celle]

Hello @Eddy - and

Please will you tell us the full date of your knee replacement, whether you had a total or a partial replacement, and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately in the future.
Thank you.

Yes, there's every chance that you will get back to doing all you want on your cycle, but don't rush things. Let your knee take all the time it needs to recover. This is a long recovery, more of a marathon than a sprint, so you need to pace yourself.

I'm going to ask @Roy Gardiner to come and talk to you. He's a keen cyclist, back to doing a lot of challenging cycling.

Here are our recovery guidelines, to help with your recovery:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. Try to follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Homemadesalsa]

Hey Eddy- I'm a mountain biker, not so much a road bike, but I'm 59 and 5.5 months out from my R TKR (april 6). I've been on a gravel bike since mid-June, and mountain bike july 4th or so. I had a big breakthrough at 5 months where I felt like I could finally hammer both up and downhill. I quit PT at 3 months and have been working with my coach, who used to work in a PT practice but is now workingwith individual clients, mostly via the TrueCoach app. Mobility exercises have been crucial, and I'm also doing some upper body weight work, but mostly using bodyweight on a mat, probably 3 days a week.

Also getting massage with some scar tissue work about every other week. Initially it was frustrating just barely spinning along, but a mixture of persistence, patience, and ice/elevation as per the guidelines here have done the trick. Let yourself rest adequately, hydrate, and do some gentle stretching when you're tired, don't push to be where you were before.

If you want it, it will happen, but never as fast as you hope for.

 

[Homemadesalsa]

Haha I thought the above pic was me but it's my buddy. Here I am below, having a great time, 4 months out.

 

[Eddy]

This is great....thanks all. I am very happy to get such thorough and positive messages. My biggest concern in having the surgery (TKR to right knee on 2 sept 2020.) was being unable to be active again. Sport in general and cycling specifically is very important to my morale and well being.
I'm able to walk unaided but I'm being conservative until I have my first PT next week. Covid is making face to face PT difficult in the UK so my PT is going to be limited.
I'm concentrating on the exercises given to me by the hospital. But being used to training and working hard I'm tempted to push things. However I see from advice on this forum that you can't rush this recovery.

Biggest issue I have at present is discomfort when trying to sleep. I can't sleep on my back and sleeping on either side results in a painful knee.

I look forward to any further advice and information. If and when I ride my bike again I will post a photo.

Many thanks

Eddy (i was going to say Eddy Merckx but I was never that good)

 

[Eddy]

Great photo! Thanks for your story, it's very encouraging to see you are riding hard after 5 months..well done. Massaging the scar is interesting. Could you do that yourself? I had my staples removed 2 days ago....the wound is gruesome and feels weird to touch.
I sat on my indoor trainer yesterday and managed a very tight and uncomfortably pedal rotation. Its definitely too soon for me to be working hard on it. Maybe a few tentative minutes each day to get the ROM back.

Thanks again and best wishes

 

[Jaycey]

@Eddy the biggest piece of advice I can give you is do not push. You are not in training - you are recovering. Pushing only results in swelling and that is what causes pain.

And no need to massage your scar. Just let nature do its thing!

 

[Roy Gardiner]

Yes to it all. I ride with no problems from my knees whatsoever. I don't do big climbs (I didn't before either) but track and time trials, no bother.

Using a static bike to gain ROM is pretty simple:

• Set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

 

[Homemadesalsa]

Eddy my massage therapist isn't working on recent knee scar, but on other older "adhesions," such as in my ankle where an old sprain led to differential pull on the lateral meniscus, and ultimately to needing a TKR. Also for where the hamstring attaches, which permits the hamstring to contract and expand fully, which was an initial problem for me. Look up PPS, pain pattern solutions. It's cool work.

 

[Eddy]

Really appreciate these responses. Since posting I've looked at a lot of the advice available on the forum. I can see I need to take it easy and I am doing that. Tried my trainer again today, very gently, and realised my knee was too tight and stiff to achieve anything so I stopped. Walking is getting easier and my exercises are pretty much pain free. I did massage my scar gently with vaseline and it is a very strange feeling but it has helped with itching.

So pleased I found this forum to share experiences with sympathetic TKR friends

 

[Oregon mom]

Haha I thought the above pic was me but it's my buddy. Here I am below, having a great time, 4 months out.

This is so inspiring! I can't wait to cycle again.

 

[Oregon mom]

So pleased I found this forum to share experiences with sympathetic TKR friends

Amen. This forum has been truly instrumental for me. I can't even imagine where I would be emotionally, psychologically and physically were it not for the dearth of information and support here.

 

[Oregon mom]

Sport in general and cycling specifically is very important to my morale and well being.

Same here! I used to think that I wouldn't be happy unless I could run. And then it got harder and I had to cycle more. Then I couldn't run anymore. So I thought I couldn't be happy unless I was able to cycle.
I will cycle again, but never run. Giving up running was heartbreaking. I truly grieved that loss. And I was slowly being forced to give up walking. Thank God I never lost my ability to cycle. I could cycle all day long, big hills.. But I couldn't walk 20 steps!
All this to say that there are lots of ways to get sport, and humans can adapt. No doubt you will be cycling again, but know that if you find yourself unable to do something, that just means it's time to try something new.

 

[Mrs. Ciz]

Eddy my massage therapist isn't working on recent knee scar, but on other older "adhesions," such as in my ankle where an old sprain led to differential pull on the lateral meniscus, and ultimately to needing a TKR. Also for where the hamstring attaches, which permits the hamstring to contract and expand fully, which was an initial problem for me. Look up PPS, pain pattern solutions. It's cool work.

Can you tell me a little more about your hamstring issues and how you fixed them? I had bilateral TKR on July 6th. The left knee is healing really well. The right knee is hampered by hamstring issues. I’m getting pain behind that knee due to my super tight hamstring. My therapist gave me a bunch of stretches and exercises to do to help it, but at almost 11 weeks post op, it is still hurting me.

 

[Homemadesalsa]

My massage therapist uses an active release therapy technique, plus the PPS (pain pattern solutions) work I allude to above. I can't post a link but you can search active release therapy.

Plus ice and heat and stretching and rest and spinning on the bike. I bet the tens machine would help too.

 

[Eddy]

Hi all, I've read that icing is very important but not so much about heat.........what is the concensus regarding heat as well as icing to aid recovery . I have to say this is feeling really good after my walk, exercises and icing.....

 

[Bikeknit]

Eddy, I too bicycle and at 12 weeks post-op can say bicycling was my saving grace both before and after surgery. Once I started riding my bike at 7 weeks postop (suspect I could have started sooner but I was being cautious) everything went better - both physically and mentally. Before I took my bike outside I was using a trainer with the bike. Then started with a slow, no traffic, flat 3 miler. I'm now up to 13 miles with light hills but you sound like someone who rides more challenging stuff than me so I suspect you'll be doing a bit more than me at this point. Just remember your body is still healing. I sleep like a rock after these gentle bike rides!

 

[Eddy]

Hi bikeknit

Great to hear you were back on the bike at 7/8 weeks. Thats a target for me now. I doubt i will be any more adventurous..my knees were so shot i didnt do many miles. Plus every pedal stroke was painful so not much fun. I wondered if you used cyling shoes with cleats? I suppose there is some risk of hurting my new knee if my foot is is fixed in position wearing cycling shoes

 

[Celle]

..what is the concensus regarding heat as well as icing to aid recovery . I have to say this is feeling really good after my walk, exercises and icing.....

We usually advise that it's OK to use heat on muscles, but using it on your knee itself can increase swelling, which you want to avoid.
I can see how warmth at the back of your knee would feel comforting, but do make sure the bottle is only warm, not hot.

 

[Eddy]

Thanks ..appreciate this advice..I'm just using hot water from the tap so not too hot.