TKR Cycle again?

[Orange Blossom]

I am 44 years old, 21 days post op from a RTKR. I have posted 6500 miles this year on Strava. Unfortunately, this surgery has put a stop to that. I cannot turn the pedals over on a bike yet due to stiffness (leg just won’t bend). When will I be able to turn the pedals over and get back on the bike. Will I be able to cycle aggressively again?

 

[Orange Blossom]

Hello all. I am a new member of bonesmart. I feel very fortunate to have stumbled across this site and read the very informative experiences of my fellow TKR recipients. Here’s my story so far:
I am currently 21 days PO RTKR. 44 year old male. The pain has been much more than I had expected. I haven’t slept more than 2 hours at a time in those 21 days. I was an avid cyclist before my surgery, posting 6500 miles this year on Strava. Unfortunately, now I cannot even turn a pedal over. (My knee just will not bend). My question: when I be able to ride again? If so, will I be able to ride aggressively and competitively again? Any advice would be appreciated!

 

[lovetocookandsew]

Hello and welcome to BoneSmart! I'm going to leave you a copy of our post op reading list. The articles are not long and are extremely helpful. I can't answer your questions about cycling, but have messaged staff as I believe one of our mods is an avid cyclist who may be able to advise you.

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. At week 4 and after you should follow this

​

Activity progression for TKRs​

6. Access 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 a 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 history before providing advice.

 

[Celle]

Hello @Orange Blossom - and

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.

There's every chance that you'll be able to get back into cycling again, but not for a while.

@Roy Gardiner, who had bilateral TKRs is a keen cyclist. I've tagged him to come and talk to you.

 

[trailspud]

You are just 3 weeks out from trauma. Your leg bones were cut across and drilled into with foreign metal objects.

Rest. Ice. Rest more. Repeat.

I was too quick to try to excercise after both TKRs. If I had four legs, it would probably take the 4th before I’d rest right.

You will be fine in time. Time.

 

[Orange Blossom]

November 5, 2019/ Right knee.

 

[Celle]

Thank you for your surgery date. I made a signature for you and I've also added you to the November Nimbles surgery list.

 

[Roy Gardiner]

I cannot turn the pedals over on a bike yet due to stiffness (leg just won’t bend).

If your leg is stiff and swollen then using an exercise bike for training is not a good idea; but you can still use one for mobility exercises - even if you can't make a single rotation!

• Set the bike to zero resistance
• Set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain
• 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
• 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

When will I be able to turn the pedals over and get back on the bike

Soon. Don't push it, just relax and wait.

Will I be able to cycle aggressively again?

Oh yes. Pre-surgery my knees were a limiting factor, now they are not.

And when you can get full rotation:

• 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

 

[RICBAK1]

Hi my exercise bike is what got me over my LTKR,it is just as Roy says seat as high as you can manage and then gentle back and forward till you get a full rotation.I am waiting for my next TKR and this time I am not worried if I will get back on my bike I know I will,hopefully will get done before summer comes I love cycling and swimming at moment in uk weather outside is total RUBBISH so indoor bike and swimming pool.It is just one day at a time you will get there but afraid there is no short cuts.

 

[Orange Blossom]

Thanks for the advice. It just seems this whole recovery is in slow motion. No sleep. Swelling is a daily struggle and the pain is constantly there. It can only get better!

 

[Celle]

Recovery from a knee replacement does take a long time, @Orange Blossom - as long as a full year for complete healing of all your tissues.

Unfortunately, sleep disturbance is part and parcel of the recovery - did you read this article?
Sleep deprivation is pretty much inevitable - but what causes it?

Are you still icing and elevating your leg. Doing that helps reduce swelling and pain,
Ice to control pain and swelling
Elevation: the do's and dont's

In addition, you probably still need to be taking some medication to help relieve pain.

Make sure you're not doing too much exercise. At this early stage of recovery, your knee still needs gentle treatment and only a little exercise.
It's not exercising that gets you your ROM (Range of Motion) - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee is capable of achieving good ROM right from the start. Its ROM will gradually increase as your knee heals and the internal and external swelling decrease.

Unfortunately, now I cannot even turn a pedal over. (My knee just will not bend).

That's normal for your stage of recovery. It's swelling that is preventing your knee from bending further. Just as being filled with water makes a garden hose stiffer, so swelling makes your knee stiffer. Instead of trying to force your knee to bend, concentrate on trying to reduce the swelling.

We celebrate the achievement with people the first time they find they can do a full rotation of the bike pedals. The first time often happens when pedaling backwards.

 

[Orange Blossom]

Thanks Celle, your responses have been comforting. I just got back from therapy. It can be rather depressing when you see your body can no longer do what it used to do well. The past few days I have been having trouble straightening my leg. Is this normal? Is this a product of the swelling as well? Almost feels if i have torn a tendon or pulled the muscle behind the knee.

 

[Celle]

It can be rather depressing when you see your body can no longer do what it used to do well.

Well, of course your body can't do right now what it used to do well. You've had major surgery and your leg is wounded. The ends of two large bones have been cut and shaped, one of those bones being the largest in your body. Then you've had two large metal things pushed hard into those bones. To do that, your muscles, tendons and many of your soft tissues had to be pulled to the sides and your kneecap was moved aside and turned over for a while. All that has caused bruising to your soft tissues.

it's going to take a while for everything to calm down and heal.

But remember that this is only temporary. It isn't going to be for the rest of your life. Where you are now is not where you're going to end up.
You have to accept being able to do less for a while, as payment for eventually having a knee that works well and no longer has that awful bone-on-bone pain every single day.

Now, this surgery caused a lot of trauma and you won't be able to bounce back from it in just a few weeks. In fact, it takes a full year before all your tissues are completely healed. You'll be able to do most things - even ride your bike on the road - long before a year is up, but your knee is going to give you painful reminders if you try to do too much for it.

This recovery takes as much patience as you can muster, but it will be worth it in the end.

The past few days I have been having trouble straightening my leg. Is this normal? Is this a product of the swelling as well? Almost feels if i have torn a tendon or pulled the muscle behind the knee.

Yes, this is normal and it's also caused by swelling. If you've been going hard at exercises, it is possible that you've caused a little damage to the muscles and tendons at the back of your leg. They don't need to be forced - just stretched slowly and gently.

Slow down. Don't expect fast results.
Some people find it takes a long time before they can extend their knee fully.

Patience, Grasshopper.

 

[Ceegee]

It's still early days yet. The exercise bike helped a lot with my recovery. I remember starting by moving the pedals back and forth until my knee would bend enough to do full rotations. And to answer your question, yes, you will be able to cycle again. I was able to get back to competitive agility with my dog (which involves running and sudden changes of direction). Early exercises that were useful for me included walking with attention to proper gait (heel-toe movement, straightening the knee) - I did this around the kitchen island - and non-painful PT to strengthen the muscles around the knee. I'm about 20 months post-op and am still improving. This is a long process full of mostly unpleasant surprises, but it does work out in the end. Now, I'm glad I had my TKR - it has made a huge difference to my life - but if you had asked me four weeks after the operation, I would have said (and did say) that you would have to tie me up, chloroform me and put me in a bag to make me go through it again.

Best of luck! It does get better.

 

[Majic]

@Orange Blossom
You are worrying about this far too soon. Once your leg is well healed and you can walk well, then start on a static bike. Put the seat as high as possible, then first try to pedal backwards. Once you can do that then try forwards. Don't despair if it takes a while to manage it. Then gradually lower the seat. Each time go backwards first.
It will take time but it will happen. Even I managed eventually and I'm not a great cyclist. I've seen posts on here from people who have gone back to long distance cycling after TKRs.

 

[Orange Blossom]

Thanks Majic,
I’m almost four weeks PO and still can’t turn a pedal over. I had a horrible night last night with the pain and swelling. I thought I was getting past this after a (2) good nights. It was a constant pain. My hip is now hurting along with foot as well. My foot gets real cold, goes numb, then feels like it is being stabbed by 1000 needles. My quad muscle also seems to shake uncontrollably when I flex it sometimes. I don’t recall my surgeon mentioning any of these issues before the surgery.

 

[Majic]

@Orange Blossom
All kinds of weird things happen after TKRs. I put it down to nerves having to recover. Pain also comes and goes. I was told not to try to reduce pain relief at night until I was fine in the day, as a lot of healing takes place during sleep. If you can't sleep at night sleep in the day whenever you can. There are no sleep rules this early. Just get as much as you can.

 

[Celle]

I’m almost four weeks PO and still can’t turn a pedal over.

That's normal. Stop worrying about it. Full rotation will come when your knee is ready to do it, not when you want it to do it. It will come when your knee has healed enough and when its swelling has gone down far enough.

You're expecting too much, too soon of your poor knee. It's been through one of the most major surgeries you can have and it needs time and gentle treatment, so it can heal, before you can expect it to perform like a normal knee.

I suspect you're doing too much in the way of exercise, in the hope that you can make your knee meet your targets. That won't work. Your knee is in charge of its recovery and it's going to recover at its own pace. There's nothing you can do to increase the speed of recovery, but you can slow it down if you do too much.
Where are you in recovery?? (TKR)

The pain you're experiencing is you knee, telling you that you're doing too much, and begging you to slow down.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee is capable of achieving good ROM right from the start, but it's prevented from doing so by pain and swelling. Your flexion and extension will gradually increase as your knee heals and the internal and external swelling decrease.
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!

 

[sistersinhim]

I’m almost four weeks PO and still can’t turn a pedal over.

That's perfectly normal. Your knee is swollen. That restricts your bend. The more you try and force that bend, the more swollen your knee is going to be, so, you will be defeating your purpose.

I had a horrible night last night with the pain and swelling.

That is a sign that you are irritating your knee by trying to force it to do something that it's not healed enough to do yet. Be patient. The more gentle you are with your knee, the less swelling and more bend you'll have.

I don’t recall my surgeon mentioning any of these issues before the surgery.

Nope, it's very seldom we hear of a surgeon warning anyone of the awful pain of recovery. It probably would chase some of us away. All mine told me what that I'd hate him for about 3 months!

 

[Bigs]

When I tried sitting on my MTB (Giant Trance, but an old one) I attempted to pedal backwards, but couldn't bend enough.

A few days later tried again, and just about managed it, painfully, so left it for awhile.

Today I tried again and can quite comfortably sit on the bike and pedal backwards - in fact that darn hard saddle was hurting my butt more than the knee bends!

It will come.