TKR How much have your quads recovered?'

[willib]

It is now almost 8 months since RTKR and 5 months since LTKR. I realize many people on this forum have struggled to fully recover and I wish them the very best. My own experience has been far more positive than I could have imagined. In some ways, my story is for those who are still fairly active and keep postponing TKR. I probably should have done it a few years sooner. Because I was still able to ride my bike hard, hilly centuries, interval training, fast paced group rides I felt that I could keep delaying. It took 3 or 4 advils, but riding was fun and more or less pain free. However, walking was a completely different story, 20-30 minutes and knees would swell. Walking across a grassy field with uneven soil was like picking my way through a minefield. Going down stairs required careful use of the railing. Stepping off a curb required planning. It is only in hindsight that I realized how I much I had restricted my activities and affected those around me. Going downtown to a museum with my wife required careful planning to find close parking, minimize walking and sitting on a bench every chance. I almost never walked even a few hundred yards to lunch. Even helping in the kitchen was a challenge unless I could sit on a stool.

Today, it is completely different. I walk down stairs without even thinking about it. As part of my post surgery workouts I would time myself walking up 3 flights of steps as fast as I could. I can now run up, 2 steps at a time. I'm back on my bike training as hard as ever, without advil. I intentionally walk the long way to lunch just to get a bit more exercise. I feel like I could walk for hours. I can leg press more than twice my weight with zero pain. While I don't do it often, I occasionally jog 5-10 minutes on a treadmill with the idea that I should at least be able to hurry across a road to avoid getting hit by a car. About the only limitation compared to a normal person is about 120-125 ROM, kneeling feels weird, and there is no way I can kneel and sit back on my feet.

I had been worried before surgery that I would lose a lot of cardio fitness and muscle sterength, but it wasn't too much of a problem. I found myself being able to use an a stationary bike and elliptical within 3-4 weeks of each surgery. While I couldn't exercise very hard, it was enough to minimize fitness loss and by 5-6 weeks I could get my heart rate up. The weather in Massachusetts is not great for winter cycling, but with the sun coming out, I find myself slightly ahead of my cycling fitness 1 year ago, and I don't take any advil.

I plan to continue to rebuild cycling fitness and spend some time in the gym to strengthen my quads. I'm doing weighted squats and horizontal leg presses on a machine. My goal is to prove the various articles wrong. One can come out of TKR with stronger legs.

For those who are thinking about TKR and keep putting it off, maybe it is time to get it done. Best wishes and good luck to you.

 

[KTO]

I had Left TKR 4 months ago ( 52 ur old female).. I am glad I got it done. My motto became I am as healthy as I am going to b e as I am right now . I was not on any meds and I was fearful with status my knee before surgery I would be doing less activity and gain more weight... I incorporated swimming a few months before surgery. My recovery was great.. I used a walker for only three days after surgery and then cane for at most two weeks...

 

[KTO]

What I was trying to convey.. if one know they will get knee replaced in next year or two why wait? One never knows how ones health will change for the worst and causing one to delay surgery or not be a good candidate for surgery.. my activity level was decreasing due to my bad knee and I kept gaining more weight each year .. so I chose to have surgery before my knee was even worse

 

[Ceegee]

I am also one of the people who has had a good recovery so far, and I'm keeping my fingers crossed that things continue to progress in the same way. I'm 10 weeks post-op and am already more mobile and active than before the operation. I'm walking 3 or 4 kilometres per day pain-free, I'm using an exercise bike and stepper on a daily basis, am back at work full-time (I'm self-employed, working from home at a computer-based job, so this has been easier for me than for others), and am returning gradually to the sport about which I'm passionate, dog agility. I've lost weight and am fitter than at any time in the past ten years. I'm still visiting a physiotherapist twice a week and expect to continue for another month or two. My current comfortable range is 0 to 120, and I expect it to increase gradually over the next year or so, as I become more active. As a family, we're planning trips that haven't been possible for the last five years because I was unable to walk more than a block without excruciating pain.

I put off the TKR operation for a couple of years because I was afraid. I'm now kicking myself for not doing it sooner. I could have got my life back so much earlier.

 

[Celle]

What a great update, @willib . I glad things are going so well.

 

[Jmf003]

...
Have any of you tried to quantify your quad strength before and after? I'm not sure how to do it reasonably accurately. Before the first TKR I was still able to cycle hard and have a history of my performance on Strava. But cycling speed is a combination of fitness and strength so it is not a direct measure of quads.
....

Yes, but it's total leg strength, not just quad strength. I look at Strava cycling data for short, steep hill climbs which require anaerobic strength and aerobic fitness does not help much or at all.

I'm 10 months post surgery on my right knee, 8 months post on my left. 2,850 miles and 112,000 feet of climbing into my recovery training, which is a lot for me...about 50% more than prior years.

My short hill climbing speeds are still down from where I used to be, e.g. last night I put max effort into a .15 mile climb with a 9% grade and was 25% slower than my pre-surgery PR.

My overall race times are down accordingly and I can no longer keep up with the A group on fast paced training rides. I get dropped on every hill climb. It's not a problem on social rides or low heart rate training rides.

I haven't completely given up hope but I expected to be much stronger at this stage in my recovery.

 

[willib]

JMF - hopefully you will continue to recover and get stronger. In my case, my recovery has gone far far better than I could have ever imagined it. I am similar to you with 8 months post LTKR and 10 months post RTKR. I believe that I have exceeded both my muscle strength and best ever fitness before TKR.

I have exceeded almost every power measure since my previous bests in 2013. My best peak 30 seconds to 1 hour are all in the past month. Peak 5, 10, and 20 seconds are still from 2013, but I'm close. While I don't race, I have recently joined a local morning training ride that includes a few cat 2 and 3 racers. Their Tuesday ride is a hammer fest. Recently I been able to hang on for about 45-60 minutes of a 25 mile ride which can average 21-23 mph. The terrain is flattish with rolling hills/bumps. This past month I have made a special effort to add 1 day a week of very high intensity 1 min to 3 min intervals. This is where I need to improve most to hang with the guys. Since I am slightly over 200 pounds and the fast guys are 150-170 pounds and 10-20 years younger, I need more strength and anaerobic fitness for the rolling hills.

Since I was concerned about muscle strength I did a lot of squats and leg presses with increasing weights as soon as the knees didn't complain. I could see significant improvements by March and April. By May I have been outside on my bike with increasing efforts, both in intensity and duration. The past 4-6 weeks I have added maximal effort intervals, typically by going for a PB on Strava as motivation. I am training harder than ever these last 2 months, 150-200 miles per week. Part of it is simply motivation to improve now that I have new knees and part of it is that since the knees don't hurt, I can push harder and longer. I am also making sure to consume significant protein including a protein shake after training.

All in all, I feel extremely fortunate that the recovery has gone this well and I am confident that my muscle strength is better than before which is not something I thought I would have been able to say.

 

[pdx]

I can't compete with your mileage, etc., but I did notice when I added hamstring & adductor/abductor strengthening, my riding improved. Hamstring work proved especially helpful.

 

[Hortgirl]

I'm responding primarily to Susie, who went into TKR with extremely strong legs, as did I on March 14/18. I'm naturally strong, plus I enjoy weight training. I'm a bit of a freak in that I had NO pain whatsoever, not in hospital, not once I got home. I didn't take any pain meds at all, so my surgeon says I have an extraordinarily high pain threshold. That's a gift in some ways, but I'm aware it also can mean that I don't notice if I'm overdoing it, because I don't get pain. I'm waiting for a date to have my second knee done, and in the meantime (with my GP's blessing - here in Canada the follow-up is more with the GP than the surgeon) am doing pretty much what I want, which involves some heavy-duty-ish gardening. My new knee is doing just fine, tho' occasionally the quad aches and "the band" seems to cover a larger area than it did a month ago. Did you experience anything similar in the first 4-6 months of your recovery? Thanks,

 

[HoneyB]

@willib - Maybe I'll become a good experiment. After my LTKR in February, I had "conventional" PT. I had very gentle in-home PT for two weeks and then started out-patient PT which consisted of heel slides, leg raises, and various other exercises and stretches which could be duplicated at home. Three months later I had a RTKR and started out-patient PT two days after surgery with a different PT group. While I still do the conventional exercises and stretches at home, my therapy at PT has been on various weight machines from day 1. Now I'll be interested to see if there's a difference in quad strength between the two legs when they're both fully recovered.

 

[willib]

Today is the 1 year anniversary of my 2nd TKR. I feel extremely fortunate. I feel like the poster child for things couldn't have gone better. I went into my first RTKR as an avid cyclist apprehensive that I would not be able to get back to the same level. I couldn't walk straight, but I was able to ride hard until the day before my first TKR. By April when the snow melted I was out training on my bike 3 to 4 days a week ramping up to 150 to 200 miles per week by summer. By mid-summer I was able to keep up with the local early morning hammering cycling gang. In September I completed a flat east coast century in a bit over 5 hours with the help of my morning friends. At the end of October, I flew to CA for the final test, completing an 85 mile fondo and 8000 feet of climbing without any knee pain.

My original question in this forum was about how much do your quads recover. In my own case, I would say that I am stronger and fitter than ever by every single measure from sprinting to endurance.

Before TKR I was always trying to figure out ways to avoid walking and now I can walk and stand all day with zero pain. Cycling is better than ever. I used to take a ton of advil and now it is zero. While my bionic knees feel different than natural knees I don't think about them most of the time. Only kneeling feels truly awkward. With all the riding I have lost 20 pounds in the last 7 months. However, for bike weight weenies, each bionic knee is about 1 pound heavier than a natural knee. With a 2 pound disadvantage you now have an excuse to justify to your spouse buying an extra expensive lightweight bike.

For those who are considering this journey, if you have a bit of good luck and a great surgeon, it is definitely worth it. I should have done it several years earlier. Best wishes and good luck to everyone. It will get better.

 

[Jockette]

That is an awesome report!!

 

[Pumpkin]

Thanks for the update, happy to hear how well you are doing.

 

[sistersinhim]

Yay, yippee, yahoo!!! What a fantastic report! You are living proof that this surgery is worth it!

 

[KarriB]

Wow! Love hearing how your knees are giving you back so much activity!

 

[Jmf003]

Glad to hear from folks who are having success! Really awesome results!

As to my story, I am still down on power but the gap is getting narrower. I can see a path to full strength recovery but it's looking like it will take something like 15-18 months total time.

With the change in seasons I'm doing more indoor riding here in Michigan and looking at FTP test results rather than race and Strava segment times. My FTP has gone from 262 watts in November to 272 in December to 289 in January. FTP was 309 watts pre-surgery.

The exercise program that seems to be helping the most is Zwift hill climbing with the trainer difficulty set to maximum (default is 50%) and trying to keep my heart rate at or below my Maffetone threshold (180-age). That requires me to use low cadence, high wattage pedal mashing rather than spinning.

 

[JDinCT]

@willib @Jmf003 while I'm not quite as avid a cyclist as you guys.... it's very encouraging to see the types and quality of recoveries both of you have had. While understanding each recovery is different, I'm cautiously looking forward to a positive result after my RTKR on March 6th. I've been maintaining my fitness level as much as possible however my cycling distance is down about 40% over the last 6 months. I'm normally good for about an average of 3000 miles a year... 2018 was at 2240 miles combined outdoor and indoor.

Thanks for sharing your exemplary recoveries!

 

[sistersinhim]

@Jmf003, how about starting your own recovery thread and telling us all about your surgeries and recovery.

 

[Breadman]

You guys talking about cycling is making me jealous for warm weather. I just came in from shoveling the driveway.

 

[willib]

@Jmf003 Glad to hear someone else had a good recovery and is able to cycle hard and fast.

I'll be interested to see where things end up in term strength and fitness by this summer. At 14 months since my last TKR, I'm way ahead of where I was 12 months ago. While I don't race, I ride with guys that do. By end of last summer, I could hang, just barely, with the fast guys. Some have an FTP 350 and up. When they are being nice and roads are flattish, I am ok, but when they put the hammer down it is very tough. We are also at the point where we are also dealing with normal aging and a number of riders are 10- 20 years younger. The weather here is also bad, so I'm spending a lot of time on a trainer. I'm also planning on adding some yoga and more weights to help with flexibility, strength and balance, things that need improvement and cycling doesn't address.