knee replacement

AMMoffat
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Knee replacement

Postby AMMoffat » 28 Jan 2016, 10:54pm

I recently had a knee replacement (18th December) and tomorrow marks 6 weeks into my recovery. Yesterday I achieved a 95° bend which was enough (just) to turn the pedals on the exercise bike in the physio gym, albeit with no resistance. I now have a bike set up on the turbo trainer in the living room at home much to my OH's disgust. Although I was still able to cycle reasonable distances right up until the day before the op and had a good level of fitness, the muscles in the operated leg (quads in particular) are now pretty non-existent despite diligently completing the various (and variously painful) post-op exercises for 4 hours a day over the last 6 weeks.

I am relatively young to have had this op (52) and fully intend to resume cycling as soon as I am able - the incentive being my newly resprayed Roberts Rough Stuff sitting in the garage awaiting that moment.

I would be grateful for any advice or experience anyone is willing to share to help speed my recovery particularly on what I should be aiming for on the turbo.

Angela

tyreon
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Re: Knee replacement

Postby tyreon » 31 Jan 2016, 9:45am

I hope you get some replies! Better,someone's experience and knowledge.

Wotsabout going to one of these returned soldiers/war veteran's forums? They must have many who have had similar/more advanced surgical procedures,and have ex vets perfoming in sports up to and including the Olympics. You'd dfinately get a look-in there.

Have my own interest in 'failing knees'. No op yet(and none in the future,I hope).

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Si
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Re: Knee replacement

Postby Si » 2 Feb 2016, 3:07pm

My physio is adamant that you need to have some resistance on the turbo otherwise you end up with the good knee doing all the work and the damaged one just along for the ride. He also suggests that you need 110 degrees of movement to pedal properly.

However, that's as far as I can comment at the moment as I'm in a very similar boat to you having had a fractured kneecap and the muscle around it totally disappearing.

I'm currently doing 20min sessions:
- five with no real resistance just to get it moving
- for the next ten mins I do a couple of mins with moderate resistance, one min with a bit more then a couple of mins with moderate re, etc etc
- then five mins gradually taking the resistance down to nothing but gentle turning to warm down.

...but that's just me making it up as I go along.

Have found that both calves are aching excruciatingly the next day

mr bajokoses
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Re: Knee replacement

Postby mr bajokoses » 2 Feb 2016, 3:24pm

Patience is needed, I'm afraid...

An exercise bike may have considerably shorter cranks than your usual bike, making it a lot easier to pedal. As Si says, 110 degrees will be needed for road bike pedalling.

See a sports physio, it will hurt (a lot). Follow their advice, put the hours in and be ready for a long recovery.

AMMoffat
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Re: Knee replacement

Postby AMMoffat » 3 Feb 2016, 6:40pm

Thanks for the responses

tyreon wrote:I hope you get some replies! Better,someone's experience and knowledge.

Wotsabout going to one of these returned soldiers/war veteran's forums? They must have many who have had similar/more advanced surgical procedures,and have ex vets perfoming in sports up to and including the Olympics. You'd dfinately get a look-in there.


Good thought. My dog walker is a retired army sports rehab specialist, working at Headley Court amongst other centres, and has been giving me some really useful tips on exercises to add to what my physio is giving me. What the army doesn't know about recovery from this sort of thing (and worse) is probably not worth knowing

Si wrote:My physio is adamant that you need to have some resistance on the turbo otherwise you end up with the good knee doing all the work and the damaged one just along for the ride. He also suggests that you need 110 degrees of movement to pedal properly.


Good luck with your recovery, you are well ahead of me.

I've found on the turbo that I have to have the seat up so high in order to (just) turn the pedals that I can barely reach them at the bottom of the rotation so you are right that I need more bend to pedal properly and be able to add some resistance. At the moment I'm using the bike to try and increase the bend rather than anything else - now up to 99° so I'm getting there, but painfully slowly.

mr bajokoses wrote:Patience is needed, I'm afraid...


Not my strong point when it comes to inactivity :evil:

mr bajokoses wrote:See a sports physio, it will hurt (a lot).


I am, and it does :shock:

mr bajokoses wrote:Follow their advice, put the hours in and be ready for a long recovery.


Yes, I'm beginning to realise the recovery will take a lot longer than I had expected :( :(

turfroof
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Re: Knee replacement

Postby turfroof » 4 Feb 2016, 3:55pm

I had a replacement knee age 56 (I'm 60 now) . I don't know what angle I've got now, but it continued to improve over a period of months rather than weeks, as I got fitter it would swell up a bit but eventually I 'knew' that I'd got as much as was reasonable . I persevered with the saddle too high on the turbo until I could get a reasonable pedal action,then launched out on quiet lanes etc, which felt glorious! Work it, elevate and frozen peas plus time unfortunately. Saddle height is still crucial but it is well worth putting the time in. Very happy with my replacement, done a dozen or so tours on it including 2 to Ladakh and Spiti Valley - the new knee doesn't feel like the weak point!
PM me if I can be of further help
Mike

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Si
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Re: Knee replacement

Postby Si » 5 Feb 2016, 9:22am

Oh, the other thing....as someone recently pointed out to me on another thread.....get some shorter cranks - then your lower foot won't have to reach down so far and your upper leg won't have to bend so much.

AMMoffat
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Re: Knee replacement

Postby AMMoffat » 13 Mar 2016, 10:17pm

I'm now 12 weeks post-knee replacement and up to 115° bend. Yesterday being a nice sunny day I decided to go for a bike ride. This was only my 2nd outing on the road, the first being a few times round the block a couple of weeks ago to see if I could stop and start safely. Other than that I've been sticking to 15 minute sessions on the turbo trainer. Yesterday I survived 3.5 miles to a friends house, a cup of tea and then back home. Despite only 7 miles in total and a pretty low speed, you have no idea how wonderful it felt to be back on the bike again and, even better, there were no adverse after effects other than a slight ache and a little stiffness this morning.

turfroof wrote:I had a replacement knee age 56 (I'm 60 now) . I don't know what angle I've got now, but it continued to improve over a period of months rather than weeks, as I got fitter it would swell up a bit but eventually I 'knew' that I'd got as much as was reasonable . I persevered with the saddle too high on the turbo until I could get a reasonable pedal action,then launched out on quiet lanes etc, which felt glorious! Work it, elevate and frozen peas plus time unfortunately. Saddle height is still crucial but it is well worth putting the time in. Very happy with my replacement, done a dozen or so tours on it including 2 to Ladakh and Spiti Valley - the new knee doesn't feel like the weak point!
PM me if I can be of further help
Mike


It's been a great comfort to know there is the possibility of a full cycling life after a TKR, so thank you Mike

Si wrote:Oh, the other thing....as someone recently pointed out to me on another thread.....get some shorter cranks - then your lower foot won't have to reach down so far and your upper leg won't have to bend so much.


I decided against shorter cranks as I'm lowering my saddle gradually to encourage the bend which is still not great. The saddle is now about where it's meant to be and I intend to keep lowering it for a while yet on the turbo trainer to encourage the bend.

Useful advice about using resistance which I actually found easier then trying to cycle without any.

Onwards to better things cycling and regaining full fitness.

Thanks all for the advice.

Angela

groberts
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Re: Knee replacement

Postby groberts » 2 May 2016, 3:48pm

Here's a review of my post TKR experience, I found the turbo trainer very helpful - the TKR knee is good and I've just passed 1-year since the operation; blog on this later this week. As you'll see the problem now is the other knee!!

https://roundthebendpart1.wordpress.com ... -recovery/

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Si
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Re: Knee replacement

Postby Si » 2 May 2016, 4:57pm

My other observation has been: expect your other knee to hurt as well as it's doing more than its fair share of work!

tyreon
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Re: Knee replacement

Postby tyreon » 3 May 2016, 2:59pm

You seem to have progressed faster than the advice I've now remembered and which 'might' have been of use. Wotsabout the swim-gym workout. I mean,running in water. Sure,it's not muscle building or weight-bearing or whatever. But it is flexing the knee making it operational without stress. I think you can buy/hire water vests wherein you could run-in-the-water say for 3040 minutes. Boring,maybe...but it must help. Just a thought.

AMMoffat
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Re: Knee replacement

Postby AMMoffat » 4 May 2016, 9:54am

The above posts have prompted me to add an update which might be of interest to anyone else who has to undergo this surgery.

It's now just coming up for 19 weeks post-op and I am feeling pretty positive about the future with my new knee. I have regained a lot of strength and the bend in my knee is improving all the time (now c130 degrees) but still has some way to go before I would consider it "normal", whatever the new "normal" will be. I was fortunate in finding a personal trainer who is a former army rehab specialist and so can tailor my exercise programme to promote my recovery. Although I don't need the motivation of a personal trainer to exercise regularly, this aspect has been well worth having as it has prevented me from doing the wrong things, or the right things too soon, and (largely) from overdoing it, though I still have my moments. He's also not allowing me to neglect my upper body strength either :shock: I would not have got to the point I am now had I stayed with the hospital physiotherapist as their goals for full recovery did not match mine, though I can't fault the treatment or advice I had in the early weeks.

Most importantly, I am now pain-free in that knee for the first time in years. I can now comfortably swim 40 lengths (front crawl), do a 60 minute session on the turbo trainer (low resistance only still), cycle to work and for all short errands and have started a walk-run programme (more walking than running at present) to build cardiovascular fitness. I can do more than I did immediately before the op simply because exercise no longer hurts. I am still on anti-inflammatories, and definitely notice if I forget to take one, as there is still a lot of swelling within the joint. According to the consultant this can take many months to go down. Overdoing things causes the knee to seize up, but happily without any pain.

It will be some time still before I can cycle long distances and in anything other than a low gear. This is partly due to limitations of the knee joint due to swelling and to lack of strength. I expect both of these to improve over time. I am still a long way from what I consider to be fit and have to keep reminding myself to be patient which is difficult now the sun is shining and the weather is warming up :roll: However, the trajectory is upwards so I am hopeful I'll get there :D


groberts wrote:Here's a review of my post TKR experience, I found the turbo trainer very helpful - the TKR knee is good and I've just passed 1-year since the operation; blog on this later this week. As you'll see the problem now is the other knee!!

https://roundthebendpart1.wordpress.com ... -recovery/


I found your blog a while ago and your recovery for cycling was faster than mine. I'm sorry to hear about the other knee and hope you can get that fixed too.

Si wrote:My other observation has been: expect your other knee to hurt as well as it's doing more than its fair share of work!


I also have arthritis in the other knee (fortunately a long way from needing in any intervention) and it steadily got more painful from January but has improved over the past 2-3 weeks now that both knees are doing more equal work.

tyreon wrote:You seem to have progressed faster than the advice I've now remembered and which 'might' have been of use. Wotsabout the swim-gym workout. I mean,running in water. Sure,it's not muscle building or weight-bearing or whatever. But it is flexing the knee making it operational without stress. I think you can buy/hire water vests wherein you could run-in-the-water say for 3040 minutes. Boring,maybe...but it must help. Just a thought.


I am fortunate in that the local hydrotherapy pool is 5 minutes walk from my house and I went weekly for 9 weeks with my last session 2 weeks ago as I have now progressed beyond the need for hydrotherapy. The pool sessions really helped build strength and mobility over that period.

tyreon
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Re: Knee replacement

Postby tyreon » 4 May 2016, 7:22pm

Good post. Pleased to hear you're getting on okay. I have a few troubles myself and look to various experiences on here to gauge how things can be. I'm not sure what a knee replacement is. I guess there's different surgery dependant upon what is damaged and needs to be replaced.

Thanks for the update

Richard D
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Re: Knee replacement

Postby Richard D » 5 May 2016, 7:33pm

No TRK for me, but a not completely dissimilar story. The knee wasn't too impressed with the two screws going into the side of it when I had a femoral nailing last summer, though, leading to it stiffening up Iquitos alarmingly. With no weight-bearing for 8 weeks, plus the damage done to the quads during surgery, I had no strength at all in that leg by the time it had healed enough to be used for anything.

The one thing the hospital physios - and the surgeon - were most insistent on was bending the knee back as far as possible, as often as possible, to avoid the knee seizing up permanently. The first few days in hospital were incredibly painful, will them forcing me to ram the knee back further and further. 60 degrees was about it, though. The first few weeks at home saw me doing the same thing, hour after hour (with perhaps less swearing and screaming). Eventually I got it to 110 degrees.

I think I alarmed my physio somewhat by dragging myself onto a recumbent exercise bike at about the 4-5 week mark, just spinning the pedals with no resistance at first. That REALLY helped with how my knee would feel for the rest of the day; that half an hour of pedalling would leave it feeling much less "tight" or painful for the next few hours. I soon built up the resistance and duration. It took more like 4-5 months before I could get onto an upright exercise bike, though, and over 9 months before the surgeon agreed that it was healed enough to be worth taking the risk of cycling properly again.

Hydrotherapy - walking or running in the swimming pool - is fantastic stuff. I wouldn't have been capable of using a municipal pool (not until long after the point where I didn't actually need it, anyway), but I had six sessions in the hydro pool on the NHS. Definitely the best physio I got over the last ten months - in terms of the exercise and in terms of the confidence that it can instil - that one day soon your recovering limb will be able to support you properly on dry land.

But for me the knee thing was all about regaining range of motion and strengthening the horribly mashed quads (there'll always be a big chunk missing from the top of one of the muscles). What I had to be careful of was my hip and this where I'd broken it, as it wasn't under full control and sometimes the rotational motion of the pedals threatened to rip something apart if I didn't catch one of the big wobbles.

I've had a heck of a fun time recovering from all this, though. Much more interesting than "normal life". People keep asking me how I dealt with the pain (and I suppose at times it was pretty painful). The answer is in two parts. Firstly there's not a lot you can do about it at times except to endure. And secondly the pain of a broken leg, and the recovery, is small beans compared to the pain we inflict on ourselves when we try to hammer it up a long, steep hill.