TCR Rider

That's sounds about as well a recovery as you could hope for. At this point I've been able to get on the trainer for 5 minutes but the good news is the ROM is improving.
A century at four months is beyond outstanding and it's great to hear that that kind of recovery is possible. Good for my motivation to keep at it and suck up the pain. I gave up running some time ago when I had a hip replacement so I've already made peace with that.
I plan on having another fitting once I totally recover to allow for the fact that my leg is now straight and not collapsing medially. I'm starting outpatient PT today so let the next phase of recovery begin.
Thanks for sharing your story it does help.

metalheart44

HI, how's the recovery going? I bet you have made a full FORWARD revolution by now and if not you must be close. Chances are you are pedaling if the swelling is under control.

TCR Rider

Today is exactly four weeks since the surgery. I'm told by my therapist that I'm ahead of schedule. While that may be true I've still got a long way to go. Where I'm at today is I'm able to walk two miles without a cane and walk up and down stairs normally using the handrail. I couldn't do that for at least 6 months leading up to the surgery. So that's good news but I'm not walking smoothly yet. I'm riding the bike on the trainer 30 min with light resistance but clipped into the pedals, I got tired of my feet slipping around so I took a chance and clipped in.
I'm going to PT 3 times a week and just started using the leg press machine. On the other days I do the exercises at home. Really on a mission to regain flexion and extension. As of yesterday flexion was at 127 deg and extension was just about normal - full extension. I'm really happy with that since it looks like I just might winning the battle against scar tissue. Still taking pain meds but I'm tapering down in the dosage and the time between doses. That and ice ice baby.
In no way am I saying this has been a walk in the park and sucking up the pain involved in the rehab every day gets old really fast but I'm hoping I'm just about cresting the hill.

NerdLord

I had mine done Aug 21, 2017 and yesturday was the 6 week follow up.
doc was happy with my range of motion, I ache a bit from trying to get the muscles and tendons and scar tissue inside to be at the point I'M happy but considering all the abuse and hell this old legs been through.. (broken at mid calf in late '92 leaving a 3 degree bow, rod removal in '07, tibial plateau fracture in '11 and revision leaving a 14 degree knock knee bend for 6 years, foot arch problems from it all, arthritis, etc, etc..)

I feel better than I have in a decade!

giving myself this fall and winter to get into condition for touring (see my hybrid thread, I used my old campus beater and been modding it for basic noobie touring).

knee now...


knee before (as it was for 6 years)

metalheart44

TCR -- great progress!

NerdLord -- who is your surgeon? Looks like nice work.

McBTC

Fyi– Joined the 120 club today (2nd week of 3rd month after revision TKR) and using every degree of that amount of ROM to comfortably spin 165mm cranks...

TCR Rider

And there you have it. Great news! Question - did you normally use 165mm cranks before the TKR? Turned out that I didn't need to make any adjustments to my bike. Still using the 172.5's that I normally rode on and the seat is at the same height as before the surgery. What I'm encountering now (5 weeks post-op) is tightness in the hamstring and calf the knee flexion is equal on both sides according to my PT. She feels it's because the quad is still weak and the hammie is doing more of the work to compensate. So it's just a matter of keeping after it. I was really obsessed with getting the flexion and extension back now it's time focus on the strength.

I've been at 40 minutes on the trainer but tomorrow when I get home from PT I plan to see how 50 minutes feels. Once I get to an hour I'll start increasing the resistance and do a few rides on Zwift before I start to think about riding outside. I just don't want to get ahead of myself and have a setback.

McBTC

Long story but essentially, I peddled OEM 175s on many bikes over the years. The 165s were a waypoint after a TKR >4 yrs ago, ending with sub-90 cranks/ROM issues. With the revision-TKR it looks like the new norm is now, 165s, which is not a bad outcome given the articles about triathletes without knee problems who've transitioned to even shorter cranks to increase performance. The info I wanted to pass on for anyone dealing with musculoskeletal issues is that based on my experience, use of >165mm cranks will require a passive ROM >120° and an active ROM >110°.

brudford

Oct. 6th was six months out from a right TKR . At three months I could make a complete reveloution on my indoor trainer . At six months I average about 10 miles/day . Minimal swelling, however some pain is still there . I have been a RN for 26 years and from my experience give your recovery at least 1 year .

Sasquatch16

When I had my TKR they were stingy with pain meds. I took the statement on the bottle "Alcohol my intensify effect" as a recommendation not a warning and it made a big difference before therapy. Glass of wine with a percocet worked great.

TCR Rider

I realize that no two recoveries are alike but I was able to get a full revolution on the trainer at 10 days. That really was a pleasant surprise. Yesterday was 6 weeks and I was on the bike for 15 miles (55 minutes). I've been using light resistance but working to hold the cadence to at least 80. I also started shifting to a bigger gear and standing for 30 seconds at a time. Still have a long way to go but it's progress.
I really got after working on flexion and extension 3 times a day for the first month. I'm going to PT 3 times a week and the last time the PT checked my flexion it was at 127 degrees. Now I'm starting to focus on strengthening the leg especially the quad.
I walked over 3 miles today which I couldn't do in close to a year. Stairs are still dicey but I'm doing them and they're starting to get more doable.
Leading up to the surgery I had trouble walking a block but I could still ride the bike. I rode 35 miles the day before the surgery and I think bringing as much fitness into the procedure has got to help with how quickly the recovery goes....that and having a good surgeon. I'm a firm believer that it is a joint effort. The doctor handles the surgery then it's the patient's responsibility to make the most of his or her work by treating the rehab like it's your job. Of course being retired frees up a lot of time to devote to it.

TCR Rider

I just passed the 8 week mark since the TKR. I had my PT measure the amount of flexion I had in the knee and managed to hit 130 degs. Not too shabby. I've been riding for 75 minutes on the trainer 6 times a week which, according to the Tack trainer app, gives me about 20.5 miles. Mixing in some standing and sprinting working to keep the average cadence at at least 80 rpms. May try to take it up to 90 minutes tomorrow. I'm trying to decide when to go outside to ride. Part of me wants to go out tomorrow but another part, including my wife, says to continue on the trainer through the winter and just go back to Zwift and Trainer Road. The last thing I need is to go down and have a setback.
Going to PT twice a week and working out at home on the other days. I'm up to 90lbs on the leg press machine with the new knee. Doesn't sound like a hell of a lot but considering I started at 30lbs it's progress. Considering going back to my Kettle Bell workout which I haven't done since the knee got really bad months before the surgery.
Walked about 4 miles yesterday and I have to say that was harder than riding the bike. When I got up this morning I felt like I had run a 1/2 marathon.
I will say I'm happy with how the rehab is going but nowhere near satisfied.

CrankyFranky

Thank you for your diligent follow-ups OP! It sounds like you are on track for the long haul back to recovery.

I'm very close to scheduling TKR on my right knee, as my overall fitness is declining, and I've done all the PT and injections etc. some time ago. I'm still working at 68, and can ride the flat 5 mile commute and even a 25-30 miler on the weekend - but my gait on stairs is awful and painful and due to the pain, I can gin up no motivation to do much, so I am rapidly becoming a sitter rather than a mover. I stopped doing the other training exercises because it is hard for me to isolate many exercises without pain. My cardio stamina is already weak, and since everything I do now is slow, it won't get any better until after the knee is fixed. In short, if I don't get the TKR, I feel that my decline will be absolute.

After meeting with three surgeons and checking feedback, the one I want to perform the operation simply said to schedule it and 12 weeks later it'll happen. I just have to decide whether I want to wait until after chances of ice on the ground are lessened. I'm thinking February for the operation. He said I wouldn't be happy for maybe 3 months after, and it would take a year to regain normal strength. He also said that there is a computer based exercise training that I would start, even before the operation. I'm going to call next week to enquire about that.

I have a question for everyone who's had a TKR - what type (and brand) of cycle trainer did you adopt for recovery? After the visiting PT stopped and further training was up to you, was there a program you used to keep progress moving forward?

TCR Rider

I believe that the higher your level of fitness is going into the operation will make the rehab that much easier. That being said, I would schedule the procedure as soon as possible and get on with the rehab. I see a lot of parallels in what you are going through now with what I experienced prior to the replacement. I was still riding 150 miles a week and rode 35 miles the day before the surgery but I had trouble walking to the mailbox and forget about stairs.
For me the first three weeks were the most difficult with working on range of motion which was a real beotch. It's really a battle against scar tissue at the beginning of rehab and if you don't get after it early the outlook is not good for a successful recovery. I just took the pain meds and sucked it up until I got rom back to an acceptable level and am now focusing on building up strength.
As far as a trainer is concerned I use my indoor setup that I rode before the surgery. A Giant TCR on a Tacx Neo smart trainer. At PT I use the bike they have there to warmup but I felt if I could ride on my bike without making any adjustments it would be that much easier to get back out on the road.
I'm still going to PT but I would keep doing the exercises I do there and as strength increases tweak then to add to the difficulty and continue to work on balance which is an issue for me.
All I can say is that my world was getting smaller and smaller so I couldn't see any reason to wait and just be done with it.
Best of luck.

McBTC

Yesterday, about 3 months and a week after the 2nd (final) stage of a Revision-TKR, I went on a 20 mile ride that I hadn't done in over 5 years (165 mm cranks)... leading up to that I used a recumbent trainer at the PT, at spas in hotels when traveling and also at home to help regain range of motion: you pedal backward until you meet resistance – use your hands to pull your knee up and maintain the stretch at the pain-point for a 10-count – then, pedal forward / hold stretch for a 10-count, etc. – and, continue back and forth with that for 10 minutes, continually moving the seat forward as the amount of bend increases to the point that you can turn over the pedals. After you've done that, you can go for a ride on the trainer and increase the resistance for strength but not so much as to interfere with trying to get the swelling down (a compression legging works well). In my situation, achieving >120° of bend (which is what PTs shoot for) was viewed as optimistic (docs may be satisfied if you can get at least 90°, which would have you riding a bike with ~90 mm cranks); but, your range-of-motion prospects sound a lot more positive.

TCR Rider

[QUOTE=McBTC;19971942]Yesterday, about 3 months and a week after the 2nd (final) stage of a Revision-TKR, I went on a 20 mile ride that I hadn't done in over 5 years (165 mm cranks).......

That's great news.

If you don't mind me asking why did you need a revision of the TKR?

McBTC

No... an indolent infection dating back 4 years--i.e., the bug was there for years even though it supposedly was cleaned out 2 weeks after the initial surgery in 2013...

TCR Rider

That's terrible. An infection was (is) my biggest concern. About 5 weeks after my surgery I got an abscess in a tooth which really freaked me out. I was worried it would travel down to the knee. Started taking antibiotics and went to the dentist the next day. Seems as if a week on the antibiotics knocked it out.

McBTC

There has been quite a few studies on that and based on the research the ADA has concluded that there essentially is no risk of that happening but it nevertheless is concerning to us patients. In most instances it's the hospital that gets blamed, probably because of the high degree of variability between them.

TCR Rider

That's good to know in fact my PT told me pretty much the same thing.

zjrog

Glad to hear your TKR is doing so well TCR Rider!!!

This Thursday, is my 7th anniversary for my left TKR. And it has been very good to me. I have exceptional ROM, at 146*. Kneeling and crawling even on concrete. And crossing my leg over the old knee.

I am still scared of infections, regardless of the claims a dental infection won't gravitate to other implants. A real fear as I have not only the knee, but two rods and ten screws in my back. I recently broke a tooth and they pulled it and replaced it with an implant. A couple weeks ago that implant was removed because of an infection. I went on antibiotics for a few extra days because of the other hardware...

TCR Rider

That's a great result. I too have been able to kneel on the floor, with extra cushioning, to do exercise and yoga.
The infection thing really is a big concern for me since I also have more hardware from a hip replacement and surgery to correct a malunion of a pelvic fracture not to mention dental implants. I"d rather err on the side of caution and take the antibiotics because I don't know if I could handle any complications.

McBTC

Unfortunately, the better safe than sorry approach is not risk-free either because the findings suggest that the incidence of complications associated with taking antibiotics is more likely than getting an infected artificial joint from invasive dental procedures although we're apparently talking about chances in the realm of, 400 in a million.

zjrog

I see you are no stranger to Physical Terrorism, er Therapy... I tell everyone contemplating a TKR, to ask around and see who in your area is a the best therapist for TKR, and see them. Then, Do ALL the therapy, and ALL the home exercise they give you. That patience I learned from my TKR and therapy, were needed when I broke my back 9 months later... Saw the same therapist and I am not on daily pain med...

My therapist is still shocked with my results, he swears everyone loses 10 or more ROM after leaving therapy, I gained. But, I use it every day, crawling in and on and under equipment at work, working under my cars at home, playing with my grandkids on the floor...

I tend to err on that same side of caution. But I also agree there are some risks associated with over use of antibiotics. Which is also why I limit my use of hand sanitizers. A few bugs and germs are actually healthy for you, the antibiotics and hand sanitizers don't discriminate.

I wish you continued improvement!

TCR Rider

I totally agree. I firmly believe that a successful recovery depends on two things, good work by the surgeon and the willingness to work your ass off at rehab. I was going three times a week now down to twice. I do all the PT exercises at least once at home and the flexibility and stretching work every day.
What I am working towards is getting back to cycling at as high a level as possible. I've been on the trainer 6 days a week and was able to ride 90 minutes on Sat and Sun. The other days it's been for 75 minutes keeping the cadence between 80 and 100 rpms at moderate power. According to the Tacx Training app that I'm using it equals 132 miles for the week. That's trainer miles so I don't put that much weight on that metric but it's just a number to keep me motivated.

As far as the antibiotics go I try not to overuse them. I took them for a week at the advice of my dentist to knock out the tooth infection. Both the dentist and my surgeon say I should pre-medicate with antibiotics before having dental work done so that's what I do. I have heard another school of thought that says they're not necessary but my guys both say to take them so so be it - so far so good.