Total Knee Replacement (TKR)

RBR reader Mike Henderson had a total knee replacement in 2010, recovered and continued cycling strongly. He had his 2nd TKR in November 2011 and volunteered to document his recovery and rehabilitation to provide RBR readers who may be considering this or some other serious surgery some insight into what it entails. His hope, he said, is to encourage and inspire roadies to get back on the bike and continue on down the road. Those reports can be found in issues of RBR Newsletter from November 2011 through January 2012. What follows is Mike’s wrap-up on the entire process, including an update on his latest cycling exploits. To say the least, he’s back!


I still can’t believe how well I’m doing and yet it hasn’t even been a full year. Last November, I had Total Knee Replacement (TKR) to my left knee (after previously having the procedure on my right knee). Recently, I completed my first double century (called the Grand Tour) since the surgery, in the Malibu area of California -- only 7 months after the TKR.

I wrote some short articles for RBR Newsletter as I progressed in my early recovery to help others maybe look at this as one solution to knee aches and pain. Let me make this clear: I am not a physician. These are only my experiences. You should always go to a professional orthopedic who is qualified to evaluate your specific problem.

I received a great deal of notes, emails and letters from people across the U.S. of various ages with additional comments, thoughts and questions. The majority came from people in my age group of 50-ish.

My feeling is there are a lot of people in a similar situation to what I went through. Over the last 35 years I’ve had various types of knee problems, with my first operation in high school. From there I had 7 more. Over time and use I was down to bone on bone in both knees.

Nothing Else Worked

The bone on bone brought with it aching pain, mostly at night. I did try various methods such as aspirin, injections, ice, massaging, etc. But it reached a point that nothing was working any longer. Another cycling friend who was also 50 had just had knee replacement. He was doing great and suggested his doctor.

I met with his orthopedic, Dr. Coppe, and he did a full evaluation. We decided to start with the right knee and see if the left could go on for a while. After my right knee replacement, the recovery went spectacularly well, and 8 months later I did a 620-mile ride from San Francisco to San Diego over 7 days with the Challenge Athletes Foundation (CAF) as a Group Leader. Less than a full year later I was having severe pain in the left knee and decided to have that knee replaced as well. Originally, my orthopedic wanted to do both at the same time. I thought that would be a bit much, and am glad I did them separately.

My plan was straightforward regarding my recovery, and I followed the instructions of my orthopedic surgeon and physical therapist to the letter. I first ensured that both understood that I was a cyclist and wanted to get back to full power and capability.

Cycling-Based Recovery

A major portion of my recovery was centered on cycling. At first it was just being able to complete a full rotation, which took me a few weeks. Realize that knee replacement is similar to breaking your leg in half. You are rehabilitating your muscles, joints, tendons and nerves as they adjust to these artificial parts. Once I could do a full pedal stroke I then started to focus on an amount of time -- 5 minutes, 10 minutes, 15 minutes, etc., without any resistance.

During this process I was also doing a lot of other exercises such as: standing on one leg for balance, step-ups one leg at a time, back extensions to strengthen the lower back muscles, squats, etc. We incorporated stretching as well, which was an important aspect. You don’t want the muscles to get tight and inflexible.

The hardest part of the process was getting the knee joint to flex again. This was an everyday workout with pain -- a lot of pain. But the outcome was well worth the time spent. Over time I was able to bend the knee back to 110 degrees, well beyond what is needed to cycle (which in general is 90 degrees).

About a month and a half later I was able to ride on the road and again started out slowly. I signed up to coach the Leukemia & Lymphoma Society Team in Training program for the Lake Tahoe Century. Having a goal kept me on track and moving forward.

Balloon-Like Swelling

On the first ride with them, on flat land, my knee swelled up like a balloon. At that point I thought I might not recover from this operation in time for the scheduled event, but gradually over the months my knee improved and there was less and less swelling.

Eventually my strength and endurance came back, too. I was instructing twice weekly SPIN classes for the group, and as the sun stayed out longer we switched one of those days to Mount Soledad repeats (long climbs).

When June 3rd came around, I was ready, strong and more than anxious to see my performance on a 100-mile ride. It was a perfect day in Tahoe, very unexpected, with sunshine and temperatures between 50 and 70. The day after the ride it snowed, hard, not unusual for June in the mountains. I had no problems climbing, pushing others up hills and returning to the course to ride in with my slowest group. This actually put about 120 miles on the day for me.

I had heard about a Double Century on June 23rd and spoke with the coach, Darryl Mackenzie, about my progress and if my existing training would suffice. He was very encouraging and indicated it shouldn’t be a problem with the group he was training called Double Team. Darryl has over 10 years of Double Century instruction and has written numerous articles and a training manual on this. The very next Saturday after Tahoe we did 130 miles.

Grand Tour Was a Great Test

The Grand Tour tested not only the strength of my leg but also my endurance and mental fortitude. Ask yourself, have you ever been out for a ride and spent 16 hours in total on it? Your mind has to wrap itself around this. The group I was riding with, 11 other people, made it that much easier as we talked, shared life experiences, and swapped stories. I couldn’t image doing it all on my own, and we picked up several lonely riders along the way.

The end result is that I’m a better man and I think much stronger than I was before this started. Not having to deal with knee pain has allowed me to extend my capabilities as a cyclist. I’m looking forward to a triple crown next year (3 doubles in one year) along with other challenges. Mountain biking, rock climbing, surfing, etc., are back on my list as well.

I was asked to be a part of group on knee replacement by WEGOHealth (www.wegohealth.com). They created short videos on mine and others’ personal experiences to provide insight to those assessing this type of treatment. I truly believe that being well-informed is an essential part of this process, and there is more and more information available all the time on the web.

I sincerely hope this helps someone out there realize that knee pain is not something you have to live with. Total Knee Replacement is a drastic process, with pain and a lot of work during the recovery, but the end result will be years of pain-free movement, which is essential to an active life.

-- Mike Henderson


Other RBR Reader Comments:

I was not quite 42 when I had my left knee replaced 3 1/2 years ago. An injury forced the issue. I had to try it in order to ride again -- or engage in any athletic activity, for that matter.

I'm very pleased with the result. I was back on the bike in 3 months and back to pre-injury condition within a year. My quadriceps returned and I have yet to experience the aching, swelling and excruciating pain caused by 20 years of osteoarthritis.
 
I haven't achieved normal flexion range and do not feel comfortable with long rides (60+ miles) or daily training. I think my power is greater than ever, though, now that I'm pedaling with 2 legs instead of 1 1/2. -- Steve R.
 
I had both knees replaced just before I turned 65. I started riding a recumbent about 6 weeks later and my mountain bike a week after that. Less than 4 months after the operation, I did an 80-mile ride. Two months later, I did 340 miles in 6 days. I finished the year with about 3,700 miles and I'm going strong this year, too.
 
I am thoroughly pleased with the results. No water on the knee or stiffness the next day. I was told my titanium knees will last over 30 years, so I'm not worried about wearing them out. -- Bob S.
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