By Stan Purdum
On my bike, I recently completed three laps around the middle school parking lot across the street from my house. And I was delighted.
Okay, it’s a no-big-deal ride, one that any school kid could do — except that I am 78 years old, and it was my first ride on a moving bicycle since I got a total-knee replacement for my right leg 36 days previously — and I was able to pedal with only a slight twinge of discomfort from the remaining stiffness in the joint. And I’m told that will go away as the healing progresses.
Over the last two years, I’ve been dealing with pain in that knee, as well as some significant nerve pain that ran along the outside of that leg between the knee and the foot and then along the side of my foot and into the toes. The nerve pain was at its worst while driving the car with my foot on the accelerator.
My orthopedist had been helping me by injecting cortisone into the knee, which felt like a miracle cure, alleviating both the knee and nerve pain, but the relief wasn’t permanent. Also, I had heard that cortisone isn’t good for the cartilage in the joint, so before starting the shots, I asked the doctor about that. He had already X-rayed my knee, so his reply was, “Stan, you don’t have enough cartilage left in your knee to worry about.”
The effect of the first shot lasted about nine months, the second one about three months, and the third one only six weeks. I continued to ride my bike through all of this, but between shots, the knee let me know it wasn’t happy to be pumping the pedal. And walking more than a block or so caused great discomfort.
Knee replacement seemed the next logical step, but I wanted to keep riding, so I asked some cyclists who have gotten new knees about it, and they all said it could be done.
Thus, I asked the ortho doctor to put me on his surgery schedule. He was willing, but he warned me not to bother unless I was prepared to cooperate with the aggressive program of physical therapy that would begin just two days after the operation. He told me of one patient who didn’t do that and now has only limited movement in the leg with the replaced knee.
Planning to keep riding, I readily agreed. I had the surgery at about 11 a.m., and by 5 p.m., the therapy team had me up, taking my first steps. I came home the next day.
Thereafter, I threw myself into the therapy regime, not only attending the sessions, but also doing the exercises at home. But I quickly understood why some might resist the therapy — it hurt!
Much of the pain is because post-op, the knee swelled and stiffened up — which I’m told is normal — so bending it or extending it so that it’s fully flat on a surface when stretched out, is not easily done. Those become two goals toward which you work with your therapist. And the process is truly one of no pain, no gain.
During the first week of therapy, I did pretty well, and the therapist complimented me on my progress, but sometime over the weekend, I started to feel like I was going backward. The knee tightened up and I couldn’t complete the home exercises without more pain than I’d been having. When I presented myself for the next therapy session, I told the therapist about that and received in return not one iota of sympathy. It happened that I had been assigned to a different therapist that day — a man in my age bracket named Doug who’d had both of his knees replaced, so he wasn’t about to be moved by my whining.
Doug explained my situation as follows: “When the doctors do this surgery, they fill you with monkey juice. But after a few days, that stuff runs out and you feel your knee more.” I doubted “monkey juice” was a medical term, but the explanation matched what I’d experienced.
Then he pointed to the exercise table and said, “Now sit down there and put your leg out and let’s get going.” And we started — ouch! — again.
In the middle of the third week, I had a post-op appointment with the surgeon, and I arrived moving pretty well. I had already abandoned the walker and was using only a cane, and that only when walking distances. The doctor told me I was in the top 5% of his patients in terms of my progress and returning function. (I credited that to being a cyclist and riding right up to a couple of days before the surgery, but whatever the reason, it was good to hear.)
At the therapy center, they had a couple different versions of stationary bikes, and from the beginning, they started my workout by having me pedal for about 10 minutes to warm up. Their recumbent stationary bike had lots of adjustments available so that they situated me far enough from the top of the pedal stroke that I could complete the stroke without getting a jolt of pain in my repaired knee. But at home was a different story. My wife has a recumbent stationary bike, but it doesn’t have as many adjustments, so my first attempts at pedaling it were disappointing — and electrifying if I forced myself to go to the top of the upstroke.
I also set up one of my road bikes in a trainer, but pushing the crank all the way around on that was worse than on my wife’s recumbent. But I stayed at the therapy, and about 3.5 weeks out from the surgery, I finally got the crank all the way around on the road bike, slowly and gingerly, without sending me into the stratosphere of pain. In week five, I rode my bike in the schoolyard, and by the end of the week, the therapist released me from the formal exercise program, but he gave me a regime to continue working on at home.
One of the most difficult issues for me during recovery was sleeping — there was only one position I could lay in without stirring up pain — and before long, that position itself became uncomfortable. Doug told me that’s a common problem for knee-replacement patients and that I should do whatever I needed to do to get through the nights. For me, that meant sleeping in the Lazy Boy chair for several nights. On my worst night, I did finally fall asleep, but I dreamed I was maneuvering in a narrow tunnel where there was a hot and steaming pipe attached to the wall, so hot that I had to avoid touching it. When I awoke, it was clear to me that the tunnel was my bed, and the no-touch pipe was my right leg. Eventually, the doctor added a muscle relaxer pill to the pain meds he’d already supplied, and that seemed to help me get to sleep.
Right from the start, the surgeon had told me that the main part of the recovery would take six weeks, and that has proved so for me. I’m writing this in the sixth week, and earlier today, the surgeon gave me the all-clear to resume driving and all other activities.
I’ve got the bike loaded in the car, and we’re adding the stuff we need to head for our winter quarters in Florida, including the strap and stretch band to continue my at-home therapy. We’re two days away from departure, and when we get to Florida, in addition to the self-conducted exercises, I plan to ride myself the rest of the way back into shape.
Stan Purdum has ridden several long-distance bike trips, including an across-America ride recounted in his book Roll Around Heaven All Day, and a trek on U.S. 62, from Niagara Falls, New York, to El Paso, Texas, the subject of his book Playing in Traffic. Stan, a freelance writer and editor, lives in Ohio. See more at www.StanPurdum.com.
Fred says
Congrats on the new knee Stan. Sounds like you’re on your way to complete recovery.
Stan Purdum says
Thank you!
P. R. says
I’m 72 and had TKR surgery about 7 years ago. I, like you, was riding up to the day before the surgery and that made all the difference. I was on stationary bike at rehab within two weeks doing 20 minutes daily. If you are not in shape, the TKR surgery will kick your butt for several months.
Now, last September 2023 I had surgery on right foot for lisfranc overuse fracture (50 years of running and biking) plus “turning” big toe back in line. I have nine screws in my foot. This was much, much worse thanI anticipated.. In mid-Janurary 2024, my foot is still swollen and I cannot get a “normal” shoe on my foot and surgeon anticipates it will be March before I can get a bike shoe on my foot.
Lesson here? TKR is worth it if you are in shape.. Not sure about the foot surgery, even if you are in shape,. as recovery can be nine months. But eventually it should be worth the hassle.
Doug says
I’m 75 years old and have been a avide bike rider for 50 years. I also ran a lot in my 40 to 50’s. A year ago I had my TKR on the right side. Reading this article sounded like I was reading about me. My wife has been a real blessing in that she made or encouraged me to ride after the surgery. Now a year later the knee is still a little tight but doesn’t really hurt. Riding is a must. As long as I can get out for an hour a day it really helps keeping the knee flexible. I’m by the Idaho Washington border so indoor rides are my only option.
Thanks for the story
Michael says
I found your article very interesting. I’m 73 and a long time rider. I had knee surgery on October 12th, but not knee replacement. A bike accident severed my quad tendon. The surgery to reattach the tendon is relatively easy, but the recovery is difficult. No therapy or bending the knee for 6 weeks. Now 12 weeks out I finally making progress. Riding 10 miles every day seems a major accomplishment. Good luck to you from Mike in the Sarasota area.
Bob says
I’m 73 with both knees replaced. Keep at it. After about 6 months you’ll even stop thinking about your knees when you’re out riding.
Pete Weatherby says
These are nice stories, and I am sincerely happy for everyone, but I am one who is not pleased with the outcome of my total knee replacement of a year ago. And actually, the statistics show that I fall into the 20-30% of folks who are not pleased with their new knee. I do still have hope that things will improve, but at this stage of my life, I hadn’t planned on being taken out of the game for this long. Do I regret it? I won’t let myself say that, indeed the osteoarthritic pain is gone because the diseased bone is gone, and I’m grateful for that, but it’s been replaced with reduced range of motion and strength, stiffness that is literally 24/7, and a different kind of pain if I exert it too much. I pray that orthopedic regeneration solutions will one day eliminate joint replacements!
Stan Purdum says
Sorry your TKR didn’t bring you the results you wanted. I hope more time will bring greater improvement.
Alyson P'Neill says
Hi All ,Im 69 had my TKRon my L knee last Feb so 10 months out .Stan you are flying it, great job ,The work we have to do to get back is full on but I did it solidly for 5 months ,3xDaily for the first 2 months and the 2xdaily for the next 2 months ,Im back on the road properly since 5 1/2: months before that I was on my stationary bike ,actually my own road bike doing 20 mins 2xdaily .
Just come back from an hours cycle this afternoon .on the road bike ,building up to do much longer cycles.
Alyson O'Neill says
Hi All ,Im 69 had my TKRon my L knee last Feb so 10 months out .Stan you are flying it, great job ,The work we have to do to get back is full on but I did it solidly for 5 months ,3xDaily for the first 2 months and the 2xdaily for the next 2 months ,Im back on the road properly since 5 1/2: months before that I was on my stationary bike ,actually my own road bike doing 20 mins 2xdaily .
Just come back from an hours cycle this afternoon .on the road bike ,building up to do much longer cycles.
John F. Pristash says
Hi All. I’m 75 and have had both knees replaced, 6 and 10 years ago. I’m still able to comfortably ride 3-4 times per week, averaging approx. 25 miles per trip. My Ortho Doc continues to encourage me to ride, saying “if they wear out, I’ll replace them”! My only bike adjustment was to raise my saddle a very small amount. Knees still get a bit sore, but much less with the adjustment!!~
Herb says
Hi everyone.
Are most of you using platform pedals after TKR or clipping in? I’ve been using SPD-SL pedals on my road bike. I am scheduled for RTKR in 3 weeks and can’t wait to get out there again. Biking wasn’t too painful, but I swelled up like a balloon for a week afterwards. Running and tennis were out of the question.
Thanks for the info.
Stan Purdum says
I actually switched to flat pedals a few years ago.. As I have gotten older, I’ve appreciated the ability to get my foot off the pedal instantly in the case of a fall. So when I had the TKR, I was already using flat pedals
Pete Weatherby says
Hi Herb, after my TKR, I couldn’t imagine clipping in and esp. the lateral movement of clipping out. I thought flat pedals would be the only choice for my future. But no! I gave it a try at pretty much the loosest settings, and before long I was clipping in as before. Eventually I tightened my settings to probably close to what I used pre-TKR. There was also a device that for me was instrumental to get me back on the bike quicker. Probably a few months sooner than otherwise. It’s a device that allows you to get up and over top dead center of the pedal stroke (the painful part). It’s ingenious. Simple in concept and design, but an amazing implementation. Here’s the device (note it works with pretty much all pedals – just happens to be pictured with platforms): https://t-cycle.com/collections/assist-accessories/products/easy-knees-pedal-swing-and-crank-shortener-kit Worth every penny! Best of luck, Pete
Herb says
Hi Pete. Thanks so much for the suggestion. I was looking at something like that a few months ago online, but couldn’t locate the site. Glad to hear using clip in pedals is not off the table. 3 weeks from today I start my recovery.
Best wishes, Herb
Peter Weatherby says
So happy to help Herb. There are a couple other similar products out there, one from Europe. I checked out all of them before settling on the Easy Knees product. Designed and manufactured in Oregon. After I didn’t need it any longer it got loaned around my over 55 neighborhood, actually ending up in at least 3 more sales that I’m aware of! Best to you Herb. It’s a challenging recovery for sure, but many have phenomenon results!