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.
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.
big fin deal
I am 3 years out after a staged 1 month bilateral and am doing 3-4, 20-25 mile rides per week at 61 years and happy that I’m riding nearly pain-free. 1 knee didn’t rehab as well as the 1st due to overdoing it rehabbing knee 2, had a calf tendon tear.
What a life changer TKR is…so happy to be passing hikers when climbing mountains again instead of sitting and waiting..
Thank you for sharing your story. My knees are trash (not from biking) I am 53 and am headed for injections and eventual replacement. I was really hoping to enjoy several decades of cycling.
I had a single TKR at age 49. Quite honestly, it was brutal. I literally did everything right before and after. Lost almost 100 lbs prior to the surgery, and was in good shape. The weight loss was from a big change in diet and TONS of exercise (weights, elliptical, walking, and rowing). The rehab was excruciating, and to this day, 2 years after the fact, I still have some swelling and pain after my rides. They are usually 40-50 miles every other day, so I’m asking a lot…but still feel I’m young enough and look after my nutrition enough to do this. I believe my surgeon wasn’t great, even though the procedure was robotic. I still can’t put a lot of power down. The knee just won’t let me. Oh, well. At least I’m still truckin’!!
I am 59 and 4 weeks out of one total knee replacement. Doing well, just getting on my stationary bike. I wonder, do you wear toe clips when you cycle? Seems kind of dangerous with the twisting of the knee to get out of them. I was wearing them before the surgery.
My TKR (right knee) was about seven months ago (March 03, 2020). I use Shimano SPD pedals rather than toe clips. I used flat pedals without clips of any sort for the first few months. Twisting out of the clips is a concern. What worked well for me was to disengage the pedal at the bottom of the pedal stroke. The leverage of the extended leg makes the motion easier and safer. The difference is dramatic. Likewise I engage the pedal at the bottom of the stroke once in motion. This was a tip from my coach. It works! Please follow up if you would like detail.
Steve,
I am 5 weeks post op and back on the trainer. I notice I can’t quite clip in like I did before surgery just yet, even though my flexion is over 90 degrees. My PT had me set my foot on top of the pedal and scoot in back so I could go all the way around. I do something similar on the trainer. I am also wondering if I could move my clips on the shoes back to help. Thoughts?
5 weeks is early days. After two rounds of PT at about six months my flex was 127 – 130 degrees, extension full (zero degrees). I an old guy (74). Clip position is not a big deal, pedal position is. Make sure to put your pedal at the bottom of the stroke. Full extension of the leg makes clip-in much easier. If you miss the first try pedal around to the bottom again. Take it easy. At 5 weeks there is still swelling. Don’t aggravate that.
Steve,
Thanks for reaching out. I haven’t a question in a while but yes over the years I still get one or two every once in a while. I know the hospitals are doing all that they can. Another cyclist friend of mine was for an operation on his throat. Thankfully it turned out well.
I’ll keep your note handy in case someone has a quesiton that relates. Good to hear you are doing well.
Thansk for the note
Mike Henderson
I am two years out with a partial knee replacement. It was never right post surgery. I went to PT three times a week for six months. I had and have a lot of stiffness in my knee. After many doctor appointments, X-rays, special MRIs, ultra sound, injections in the knee to try to get it to calm down, last week I was finally advised as the potential cause of my pain and stiffness. An X-ray showed arthritis in the non replacement compartment of the knee and I am bone on bone in that compartment. I was advised I am in need of a total replacement.
My TKA recovery was six weeks to limited cycling. Seven months for typical cycling with no pain. There is still some soreness but it’s manageable. I expect continuing improvement. My surgeon does about 500 of these each year. Lots of experience is a good indicator of skill. No robotics. Thirty years’ doing this.
I had a tkr in August 2020. I love to do spin classes I’ feel amazing. I’m wondering if it’s to early for spin classes.
I resumed cycling at 7 weeks from TKA. First week was 2-4 mile test rides. Then 10 miles. Start easy. Watch out for swelling or pain. August to November should be fine. Everybody is different. Don’t overdo it.
Each person is different on their recovery and slow is fast as they say. Take it a small step at a time and if it feels ok, add sometihng. Time, resistance, speed, etc. but again, just a little. Keep it up.
Mike Henderson
I had a TKR aug 24 2020. I still have pain mostly at night. Got on my bike 4 days ago. I got an electric for rehab purposes. I love it. I feel good except at night after riding. I think 10 miles sounds good. Also the next day I feel better after riding. Good advice to go slow and gauge your activity by how you feel!
I’m scheduled for a TKR later this year, and I just turned 30. I appreciate reading everyone’s stories – it’s been tough trying to deal with this, and I’m encouraged that it shouldn’t take too long to get back on my bike. I’m an avid biker and do annual 120+ km rides, and the thought of spending any time off my bike isn’t ideal.
I’m curious if anyone had major issues with ROM going into the surgery, and what the outcome was. For context, I have septic arthritis from an ACL reconstruction, and only have ~100 degrees of comfortable ROM.
Thanks!
Katrina
Hi Katrina,
I hope your knee is doing well. I too had a previous ACL reconstruction, which allowed me to backcountry ski, backpack and have a dance career for many years, in addition to bike racing. After the ACL, my knee was never quite the same, though, and I’ve always had ROM issues. I’m about to have TKR and have the same question you asked here: Did that previous ROM affect your recovery from TKR? I’d be grateful if you’d share your experience. Like everyone, I’m eager to get back on my bike asap!
I hope you and your knee are doing well, and thanks in advance.
My name is Mike Henderson and I am the person who posted the original article on TKR. Interesting enough is that I’m going in for hip replacement this Feb. I had the right hip done a few years ago and on my final exam the Orthopedic, Dr Fraser, said the other hip would not be far behind. The full body x-ray will be something to hang on the wall; shoulders, hips and knees.
Having an operation of any sorts should not be taken lightly. You will be informed that things can and sometimes do go wrong. But with that in mind I have had over 28 different operations in my 61 years and have never once had any bad things happen. Twice I’ve defeated cancer and survived the wonders of chemo. My right shoulder has been replaced and the other has a strap holding bones together. Both knees and one hip have been replaced and soon the other. My knees had a lot of pieces removed from them in my early years from sports I played. I’ve used and abused this body and let the warranty lapse but have enjoyed every minute and continue to push this flesh to the limits. This summer I have a 300-mile, 24 hour in one day bicycle ride scheduled to raise funds to fight cancer and test out my new hip. Date to be determined but possibly Sept or Oct.
My main point is be prepared for some pain and frustration. Pile on a lot of optimistic outlook and as much knowledge as you can find. The internet is full of articles, helpful videos and thoughts. It won’t be easy and it’s going to take effort on your part to make it to a positive result. Doctors are not miracle works. They are human and most are doing the best that they can to help us live. Watch a few YouTube videos on the type of operation you are coming up on and you’ll have a better appreciation for their job.
Therapy, exercise, rest and proper use of the medications has helped thousands. I’ve found the few who complain or have issues brought it on themselves by not following all the guidance. Yes a small percentage something went wrong, that’s life.
Good luck with your procedure
.
I continue to coach and help others with Total …Whatever Replacements. Remember, I’m not a doctor just a lifetime of experiences with being under the knife. I’m available if you want to ask questions.
Best Wishes. Mike Henderson
Thanks for the wise words of advise! And wow, you have quite the story. Not much more to be said for the resilience of the human body—your story is incredibly encouraging.
Luckily I’ve had sometime to prepare myself for a TKR, I have septic arthritis from and ACL reconstruction 14 years ago and consequently have had 6 knee operations—although all minor in comparison to a TKR. I’m painfully aware of the negative side affects of surgery, infection is a less than 1% chance and yet here I am. It’s tough not being able to hike, or even go on walks, with friends at my age. Thankfully cycling is something that I can excel at, so I’ve thrown a lot of energy into that.
I appreciate the stories from folks who are like-minded athletes, as scouring the web for info on what to prepare for if you’re only 30 doesn’t yield too many results! Most people I know personally who’ve had TKRs are older family or parents of friends and they don’t have the same drive to get back to sports as I do.
I know my knee will never feel ‘like a normal knee’ after a TKR, but I’m excited to get it done and have some relief from the pain!
Patience and directed Physical Therapy will be critical to your recovery. You will be off the bike for 7 weeks or so. I resumed cycling very carefully. First rides were short (3 miles) for several weeks. Build gradually. If you try to force your way thru this your knee will swell and recovery be delayed. By seven months I am cycling close to Pre Op levels. Recovery will continue. By 18 months I may no long notice my new knee.
I set up my bike with flat pedals before the operation. No clips to resume. When resuming SPD pedals unclip at the bottom of your pedal stroke. Avoid twisting your leg.
My first TKA was March 2020. My second was last week, January 2021. One knee at a time, thank you.
This is a well established procedure. Build strength beforehand. Be patient Post Op. Listen to your Physical Therapist. Good luck.
Ah yes, will definitely be putting on flats. Good reminder! I’m definitely going to have to work on the patience piece—patience is a virtue that I do not possess 😉 Luckily I have a good team around me, a lot of my friends are physios and personal trainers, and one friend is an ortho who I can bounce questions off of. My husband is a professional mountain biker, so between the two of use we basically have a full physio set up at home—no excuse not to rehab for me.
I’m 4 weeks out from a partial knee replacement. It’s been great. I already can do 10 minutes on the stationary bike. I’m in Florida and my bike is in the condo and it is hard to resist. I already overdid walking and got increased swelling. I don’t want to screw this up!
Swelling is normal and expected along with pain. There are many different levels and it varies for each of us. Ice is one of your best friends. We have a ice machine on our frig and it can’t make enough for my first week of needs after replacement surgery. To help II fill up my freezer with a huge garbage bag starting a few days prior. For me, ice is the tool that best fights the pain and thus lessen need for prescribed meds and even over the counter. Aspirin will help reduce swelling and again we each have different levels our bodies will tolerate.. You doctor will give you guidelines which you can adapted for yourself. Slowly but consistently keep with the therapy. It’s going to hurt some and this is normal.
Swelling is a warning. This can delay recovery. The stationary bike is the best reintroduction of cycling. Short intervals daily are better than longer efforts. Physical Therapy is helpful too.
Be patient. I’m at 45 days just returning to the road bike. Four miles is OK. Ten miles is not as I discovered! My right knee took 64 days to get back on the bike. You’re in early days. Don’t risk swelling and possible blood clots.
Tips for the road bike: install flat pedals without toe clips (no SPD yet either) and ride in street shoes, raise your saddle an inch or so (you will feel tightness in your knee at top of the pedal stroke). When you get your saddle back down and install clipless pedals again be sure to disengage your shoe at the BOTTOM of your pedal stroke. Your new knee won’t like flexation and twisting. Extending to the bottom stroke reduces flexation and twisting effort.
72 year old club cyclist from London UK here with an average weekly distance of 200km. I had TKR on left knee last September 2020. I had no weight issues and leg strength after years of hard riding was great; I rode until the day before the operation.
After years of increasing discomfort and pain (mainly caused by running I should add) my goal was two-fold: to be able to walk normally and play with my grandkids, and to be back on my bike ASAP. The former was achieved rapidly and I was walking 3/4 miles by the end of October with no pain or reaction in the new joint. I had three sessions of physio – mainly concentrated on flexing and straightening – and did a set of stretching exercises diligently each day. I have a bike set up permanently on a turbo so climbed aboard 4/5 weeks after the op. I couldn’t turn the cranks a full revolution- the knee simply wouldn’t bend enough and the pain of trying was unbearable. I didn’t see any sense in forcing the issue and setting-back my recovery so contented myself with just rocking the pedals back and forth – and over the course of the next few sessions noticed that the restriction was lessening. I was soon able to turn the pedals fully standing up but pedalling seated was still quite painful and I was torn between pushing through it, or accepting that it was going to be a longer journey than I’d hoped.
All the advice I received was to be patient and not aggravate the healing process. This was November – two months post-op – there was still swelling and heat around the joint so I simply accepted that it was going to take time and readjusted my target of riding by Christmas to riding by early spring. The surgeon had advised me that it would be 6 months before the knee felt anything like normal and 18-24 months for full recovery. For a few weeks I stopped using the turbo and concentrated on walking, so when I finally got back on the turbo I was pleasantly surprised to find that the knee felt freer. It also became obvious to me that I could help matters by raising my saddle, thus making the angle at the top of the revolution less acute, and by shortening crank length.
I have six bikes, some Shimano-equipped, the rest with Campag. Sourcing short cranks was not easy (I have yet to find anything below 170mm from Campagnolo) as there seems to be an accepted view that the taller you are (I’m 182cm) the longer your cranks should be. This is a view that has been challenged by many pros – Wiggins used 165mm when for the attempt on the 1 hour record attempt – and is probably a debate for a different forum but I use it to illustrate how hard it was to obtain anything short enough for my purposes. However eventually I found an Ultegra 160mm to replace the 172.5mm on the turbo bike. . I was fortunate inasmuch as the left (non-drive) was the easiest- and cheapest! – to replace. A few minutes with a couple of tools and …. bingo! The difference was instant. I was able to spin the pedals seated immediately without the discomfort I felt at the top of the revolution. I started to do regular 30 minute spins and this week exactly 5 months after the operation went for a very short ride on the road. I used a CX bike with a 48/32 set up to give me lots of easy gears with a 165mm left side crank and did. 15 minute warmup on the turbo bike before venturing out. It felt a bit weird at first – different crank lengths causing slightly lopsided pedalling but I soon adjusted. I rode for 20 minutes and felt great.
Pedalling is not entirely smooth – the knee is still stiffer than I would like with less flexion than I need – so my left hip rises slightly at the top of the pedal stroke. Hopefully this will decrease in time. I have used clips on the turbo since Day 1 and never found clipping-out a problem. The CX bike has 2-sided SPDs which made things easier. I start off with my right foot clipped-in and push off with my left leg. Having ridden with cleats since they superseded toe-clips clipping-in was an unconscious action until this week when I realised that my left foot normally grabs the cleat as the pedal rises to the top of the revolution. Not any more! On my second ride this week I used one of my road bikes fitted with SPD-Ls and was not at all comfortable trying to find the cleat on a single-sided pedal so have put the SPDs on that bike now.
It’s going to be some time before I can ride any distance I know and there is a lot of tweaking to be done on the bikes – crank lengths, saddle height and position on the rails.. Stem length and stack height are also variables to experiment with and I think I’m gong to reequip my Campag machines with Shimano 165 chainsets.
This is a much longer piece than I’d intended but I hope that anyone going through the same process might find my experience of some use. I did a lot of reading before I finally took the plunge and had the operation and was heartened by the amount of positivity I found. I haven’t regretted the TKR for a moment despite the pain and discomfort of the immediate post-op period- to be able to walk again with no discomfort is reward enough and if I can get back to cycling the kind of distances and pace I’ve been used to that will be a wonderful bonus. Keep your chins up and your a***s on a saddle!
David
I am 74, quite fit and had a right TKR July 2020. I also have significant arthritis in left knee. Very slow recovery and still have significant pain and stiffness. I am recently back on my E bike. Pedalling is fine but I am quite nervous when dismounting, which I do from the right side of the bike (always have). I put my foot on the ground when the pedal is in the down position, but feel if I had to do this in a hurry I would fall off. Any suggestions would be very much appreciated.
Marcia
Hi! Thanks for the info. Avid cyclist here as well. TKR August 2020. I ride my stationary for 45 min to 1 hr a couple times a week. Not outside yet, snow on the ground still here. I’m waiting for the Spring, hope to be able to go out then. I worry about clips, probably not going to use them at first, I don’t know. The thought of twisting either knee does nothing for me. Stiffness is huge, you are smart to stretch. I find that when I get going it stretches the knee out, feels better. I’m still doing quad exercises from my PT because my muscles were atrophied, which helps a lot. I walk about 3 to 4 miles but find I am more comfortable on the bike. I agree with you, patience. I can see a big difference with time. Hang in there!