Need Advice on Knee Replacement

After riding a lot of miles in June with little pain, I decided to switch to swimming during the heat of July.  In that time, I noticed more limited mobility in my left knee.  But, I thought the swimming would help!

I finally got the modified handlebars on my trike and went for a ride yesterday.  After a mile, I still could not get my left knee to loosen enough to have a normal stroke.  It used to only take a block before it was loose.  Standing up has become difficult, also.  I can't bend my knees enough so I can put my weight over them.  So, I made an appointment with an orthopedic surgeon.

I was told in 2009 that I needed a total joint replacement but I was in my early fifties and they say these joints will only last 10 years.  Also, I was overweight and that would wear out the joint faster.  I tried Synvasc injections and had two cortisone shots in that knee.  The cortisone shots worked great for 6 months but I know they will soon deteriorate the joint.  Without a joint replacement or something else, I might now face the rest of my life in a wheel chair.  

Any advice you can give would be greatly appreciated.  I know the options have changed since 2009.  Any without pain?
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  • I just completed my 4th joint replacement. I was in a serious motorcycle accident in 1966 that nearly killed me. I have been suffering with physical issues ever since.

    Perhaps the biggest mistake was waiting too long before beginning to replace all my bad joints. I have had so much less pain in every joint I have replaced. The first, left hip, was replaced in 2010- 3 weeks later I has loading boxes in the moving van. I have never experienced ANY pain in that hip since 2 weeks after surgery. Next, was my right knee. The cold machine (highly, highly recommended) given to me for 2 weeks use, was defective for the first 3 days before anyone (other than me) was convinced I was right (it was cooling to only about 60 degrees- it is supposed to cool to 43 degrees!) that caused me considerable pain as the swelling was not going down. Eventually, they replaced the cooling machine with one that worked properly and I was on my road to recovery. The pain was gone after 8 weeks of PT. It should have been gone in 5 to 6 weeks had the cooing machine worked properly. It did take roughly 2 years before the knee felt like it was part of my body and not some foreign object inside my body. But it didn't hurt once PT was completed.

    My third replacement was my left shoulder. I figured that would be very painful. It wasn't. Six weeks of PT and there was no more pain... and none since! I didn't need any of this PT on any of the joints for the pain, rather just to get range of motion for full functionality and some strength training. The 4th replacement was my right shoulder (all of my joint replacements have been total joint replacement). I am currently 2 1/2 weeks out from surgery. I have some pain (but I have already weaned myself off of my post surgery prescribed narcotics). Both PT and my Surgery team tell me I am currently 2 weeks ahead of expectations. They have already cleared my to drive my car, and have cleared me to ride in RiderFest August 6- 3 1/2 weeks after surgery. I anticipate I will be pain free by then.

    In 2010, I was told my new hip should last 30 years or more. My knee is supposed to last 25-35 years, and my shoulders should never need replacement... even if I live another 40 years (at 66, I seriously doubt that could ever happen). I think you got some bad information in 2009. One thing to weigh, is the fact that every year you put off having the joint replacement you need, the slower and less complete your recovery is likely to be. I still have one knee and one hip to replace before I will be finished... unless my Rover rehabs my last knee and last hip.

    So, here are my recommendations-

    1) Before surgery, find out how much PT you have available for joint replacement from your health insurance company or Medicaid/Medicare. Typically PT is prescribed 4 weeks at a time, for 2-3 visits per week. If it seems you have plenty, get your orthopedic surgeon to call in 2-4 weeks of pre-surgery PT. Your recovery will be more complete, faster, and less painful the better shape your joint and associated muscles are in at the time of surgery. I did 2 weeks of PT (six sessions) immediately preceding my surgery. My medical team and I all believe that is the reason I am 2 weeks ahead of schedule.

    2) This is perhaps most important. Be sure to choose an orthopedic surgeon who has lots and lots of experience - especially with replacing knees. Try and choose one of the top orthopedic surgeons in your state. I see Dr. Joe Burkheart who has been rated as one of the top 60 orthopedic surgeons in the US, and top 5 in Michigan. You should also find out which manufacturer of artificial knee joints your surgeon uses. They are not all created equal. Ideally you want a surgeon who uses the medical parts you believe to be best and is a top orthopedic surgeon.

    3) Make sure you investigate PT facilities in your area ahead of time. Really good ones can be hard to find. Most work on a weird 30 minute schedule where you spend 15 minutes one-on-one with a therapist, then 10-15 minutes on specialized equipment in a group setting. At the end of your 30 minutes, you are dismissed and not allowed to do any more work in the group area. The ones I prefer, do more of a team approach. Here you get a specific therapist that works with you and keeps your progress report and does some one-on-one work with on each visit and give you specific exercises to do while there (and more for homework). Your therapist will spend time with a few other folks while you are doing your exercises, but all the therapists keep an eye on everyone. And any of them might give you some pointers to assist your recovery. At places like these, you aren't limited to just 30 minutes. I typically spend 1-2 hours there if I have the time and the therapists don't think I'm doing too much. I am not a fan of skipping PT (it isn't required) or doing home PT. The equipment available for your recovery will be much better than anything you might be able to do or use at home, plus you have the benefit of experts who will make sure you are doing things properly. Once Medicare says I've had enough therapy, and they won't pay for any more, My PT facility offers a one month "maintenance" program where you get no direct time with a therapist, but you are free to come in and work on the equipment under therapist supervision, for a one time fee of $50. I love these guys, and would never even consider any other PT facility. I checked out 7 PT facilities before I found my current one.

    4) Get your medical team to follow the Mayo Clinic post joint replacement pain control regimen- You don't get narcotics containing any over-the-counter medications, just the narcotic. You first get your base pain control established by maxing out on the normal over the counter products (Tylenol & Motrin if you can take both) at there daily limits. Then, every 2 hours (or there is a 4 hour option) you alternate taking one oxycodone, then one dilaudid, while you alternate taking a Tylenol with one narcotic and a Motrin with the next one 2-4 hours later. This has proven to be the BEST and MOST EFFECTIVE way to control pain following joint replacement. It does so by attacking the pain with 4 medications that all work a little differently. After a couple of doses, you will have residual quantities of 4 different medications at all times, and never too much of any of them. Further, this is the best way to eliminate the possibility of addiction to either of the narcotics. This is what we did after my knee surgery to relieve the pain I was experiencing because of the faulty cooling machine. Don't try and be tough and try to refuse pain narcotics or stop taking them too early. This will delay and retard your recovery not to mention making it a much worse operation/recovery experience.

     





  • One more thing. There are two basic ways they replace knees. The more traditional approach is to immobilize the leg while in a jig, cut the leg above and below the knee and remove it. Next, grab an artificial knee off the shelf that appears to be approximately the same size as your bad knee. The better approach (and you may have to specifically request it) is to get an MRI of your actual knee which is then used to make an exact replica artificial knee - exactly the same size and shape as your old knee!

    Best of luck with whatever you decide to do!
  • Thanks for all the information!

    I'm not big on taking narcotics.  I only took one pill after my hysterectomy because I developed a fever once I got home.  I had orthroscopic knee surgery in 1995 and they also remove a growth on the front of the lower leg bone.  Then they had a manual cooling machine.  A knee wrap was attached to a small water cooler containing ice water.  You would let ice water into the wrap and replace it as it warmed.  It was awesome, really helped me get sleep!  I don't remember taking anything more than Motrin then.  I was off crutches in a week because my armpits and hands hurt so bad I couldn't stand using them.  Since I was home alone, I figured it was better to go to work where people would help me occasionally.

    As you can tell, I have a very high pain tolerance.  I gave birth to twins with no pain meds.  That's why the pain I'm experiencing now has me concerned.

    Since I have arthritis, I expected the exercise would loosen the joint.  Instead, my range of motion has decreased.  I have been doing walking motions in the pool since I can't walk on land for any great distance (mostly due to my back) and I also tried knee lifts.  They didn't go very high.  Now my left knee won't straighten nor will it go past about 70 degrees.  It's kind of useless!

    Have any of you tried physical therapy first before surgery?  I think they might consider this.
  • I have been told that I have a high pain tolerance, but when they made the mistake with the cold water machine (mine was a machine that cooled a water to 43 degrees and sends it into a shoulder wrap). Knee replacement surgery can be more painful then childbirth my doctor told me. And when it comes to pain, it is ALWAYS easier to stay ahead of the pain then it is to catch up to it if it does turn out to be excruciating. You can always start to wean off the pain meds once you wake up after surgery. But I tried to do without pain meds for my hip and am glad I choose to use them for my knee. I went through unnecessary excess pain for the first week following hip surgery before my doctor insisted I use my meds. I'm grateful I did, I greatly shortened my rehab.

    I did PT every 6 months for a year before having hip surgery, but none just before surgery. My pre-surgery PT for my most recent shoulder replacement occurred 2 weeks immediately before surgery.
  • One more thing. My orthopedic surgeon was the one to suggest getting a trike to best rehab from knee and hip replacement with one caveat- he told me that to properly ride a trike or bike without putting undue strain on knees and hips, I should peddle at a high cadence. I was told that I should seldom if ever peddle at a cadence below 60 (60 crank revolutions per minute), and it would be better to keep the cadence between 70 and 90. Riding this way takes some getting use to, but will be much kinder to your knees & hips. I'm told that professional cyclists typically try to maintain a cadence of 90 to 120 since Lantz Armstrong did so well for so long doing just that.

    Unfortunately, cadence readers are not so easy to come by for a trike. Seems it may be necessary to get one that uses Bluetooth or something called Ant+ I think. He suggested a Garmin 520, but they run $300+. It is actually a bike computer that offers multiple functions, but I can't bring myself to spend that much money. He said what ever I get to be sure it doesn't use magnets. Apparently the G520 was the only one he knew would get the job done.
  • Thanks, you convinced me to use pain meds.  You asked about the surgeon.  If I were still in the Florida panhandle, I could have seen Dr Andrew, the Orthopedic doctor to the athletes.  But, I'm sure the one I chose down here is great.  I think they do more joint replacements in South Florida than anywhere else!
  • I tried riding again today.  I made only 5 miles at an average of 6 mph and didn't have a single stroke without pain in either knee.  I go to the orthopedic doctor on Tuesday.  

    The only reason I stopped swimming was that I was concerned about the cleanliness of the pool.  Through the entire month of July I never saw the pool maintenance guy.  I was there between 7 and 10 am every other day.  Two times last week I found a large frog in the pool.  Most pools down here use salt instead of chlorine.  I don't know if that's better or worse for killing germs.  
  • Well, it looks like I'm getting two new knees at the same time.  The doctor said they will replace one on Monday and the other on Thursday for a 5 day hospital stay.

    He also said these were the worst knees he's ever seen.  No other patient had let their knees get this bad.  And here I thought the riding was helping!

    The surgeries will occur about the end of September.  Then they want me to stay in a rehab facility for 3 weeks.  I just need to find out how much my insurance will cover and how much out of pocket I'll need to pay.  It's really expensive to get healthy!
  • Best of luck to you with the duo knee replacements. I have only heard of someone getting two knees done at the same time- she was a gas meter reader who needed to walk and drive every day for her job. She did exactly as your surgeon is suggesting- 3 weeks in a residential rehab program. I'm told that miraculously she was back on the job in a month! I hope you recover completely and quickly. I'm sure you will, as your high pain tolerance and strong work ethic will serve you well. Just make sure you line up some assistance at home in case you need it. Also, if you haven't developed a high cadence trike ridding habit, you will need to in order to protect the knees. It was suggested to me that I try to keep my cadence between 70 and 90 crank rpm. The pros try to maintain 90-120 I'm told. When you use a high cadence, you are kind to your knees and hips!
  • A guy came into the PT facility I utilize today, with two new knees... done the same day. He said he was only admitted to the hospital for 3 days before they released him to the residential rehab facility. He was there just 2 weeks before they released him to finish therapy as an outpatient closer to home. Why are they planning to make you go through the operation twice rather than do them together?
  • I don't know why he wants to do two separate surgeries but will ask my doctor.  I was looking for rehab facilities to see if they were a preferred provider for my insurance.  All I found were alcohol rehab facilities.  I need to get names from the doctor to verify which best.

    I was thinking last night that maybe I should do one knee at a time.  But, it's probably easier to get it all done at once.  I know it will be cheaper.  Only one copay.


  • Instead of looking up rehab facilities, try physical therapy. Acute physical therapy is, I think, in residence. Just a thought, I am no expert.
    Perhaps the reason for two surgeries is your personal physical condition. Asking your doctor is a great idea.
    I wish you all the best
  • My wife went to a rehab facility for two weeks following her last knee replacement. It was in same nursing home facility where my father resided. They had one wing for "rehab." So, try some nursing homes in your area. There might be some set up similarly.
  • Thanks for the help!  I will ask the doctor.  I also need to ask why he prescribed me narcotics when I don't even take Motrin on a daily basis.

    I don't mind being in a facility with older adults.  I'm not that much younger than some of them.  

    Trikebirder, I measured my cadence today using my Apple Watch.  It was 32 with a speed of 8 mph.  I really can't go much faster because my left knee won't bend fast enough.  Maybe in a few months!

  • I am confident that you will be able to get your cadence up with a bit of practice following PT. I spent an extra hour at PT yesterday (I love that they will allow me to do this!) and spent 40 minutes riding their Cateye - Recumbent-like - cycle exerciser. Maintained a cadence of 70-77 rpm most of the time. I tried to pedal at 90 rpm, but was unable to maintain it for any length of time. Additionally, I got really exhausted trying to do so. I thought I was probably riding my trike at a cadence about 60 rpm, I now realize that I have probably been very inconsistent in cadence and probably riding between 45 and 60... that's why I need a cadence sensor. Perhaps after riding at an average cadence approaching 90 rpm for 500 to 1000 miles, then perhaps I could get by without one, and know approximately what my cadence is, but not otherwise. Furthermore, I did notice that the pros who participated in this year's Tour ALL were using cadence sensors. So, if the pros who literally ride thousands and thousands of miles each year think they still need a cadence sensor, I suspect that it is perhaps a little naïve to believe that any of us casual riders can "know" what cadence we are riding at with any degree of certainly.
  • edited August 2016
    Another thought harkening back to my wife's first knee replacement. Prior to the replacement surgery, her surgeon prescribed at least two months of PT. He did that to strengthen her leg in preparation for the surgery and rehab. She has always felt that was good for her and contributed to a very successful rehab.
  • Yup, the better you are prior to surgery will impact your recovery
  • I was riding every other day then from November until June.  In July I switched to swimming because it was very hot, even in the early hours.  This week I did each on alternating days.  I plan to continue that as long as I can handle it.  I really want to lose some weight before the surgery.  I know that will help with the rehab.

    BTW, it seems I will be doing rehab at home or at my sister's house.  I found out today that two facilities are Medicare only (I'm not old enough) and two are not recommended due to the care provided.  There is only one facility they recommend and there is no guarantee I will get in.  I'm instead going to see if one of my sons can come help me along with my sister who is a nurse.  I'd rather be at home anyway!
  • Strictly from my own personal experiences sharing stories with other joint replacement patients, I don't recommend it. I would encourage you to see a bonefied Physical Therapist. Your sister and sons can always play a backup role if you can't get into the one possible facility that remains, and many universites and hospitals do therapy on an out patient basis. There are also PTs who can come right to your home.

    If you needed a tooth filled or pulled, would you settle for having your nurse sister do it? Or take your Ford SUV to your Chevy salesperson brother-in-law to replace the trans axel? Just saying. 
  • Both a physical therapist and a nurse will do home visits.  Sorry, I forgot to add that.  My home is handicap accessible also.
  • I talked about your situation with my PT gurus today. They all agreed that a PT specialist is the best option for a quick and complete recovery. I'm glad to hear that a PT expert will be making home visits for you. That said, my gurus all agreed that trying to rehab exclusively from home will take longer and has a greater risk of not being as complete a recovery as one might expect with regular visits to a PT facility. And they have all worked with PT in folks homes. So if there is any way you can get to a PT facility which will have specialized equipment and can watch your technique while you rehab, I believe you will grateful you did.

    Now, with all this said, both my surgeon and PT guys tell me that 10 years after surgery, nearly everyone performs identically. The question becomes, how quickly do you want to reach total recovery rehabilitation? I confess, it sounds like your options are quite limited. I am confident that ultimately you will choose your best options(s) given all the information you receive from all trusted sources. Best of luck going forward. 


  • I'm going to talk to my doctor's office on Monday to get this finalized.

    I've been biking or swimming in a lot of pain the last year.  I guarantee you I will do everything I need to do to recover as soon as possible.
  • Well, the dates of my surgeries are 31 Oct and 3 Nov.  Wish I could do it sooner but it's hard to schedule both in a week.  I save a lot of money by doing both during one inpatient stay and one rehab period.

    PapaSkisNTrikes, I have continued to swim to try to lose weight before the surgery.  I do all different types of aerobic exercises while treading water.  I recently started jumping up and down in about 4 feet of water to try to strengthen the knee muscles.  I figured that would help the rehab.  Any other suggestions on exercise?  I tried riding the trike but it's just too painful.  My range of motion is so limited.  

    I can't wait to get this over with!
  • All I can say, based on my wife's experience with two total knee replacements, plus her input as I print this out, is, after the surgeries A) therapy, therapy, and more therapy, B) keep moving as much as possible, and C) working/focusing on total flexion both straight and bent.
  • FloridaBound, wishing you good things ahead.
  • Any suggestions on exercises to do before the surgeries?
  • edited August 2016
    Shorter crank arms will make for easier acting knees and also sometimes hips; less range of motion required and reduced leverage. Mother-in-law (84 this year) has bionic hips and knees and rides a trike all the time (2-5 miles at a time). She was told to ride by her surgeons both before and after each surgery.
  • Ok.  Another person also told me riding with strengthen the leg muscles and make recovery easier.  I'll get back on the bike if the thunderstorms ever stop!  Gotta love summer in Florida!
  • I had both knees replaced, right almost 10 years ago, and left almost 9 years ago. No regrets!! Good physical therapy is the key to success, as well as a good surgeon!! The one I used was strictly a knee surgeon. He was doing about 300 a year, and could do one in about 30 minutes. He was very careful about the surgical site, and would cancel surgery if there was a nick, scratch or pimple near the area. (So protect the area as surgery approaches.) He has a very low complication rate.
    I, too, have a high pain threshold plus allergies to the common pain relievers. I have discovered that tramadol works well, and for me, no drowsy effect. One of these 30 minutes before PT really helps; and, as I said, good PT is the key to success.
    I know that there is controversy over premedication with antibiotics before dental work after knee replacement, but my doctor was for it, and we've had 10 years of success.
    I hope all goes well!
  • I was required to take 1000 milgram antibiotic prior to dental work after having cervical spine fusions.
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