As mentioned, October 7th was the annniversary of the total knee replacement (TKR) of my left knee. I've been thinking about how to sum up some of the things I've learned during my recovery, and thought I'd compose list, because that's what journalists do when we can't think of anything better:
1. Cycling is the perfect form of physical therapy for TKR recovery. It pushes range of motion (ROM), strengthens muscles, and helps loosen and pump inflamation out of your knee. On Oct. 30, 2009, roughly three weeks after my surgery, I was able to pedal a bike using a 360 degress motion. Some TKR patients get back to cycling a tad more quickly, but I had limited ROM those first few weeks, because I tend to swell a lot after a big surgery like TKR. Of course since then, I've used cycling as my main means of recovery and strengthening from the surgery. By May, I was able to ride a 60 mile ride with some friends, and by September, I completed a full century in good form (for me, anyway, which I about 6 hours on the bike).
2. Prepare to start slow with the cycling. For me, this meant setting up a cruiser bike with platform pedals on my indoor stationary trainer, and putting the seat up considerably higher than normal, which in effect makes it easier to revolve the pedals without bending your knee as much (I've read it takes a 110 degree bend, but it can be done at a 100 degree bend if you cheat on form and bow your leg out slightly or keep your ankle up a bit at first). The platform pedals also make for less stress on a still swollen and painful knee. Don't worry, you'll be back on your road bike or "normal" bike soon, but I would advise setting yourself up with something easy to ride with comfy seat and platform pedals, at least for the first week or so of being back on the stationary bike.
3. Take advantage of physical therapy sessions and do all the ROM stretches, leg lifts, and other tricks your PT folks suggest. It's amazing what they have in a good PT clinic--sort of a combination of a health club crossed with semi-torture devices reminiscent of pictures of the Spanish Inquistion. They will whip your ROM back into shape for sure! In short, just because you are a cyclist, don't think that cycling is the best and only way to recover. I found ROM stretches, leg lifts, and quad flexes with a light ankle weight to be extremely important to my early recovery. My insurance only paid for physical therapy through late December, so roughly about 8-9 weeks, going three times a week, as I recall. I had some hefty copay on it, but it was well worth it.
4. Keep up with the ROM stretching and weight lifting after formal physical therapy ends. After my PT wound down, I joined the local YMCA so I could keep up with leg lifting machines and the use of an elliptical trainer. When the outdoor cycling season began again in late winter/early spring, I kept up with the leg lifting, even though it probably made me slower on the bike because my muscles were in near constant recovery mode. But I knew I needed to target the rebuilding of muscles, and that the leg press, quad extension, and hamstring curl machines would help. I stayed with fairly light weights at first, but kept it up regularly until early summer. By summer, I curtailed the leg lifting because I was cycling more than enough to get a good workout for my legs. However, through summer, I worked my calf muscles with weights at least once a week. Over the years, the valgus deformation of my left leg has caused my left calf muscle to atrophy, and I wanted to build that back. Only now is that left calf getting back to the tone it had 15 to 20 years ago.
5. Be patient with your return to high-paced, hard cycling. By late spring, I was feeling pretty good pedalling my road bike, but I didn't have the sort of high-end power needed to keep up with fast riders. I was keeping to shorter distances (less than 100 kilometers), and not doing any sprint work or climbing out of the saddle. In fact, when I did try to climb out of the saddle, it hurt a little bit, though it felt good to test the limits of what I could, and hurt less with each test. As the summer wore on, I felt better on the harder efforts. Maybe others could come back more quickly to their cycling peak, but I would advise that if you race or do fast club rides, don't plan on being able to go balls out for many months after the surgery. In fact, I would recommend taking a full season off from competitive cycling, allowing your new joint to slowly strengthen and lose all swelling, which my surgeon says can take up to a full year. Steadily work your way back to faster riding, perhaps targeting an event about a year after the surgery as your "comeback" event.