As written about in my last post, it's been a year since my total knee replacement (TKR), and I'm sharing my top lessons learned. Here is the second half of those tips:
6. Get refit on your bike. In my case, my left leg ended up being much straighter than it was before the surgery. This can be fairly common among TKR patients, because the "bone-on-bone" condition many of us suffer through prior to surgery wears away of the bone on one side or another of the joint. About three years before TKR, I had a bike fit specialist set me up with some shims to try to bring a more even pedalling motion to my arthritic leg. At the start of the 2009 cycling season, I had another cleat fitting after I moved to Green Bay that resulted in a further modification my shim set up. After my TKR, I started pedalling using no shims, but after several weeks, went back to my local bike shop (the Bike Hub) so that the fitter could take another look. We ended up using less shimming, slanted toward the other side, and moved my seat position a hair higher. After riding the roads in the spring, I took out one shim, and that has resulted in a good pedalling motion. However, I should probably go back again for a final look, as I feel my motion may be a bit off. A professional bike fitter can spot little imbalances that even an experienced cyclist won't notice on his or her own motion.
7. Don't be surprised if your artificial knee is noisy. When cycling, my artificial left knee still makes a lot of noise, but it doesn't hurt when it makes noise. Before TKR, my left knee also made a lot of noise while cycling, and, it also hurt sometimes under harder efforts. I was sort of hoping my new knee would be less noisy, but overall, I'm not disappointed. It functions well both on and off the bike, and I've come to the realization that it isn't going to feel like the type of normal, natural knee I had as a very young man. After all, my first knee injury was in 1976, and I had two knee surgeries before my TKR.
8. Be ready for setbacks. For me, after a successful summer of riding and a great outing in my first post-TKR century in early September, I had a painful "clunk" from my patella (kneecap) area a few days after doing the century. I attribute it to overuse, since right after the century, I went stream fishing for a couple of days, and then was lifting and portaging a canoe. Thank God, the clunk went away and hasn't come back. It also took a very long time for my swelling to completely subside--close to eight months. In short, be patient, and don't get discouraged by setbacks. Instead, be positive--your condition will improve with time.
9. Pushing your limits is a good thing. By late winter, it was warm enough to ride outdoors again, and despite trying to take it easy on the bike, I couldn't help testing the new joint by trying to pedal out of the saddle now and then. When I first did this, I could feel a little twinge of pain, similar to the pain I felt when trying to lift heavier weights on the quad extension machine. Whenever I felt a twinge, I would ease up. But right after those little twinges, my knee actually felt better--looser, stronger, and not as creaky. How far you can push it is the tricky thing to figure out. Most people going through TKR know their knees pretty well, and can sense when they can go harder. It's my belief that some harder efforts on the bike or using progressively heavier weights in the gym are the best way to really break up and pump out the last of that lingering inflamation.
10. Get off the bike and start enjoying other activities. In the last year or two before I had the TKR, cycling was the only activity I could do on a high level without much pain. I could only walk about a mile or so without my knee swelling up. Standing in line at stores, at a conference gathering, or farmer's market, or that sort of "milling around" event, was out if the question if it involved more than a few minutes of standing. Now I can hike eight or 10 miles without pain, enjoy walking in the outdoors, (like I did at Yellowstone--see video), or wade a stream fishing for several hours.
I love the bike. It's been a savior for me these last several years and as the cornerstone of my TKR recovery, but now that I can do more of other things, I am.