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  1. #1
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    New knees and biking

    I got a complete set of new titanium knees 3 years ago. According to all the experts I am not supposed to run, lift weights, play tennis, football, soccer, rugby or any other "leggy" sports. However bicycling and swimming are good. I hate to swim, love to ride so that was an easy choice.

    I have put about 1,000 miles on my road bike in the last 12 months and as a result I am riding faster and harder than when I started. I know this doesn't sound like much but I am pretty proud of being able to average 14 mph for 30 miles.

    Now here is the question. I know that when doctors and the general public say to go biking for exercise that they are thinking about the usual person going 8 to 10 mph while meandering on the trail wearing flip flops and a straw hat. Am I pushing too hard for my titanium knees? There has always been some "play" in the knees and I was hoping that the exercise would "tighten" things up. They still pop like they did when new and I do feel a little soreness after a hard ride.

    Any words of wisdom?

    Buck67

  2. #2
    tlg
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    Quote Originally Posted by Buck67 View Post
    Am I pushing too hard for my titanium knees?
    What does your orthopedic Dr say? Wouldn't you trust his advice over a bunch of unknown internet strangers?

  3. #3
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    I was hoping to hear from riders with metal knees. My surgeon didn't look like the type that has ridden a bike since grade school.

    Buck67

  4. #4
    wim
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    You're correct about most doctors not really knowing much about the kind of cycling we're talking about here. But whoever you entrusted your knees to should know plenty about biomechanics, including stresses put on a knee joint by different activities.

    I would go back to your doctor and explain what exactly it is you're doing. If you are using clipless pedals, it's important to mention that fact. You may have to explain the intricacies of such pedals to your doctor, including how float works and how none of those pedals allow canting of the foot (inversion and eversion is the biomechanical term).

    Can't say if you're pushing too hard. Even pushing a huge gear, forces (Newton) on the knee of a recreational rider are rarely more than climbing stairs. But the difference between climbing stairs and cycling is that in cycling, you generally stress the knee many, many more times than you would ever climbing stairs because of the typical duration of bicycle rides. And, as mentioned, your feet are limited in movement if your shoes are locked to the pedals. That limitation can have a significant effect on your knees.

    At any rate, just some thoughts. Bottom line: talk to your / a doctor, which I decidedly am not. And I don't have metal knees, even though I loved to push huge gears (like a 53 x 13) for long periods of time when I was still riding race-type bikes. I'm 70 now and have lost interest in riding such bikes, it's a mental thing.
    Last edited by wim; 09-09-2013 at 07:00 AM.

  5. #5
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    Quote Originally Posted by tlg View Post
    What does your orthopedic Dr say? Wouldn't you trust his advice over a bunch of unknown internet strangers?
    This. Some of us have titanium plates in our heads. There is a "tightening" exercise........lightly weighted leg extensions, but they're mostly for knee cap stabilization. Again, see your doc.

  6. #6
    wim
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    Quote Originally Posted by tlg View Post
    What does your orthopedic Dr say? Wouldn't you trust his advice over a bunch of unknown internet strangers?
    Sure you would, but only if he or she is somewhat well-informed about the sport. Some doctors have never heard of clipless pedals or are amazed to hear that someone actually rides 100 miles in one day. I think that (perfectly understandable) knowledge deficit is one of the OP's concerns.

  7. #7
    tlg
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    Quote Originally Posted by Buck67 View Post
    I was hoping to hear from riders with metal knees. My surgeon didn't look like the type that has ridden a bike since grade school.
    You don't know if you don't ask. If he's intelligent enough to cut open your body and replace parts of it with man made components, I'd hope he's smart enough to comprehend the type of exercise you're placing on those components. I assume you're not the only person he's put replacement knees in. Surely he has other patients with similar concerns.

    If he can't answer your questions, see if there's another Dr in his practice who might be more knowledgeable with sport activities. If there's no other Dr then you should consider finding a new practice.

  8. #8
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    I had my right knee replaced 10 years ago and my last check in March showed very little change from when it was new. I have ridden over 4000 miles in the last three years since I started riding a bike and during the winter, I work out on stationary bike and elliptical at the local Y. I am looking to have my left knee replaced this Christmas so that I can be ready to ride next summer. I use clipless and have little to no pain in either knee when riding. Can't say that with my left knee doing other activities, like walking up stairs on putting too much weight on the knee.

    I also coach high school soccer and track so I keep myself busy and my Ortho's opinion is that I can keep on doing what I am doing. Hope this helps.

  9. #9
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    this is really a tough question.

    If your doctor is just a general ortho and is not a sports ortho, then even he may not know how to predict what will happen to your knee. I find that most doctors will err on the SAFE side, and they'll recommend you not to do the things you love/dying to do. Or if they do, then they will say something general like "just go easy". And I suspect most doctors say these sort of generic things is because there really isn't much statictics in the literal regarding knee surgery and playing sport.

    Although I've not had knee replacement, but I've had knee surgury. The surgery was to replace torn ACL, PCL. I also had some cartiledge tear underneath the patella. My ortho at the time was a young doctor who specialized in sport (specifically, he dealt with ski athletes who injure their knees a lot). He did my surgery, and afterward, he told me to "avoid" running on hard surfaces, no playing basketball (which I loved at the time). Eventually, I got around to running on the threadmills (didn't tell my doctor then), and even do some very light jogging on pavement. Thru trial and error, I've found the right amount of jogging that my knee could tolerate, and it's this sort of trial and error and understanding your body.. that you will have to discover. Even the best surgeon will not know your body like you do. Now today, I've re-take up cycling, and I've found that in cycling I could push my knee harder than I would be able to in jogging. But back in my mind, I'm always aware of any pain that may be creeping up. Pretty much I will immediately tone down and even cut short a ride if I sense any pain creeping up. And I've found that thru self-monitoring how my knee feel, I can have a pretty good cycling time and be able to push just as hard as any cat4/5 guys, and even cat 3 on a climb. However, I know that my knee does have its limits.

    I have an aunt, she's old in her 70s, and she had knee replacement. While she can walk now without resorting to a walker, she says her knee is still not "pain free". But before the surgery, the pain was pretty much unbearable, makes life miserable for her. So in her case, knee replacement is merely a patch to make her life a little more bearable. So it depends on your age too I guess. The younger you are, the more likely you can do other sporting activities.

    It's good that you are asking other people online. I think it's a great resource. Given the lack of statistics, resorting to asking the online community for anedotal stories is a great collorary to seeking your ortho's advice.

  10. #10
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    I have been promising myself to go talk to the Ortho for a while. I had my yearly checkup with my family doctor and discussed the biking and he didn't see a problem with it, but I guess I had better make an appointment for a follow up with the Ortho.

    However, I do want as much input from folks that have had this operation before I go in to see him. If you eliminate all the leg sports and biking as well, there aren't too many ways left to work up a sweat.

    I had both knees done at the same time, because I didn't want to be limping on one leg or the other for 5 years. I figured I was better off limping on both legs and getting them both strengthened at the same time.

    Buck67

  11. #11
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    New knees and biking

    Metal knees are my next step of I am not careful .. So I pretty much have to stay away from all the sports the OP listed. Cycling has been ok for me so far. I am ~9 months post op reconstruction

  12. #12
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    I wouldn't.
    Please buy my mattresses. They're on sale!

  13. #13
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    How did you wind up with the surgeon you got? Personally, I try to interview several seeking out sports medicine specialists before choosing. It's not too late to get second or even third opinion from specialists more knowledgeable about the best course of recovery for athletic/active individuals, and cyclists in particular.
    ... 'cuz that's how I roll.

  14. #14
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    I picked the surgeon with the most successful operations. At the time, I wasn't even considering biking, I was mostly interested in pain free walking. After my rehab was ended by the insurance company in a month or two I still needed a lot of work. So I have been rehabbing myself for the last several years.

  15. #15
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    I think you are wise to seek out the opinions of folks who cycle and have had knee replacements. A knee replacement is in my future, but I am trying to postpone it for a variety of reasons, including the pleasure and cardio benefits I get from cycling 150-200 miles a week. I have been to three different and experienced orthopedic surgeons who do only knees and hips and they generally say that I may have to reduce my level of cycling post knee replacement. The reasons are primarily the wear on the prothesis.

    I have searched cycling and non-cycling forums and medical literature to understand the experience of others with knee replacements who wish to cycle as opposed to ride a bike after a knee replacement. What I found is that there are a lot of folks who have had a replacement for 1-3 years and say they are better off than before the surgery, but there are very few folks post 3 years who report on their experiences. And, the medical literature seems mixed about the effects on joint wear and complications related to higher leves of cycling and other sports activities. You might want to check the Bonesmart forum and the cycling club section (it is in the social area) where there are foks who cycle and who have had knee replacements. They are generally pro replacement and most seem to be in the less than 3 year group.

    My guess is that talking with your doc will yield some helpful information, but you are also likely to get a conservative answer that will suggest a conservative approach to physical activity, i.e., it is ok to ride your bike, but cycling at higher speeds for longer distances may be problematic.

    I may be wrong, but I don't think the medical literature reveals that higher levels of activity post knee replacement is ok or not. And, I think docs that are specialists tend to come down on the conservative approach. So, understanding the experience of other cyclists with knee replacements is a good idea. I hope you get more responses from those folks.

  16. #16
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    Quote Originally Posted by azurenak View Post
    I wouldn't.
    a thoughtful and convincing argument. thanks for sharing...
    eff all y'all...

  17. #17
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    I have been riding seriously for over 25 years, racing some and averaging about 3 to 5k a year over the last decade. I was hit by a car and seriously damaged my right knee as a teenager so cycling has been about my only form of dependable exercise. i could go out and ride 60 miles w a group averaging 19plus and be on a cane the rest of the day. I just scheduled the full replacement of the knee, I expect my ability to cycle will degrade but everything else should improve. My surgeon, who is also a cyclist says, you cant ride on a fake knee like you can on a real knee. Looking forward to playing golf again!

  18. #18
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    perhaps a conversation with one of the reps / engineers from the company that made the knees would be helpful. They probably have a good idea of force and wear-out rates and might appreciate hearing your case study...
    * posted by Creakybot 2013 all rights reserved.
    * not actually waterproof.

  19. #19
    Stuart Toback
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    I had both knees replaced 12 years ago. I play Rackettball four times a week and ride about 100 miles weekly. My knees are as good as the day I got out of surgery. You can't really hurt those implants. If they are going to come loose, there's nothing you can do to prevent it. I also work in the O. R. and have participated in over 2000 total knee proceedures. If your surgeon is good you have nothing to fear from your bicycle. Go out and ride, I ride at an average speed of 18-20 all day without any pain in my knees. Now my butt is another story LOL. good luck!
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  20. #20
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    I was riding last sunday but unfortunately I sliped and got a head ijnury as I was not wearing helemet.


  21. #21
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    Quote Originally Posted by Oldlegs View Post
    I had both knees replaced 12 years ago. I play Rackettball four times a week and ride about 100 miles weekly. My knees are as good as the day I got out of surgery. You can't really hurt those implants. If they are going to come loose, there's nothing you can do to prevent it. I also work in the O. R. and have participated in over 2000 total knee proceedures. If your surgeon is good you have nothing to fear from your bicycle. Go out and ride, I ride at an average speed of 18-20 all day without any pain in my knees. Now my butt is another story LOL. good luck!
    Since bilateral TKR is in my near future, I am always encouraged to read about those who have long term success with the replacement of one or both knees. After consults with a couple of different orthos, both express concern about higher mileage cycling. The specific concern is wear on the joint from the number of revolutions in cycling and some concern about the the loads on the prothesis from climbing. Each physician has commented that debris from wear can lead to failure of the implant. Now, there isn't a lot of literature I have found that suggests how much wear results from cycling say 150 miles a week and 18mph and throw in some climbing on top of that. But, aseptic loosening/osteolysis are known factors in knee failure, but at what level do we as cyclists have to be concerned about it? (An internet search of those terms with total knee replacement or total knee arthroplasty will give you some articles to digest)

    My second consult doc suggested that after surgery I cut back to more like a 100 miles a week and 15-16 mph rather than 17-18 and eliminate climbing as much as possible. What literature I have found does not seem to have any firm evidence about what level of activity post TKR can be tolerated by active cyclists/athletes.

    So, the experience of other cyclists is very useful, but in my case it is at odds with what my docs tell me and one of them is an active cyclist.

  22. #22
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    That's a great idea, will ask the Doc when I go in later this month to update xrays

    Thanks

  23. #23
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    Awesome, great to hear.. Who's knees are you running? I am going with Wright Medical

  24. #24
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    If there is one in your area, find a fitter that tends to have a good relationship with orthopedists and PTs. Often, an experienced fitter will have more experience with knee replacement cyclists than the surgeon's who did the work, and more perspective. They can also refine your position to make it easier on your knees.

    If in the midwest, contact Cronometro for a fit.
    Get a better saddle: www.kontactbike.com

  25. #25
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    Get it touch with Andy Pruitt (or someone on his staff) at the Boulder (Colorado) Center for Sports Medicine. Being who is is an practicing where he does, I bet he answers your question several times a week. Thousands of "mature," active athletes in the Boulder/Denver area and I'm betting no small number of cyclists around here have had knee replacements. I know of a number of cyclists with full hip replacements who are still very active and ride hard, but the knee probably experiences at least somewhat more force than the hip. Part of the equation will no doubt be how long you want the replacement to last.
    A road bike needs disk brakes like a fish needs a bicycle (with apologies to Ms. Dunn)

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