T Nation

I Think I Will Have to Have Knee Replacement


#1

I am bone on bone with both knees and it affects my life daily. I am overweight which hurts the situation. Has anyone had this surgery? It is scary but I am fed up with this shit. I walk like I am 90 but I am 42.


About the Injuries and Rehab category
#2

my sis had one a while ago, took her about 6 months to fully use it but she says it works better than ever. now able to walk on her treadmill and ride her bike easily.


#3

[quote]Navin Johnson wrote:
I am bone on bone with both knees and it affects my life daily. I am overweight which hurts the situation. Has anyone had this surgery? It is scary but I am fed up with this shit. I walk like I am 90 but I am 42. [/quote]

Do not know how overweight or obese you are. But 42 yo it is too young for a knee replacement. Go ahead ONLY if you have no more options.

In any case you really have to undergo a complete rehabilitation program as well as a a nutritional one BEFORE the surgery. Try to be in “top shape” the day of your surgery. if you arrive with lots of inflammations, movement limitation, and debilitated…man, your rehab could be a nightmare.

Good Luck


#4

Well… I just had a total knee replacement (TKR) on Dec. 8, 2015. So on the one hand, no, I can’t tell you about lifting after one because I haven’t recovered enough yet to try. On the other hand, I did put a lot of thought into the decision which I will share with you.

First of all, not all knees replacements are the same. There are many, many different brands and models since a TKR is one of the most commonly performed osteopathic surgeries done. Some, like the De Puy rotating platform are supposed to give a pretty good replacement and allow to most activities except running (there is a cross fit board where they discuss this. Google “Crossfit TKA”, TKA = total knee arthroplasty which is another, slightly more accurate name for a TKR.) Some good discussions there. No I do not do Crossfit nor do I endorse it, I’m just saying they have lots of busted people who are looking at this.

Edit: Look for someone who specializes in Sports Medicine. Any competent knee osteopath can give you a new knee but since most of their patients are over 70, they are not thinking at all of a return to activity, just pain relief. They may give you something that does require you be a couch potato afterwards.

The other issue is limitations post-op due to litigation concerns. The reason is that in the US companies can get sued if they don’t make uses of such implants so limited that nobody can get hurt. Virtually no doctor in the US will tell you that a return to sport is possible. They will tell you that you can bike some, play a little golf and maybe some doubles tennis. There is research that shows this is stoopid: (http://www.aaos-annualmeeting-presskit.org/2010/clinicalpressreleases/Clinical_5.html) and that being more active decreases the failure rate by as much as 20% over being sedentary. Best you might do is get a doctor that says some of his patients to X or Y though it is not suggested, then roll his eyes.

I have looked at a lot of activities and the numbers seem to bear out a couple of things: high impact, repetitive stress will make the implant fail faster, which means marathon running is probably out. The other consistent failure mode was from Olympic lifting. Seems that the new knee feels so good that people like to land on it in split jerks. Takes 5 -1 0 years, then they need a replacement. Standard powerlifting, however, does not seem to do this.

How do TKRs fail? Well, basically one has 3 parts. Two pieces that are attached to the bones (femur and tibia), aka fixed components and a plastic spacer. The fixed components can loosen though in younger patients that is not too often the case unless there is some other condition (osteonecrosis sets in, infection,…). That plastic spacer, however, can get worn out or even fracture under high load. Mind you it is damn tough being (usually) ultra-high-molecular-weight polyethylene, but if you get it now, then it is yours for the rest of your life. What shape will it be in after 30 or 40 years? If the spacer fails, then the revision is not nearly as bad as if the fixed components fail.

Now here is where I leave y’all. I had mine done here: http://www.mcminncentre.co.uk/. First off, McMinn (the surgeon) is one of the best in the world and designs implants. He is probably best thought of as a joint engineer. Secondly, the implant I got has no restrictions and I have his blessing for returning to lifting (no Oly lifts) and martial arts (jujutsu). I am just 55 and did a lot of digging and chatting people up before I made this decision. I have a hip from him too (done in 2001, no limitations of any sort and I did heavy lifts for years before the knee went bad.) Cost is 13,000 GPB which is about $20,000. Good luck with your insurance. Mine did not pay and I ultimately decided that this was worth going solo on.

Last consideration is that this is a truly life changing surgery. It is very major and traumatic. If you have never had major surgery before, there is little I can do to prepare you for it. My left leg is now back to normal length (it was 1" shorter) and they re-oriented my shin so the foot is angled 20 degrees from where it was. This puts me back in perfect anatomical form, but it is damn surreal walking at times since this crept up on me over decades before if really went south. If you decided to go the TKR route, then the last few months before surgery means you should hit the gym for all you are worth, since you know how to train this body and post-op, believe me, you will be back at square one. However, do consider that your body will adapt to the bad knees until you replace them. Before I had the hip done, I waited too long and it took a couple of years of serious PT to fix everything (as in I was having changes to my vertebrae and other bones, things were deforming because the loads going through the body were skewed). So when the knee took a turn for the worst about a year ago, I decided that getting it done now before skeletal changes occurred was probably the most important consideration. So the longer anyone waits on a replacement, the harder the recovery is.

– jj


#5

It is obvious that you made your homework regarding the issues of TKR and sports. Sometimes it is obvious, but guess that no one can ever emphasize enough that you have to know well the type of replacement you had, as well as the resilience of it. Knowing that, you can make an educated choice regarding activities, it´s effects on the replacement, including if that activies could shorten it´s life.


#6

Knee health; Any advice?
Hey guys/gals, I’m a 24 year old male in the Army. I’m in an Infantry Brigade Combat Team so I do a lot of running and rucking (can reach up to 25 miles a week) with 45-75 pounds on my back. I’m an avid lifter (squats and dead lifts at least twice a week). I’ve experienced some joint stiffness and soreness in my knees lately along the LCL and Patellar Tendon. If any of you have experienced this what have you done?