New Knees

This is the start of a new category on my blog page. Essentially it will harvest information from friends concerning knee replacements. I’m keeping this diary both to help myself get as many opinions about my own surgery on 31st March, 2016 and how to best approach recovery for anyone else considering the procedure. If you wish to add your own stuff, please email it to me. I will not be mentioning anyone by name and adding to the blog on a regular basis in the next year.

Seventeen Months

Seventeen months and the knee still has limited bend, but some progress is noticable. I’m able to enter and exit my sea kayak easier, cycling is much better and a trip up Ledge Route did not cause too much aggravation. Any pain appears when trying to bend too far, so descending mountains is still the one area that could benefit from improvement. I might try Yoga to see if that works!

Happy birthday

A one  year old knee in a 71 year old carcass. Recently the recovery has slowed, but recovery  is still ongoing. This week I saw the surgeon and he was satisfied with progress, considering my expectations. He did say that it may take two and half years before the healing process is complete, but activity is still  possible during that time. This winter has been pretty poor for climbing, but a trip to Cogne proved that the knee still understood how to climb ice. It still has much less flexion, especially when climbing up towards the left. On one occasion, I ‘post-holed’ with my right foot, deep into soft snow. The left leg had to bend way  beyond it’s comfort zone, producing plenty pain and swearing. Fortunately no lasting damage and still able to climb the next day on Ben Nevis. Updates will be few and far between now.

Mainly, I have learned that continuous physio is essential and a will to strengthen and balance associated muscle groups, will give a knee replacement more chance of being successful. Try not to give up and as soon as sensibly possible, carry on with your chosen activity, so long as the consultant allows.

Nine months and a week update

It’s been a while since the last update. The side planking has caused some sort of muscle strain in my right shoulder, so I’m not using that any more. The knee is still progressing in a positive direction, although very slowly at times. A long sailing holiday, with plenty of swimming in warm waters must have helped. I have recently started on the hills again, with no real problems, apart from aches and pains in other parts. No doubt caused by a lack of use. Concentrating on smaller less travelled hills with fewer rocky sections. This to build more strength and stamina overall. Downhill travel is cautious at the moment and I need to build confidence in that area. Off to Cogne, ice climbing in a couple of weeks. Watch this space.

Five Months, three weeks update

A recent 130km bicycle trip from Castle Bay (Barra) to Lochmaddy aggravated the knee and caused it to swell . The physio said too much too soon and advised shorter trips to start with. The swelling has certainly reduced and the flexion is slowly getting better, but stepping down, right foot first does produce soreness in a deep step. A recent visit to another sports physio also highlighted my tendency to walk oddly and diagnosed a Trendelenburg Gait no doubt caused by years of favouring my bad knee. He recommended ‘planking’ exercises to strengthen my left glutes and core muscles. Keep going as it’s early days yet. Various paddling adventures to Islay and Colonsay, keep the juices flowing. High mountains come later in the year.

Sixteen weeks update

On my bike at last after four months and able to peddle normally. The swelling is still persisting, but reducing slowly. The discomfort from my outer knee remains if I bend deeper than 80-85 degrees (inside angle). This is possibly due to the swelling and also connected to the IT Band, which is tight. My physio has been massaging my outer thigh, down to the knee and says the tightness is reducing. The pain in my IT band started a couple of years back, after pounding (walking) the pavements of San Francisco. Next time I’ll rent a bike! Also, my left leg is shorter than my right leg and my Chiropodist has put a 4mm insert onto the heel of that foots prescription shoe insole. It’s all connected, and the shorter leg explains the soreness in my left buttock I had last year, until I changed to a leather ‘Brooks’ saddle for my bike. So, all in all, everything is positive and each month produces an improvement. Sitting in a kayak is okay, along with cycling and walking on rough paths that do not require deep bends for my left leg. Climbing is on the list for next winter after a lot of gym strengthening work and cardio-vascular improvement on the touring bike.

Twelve weeks update

Still not quite able to ride my road bike properly, although I have managed the upright in the gym today (25th June). Although the flexion  is improving. the knee still has some swelling that impedes movement. Managed a walk up to Steall Waterfall two weeks ago and also a very good overnight sea paddling trip to the Garvellachs. A planned trip to Islay is definitely going ahead to explore it’s rugged coastline in mid-July. Sitting in a sea kayak and negotiating rocky landings with care is okay. Gym and pool and static quad strengthening exercises most days now.


Nine weeks update

The gym and pool are proving very useful every day for at least an hour or so. I discovered a recumbent bicycle machine in the gym and it’s better than an upright, which I cannot turn a full revolution yet. Still some swelling, which is hindering flexion, but that is improving each week. The only real pain is still on the outside of the knee and I think that is connected with the IT Band, which needs stretching. All positive though, and I can now get in and out of a sea kayak without too much bother. Hopefully cycling on my road bike within another three weeks.

Seven weeks update

Each week produces improvements for me. I visit the pool and hydrotherapy on a daily basis. Walking up and down stairs now, although going down needs more care than ascending. I can achieve better than 90 degrees now on the replaced knee, although it’s still swollen. The original pain in my IT Band remains and I’m doing specific exercises for that as well as lots of static exercises at home and in the pool.

More below from climbing partners. This first one had a full knee replaced ten days prior to mine. He was cycling very quickly after the operation. However, he had put in a fairly intensive nine months muscle building prior to the replacement.

Hi Alan,
how’s your knee doing ? Hope it’s doing well ! Happy with the flexibility of mine but unhappy with clicking which has developed over last three weeks. Had it checked by specialist here and reckons all is okay and clicking may stay or disappear and I better get used to it ! More of an uncomfortable nuisance and than painful. Have fairly large numb area below knee on outside of leg – have you got similar problem ? However, that is not much of a bother.Had a wee mountain walk (up and down by chair lift otherwise fairly level. Cycling also perfectly okay.

From another climbing pal who had a knee replacement two years ago. He is older than me!!

Hi Alan.

Sorry not to have been in touch. Just thought an update on my condition may be informative.

We are both finding that being on our legs for a long period eventually results in us both slowly finding that the spring & flexibility seems to go out of the knees, and we become quite stiff. In some case we have put this down to osteoporosis but there seems to be an element of arthritis

In my case it does not seem to matter which knee is affected they both get stiff and sore. I put this down to general arthritis.

Both legs quickly recover after sitting for a bit, and next morning the stiffness feels more like the morning after a relatively hard day on the hill & the stiffness wears off quite quickly.

The common cause for both of us is standing for extended periods, or walking about on pavements and in shops. Looking about me I have to assume this is something to do with age. The stiffness becomes quite generalised so bending down to pick things up becomes a bit of a trial which suggests that all the weight bearing joints are affected to a minor degree, ankles, knees, hips and lower back.

I have spent the winter trying to increase strength and flexibility but the process is a bit hit & miss. The replacement knee is getting stronger and is now the most reliable, but the weakness of the un-replaced knee means that one tends to use the replaced knee because there is less discomfort, and the joint is mechanically better. However, it occurs to me that favouring the un-replaced knee & overworking the replaced knee may be counter productive. The issue then becomes getting the un-replaced knee to do its share of the work, especially when stepping down.

I have discovered that standing on one leg improves the balance muscles of both legs, and presumably develops the smaller balance muscles of the whole limb. I have had problems with pain in my feet and some swelling, which I thought might be something like gout or circulatory problems arising from the surgery or arthritis.

However, in an effort to strengthen the lower leg and avoid problems with the achilles tendon I have been standing on one leg and then rising to stand on the ball of my foot & toes. This has strengthened the muscles in the foot & ankle and the circulation seems to have improved and the foot arch is higher.

To do this it is necessary to fully extend the knee and hold it in position with quite a powerful static contraction. I have discovered that this exercise seems to build the muscle around the knee joint, so now whenever I am standing around I do powerful contractions of the knee joint which seems to be strengthening both legs, especially if one lifts the heel off the ground slightly.

It’s a slow process but the un-replaced knee seems to be improving and taking more of a share of the work and I am stepping down almost without thinking or preparing to favour the un-replaced knee. This seems to have increased the length of time I can stand about without eventually getting stiff and sore.

I deduce from this that age is having an impact, but maintaining the strength of both legs is important, and the straighter the knee of both legs and the stronger the muscles around all the weight bearing joints the better. The advice of the surgeon/physiotherapist that one should get the new knee as straight as possible, also seems to apply to both knees.

Interestingly my feet are more sensitive to changes in position [after years of wearing stiff boots] and I seem to be more agile on rough ground such as moving around in replanted clear fell forest, where I lost confidence years ago. I still prefer ascents on clear ground, but seem to be coping with rough ground better.

No real improvement when trying to cross slippery rocks, or jumping across streams etc. Not sure whether this is due to loss of power & confidence or a continuation of the disinclination to suffer the pain of a heavy landing.

Thought you may be interested as it seems that just getting back to the recent normal, and losing the pain, is just the first stage and a comprehensive evolving set of exercises lasting some years may get beneficial results. Although it will not offset the impact of age.

Hope this of some interest.


Five weeks update

In the hydrotherapy pool five days a week now. Still finding flexion beyond 90 degrees difficult, but that should improve once the swelling reduces. Walking up and down stairs normally now, with care. No pain at night. Not able to get a full revolution on the exercise bike yet. Can walk on flat pavements well for a mile or two. Still very swollen as seen by the two new photos in the gallery. Any pain is on the left side. That’s where it was before the operation. Patience!

This from a good friend

…..” Personally I’m not sure about physio as such. When we did our saas grund trip with Joe I was 8 weeks post cartilage clean out. That was early July. By mid September it was still irritatingly painful. So I saw the consultant again and he drew my attention to the state of my leg. I looked like Olive Oyl on that side and Popeye on the other. Advice was don’t faff around with physio, by now–find a personal trainer who knows about rehab, see him weekly for 6-8 weeks and do what he tells you. I did and repeated the sessions a further 2 times each week. Worked a treat and cheap at the price. Built up quads etc and did a lot of work on proception as I kept leading with good leg and that causes more problems of overcompensation in hips, ankles. Very gentle balance yoga good too. When I did other knee, same op, I was sent to a guy, same thing, same advice, who had worked with West Ham players. I only had one go with him. But excellent and he gave me dvd and note of exercises. Again he said get in the baths and swim and do lots leg extensions on machine”….. 

Three week update

Just over three weeks and all good so far. The wound looks good and has healed well. My main concern at the moment is getting flexion back. I’m only able to achieve 90 degrees at best and that requires pushing quite hard. Before the operation the pain came in at 90 degrees, so no improvement yet, but it’s early days. Of interest, I was speaking with a physiotherapist who said they kept patients in for ten days and did not like to release them until 90 degrees was achieved. That was NHS and a few years ago. I have finally been given an NHS appointment with the physio after three weeks from referral, for this coming Friday, which is a month since the operation. It appears that a whirlpool bath is good if its easy enough to get in and out and flexion may be easier in the aerated water, benefits of water pressure on fluid movement not as much as a pool as it’s depth that counts for fluid movement. Hi Life (Highland) membership at the Leisure Centre probably good value for money at the moment (and I can cancel once I’m fit and no longer need it). I cannot turn the peddle a full revolution on exercise bike but can use it with limited range to force flexion. My physio says…… “Would not usually expect enough flexion at 3 weeks for a full revolution on the bike. If not go back and forward  and repeat as that is quite a good way of stretching the flexion out”… I’m able to do all of the exercise above. some better than others.

X-ray above of a friends knee

My new bionic knee three days after op, staples removed and 8 weeks on surgeon says I am making good progress walking up to a mile a day. Still aches at night though and need to keep up the physio. Hope to get back into the hills soon!

A very active female mountaineering instructor, who also skis extensively.
Hi Alan, yes, I have had 2 fairly big knee operations – the second one leaving me non weight bearing for 6 weeks. I was able to spin on the bicycle – certainly not allowed to push hard but could happily sit on a static bike at the gym with my iPad and watch movies. As soon as the stitches healed I was able to swim (I was never really a swimmer before then) but that was great for the knee – I have kept that up to be honest because I started to see a benefit. Yes, I was pretty religious with my physio/exercise but just pulled stuff off the internet since getting a physio appointment just proved desperate – once I knew what I was doing I was ok. Lots of low level walking – nothing long but just lots of slow walking, trying not to limp. I would also go to the OAP exercises classes. I lost about 1 inch in 6 weeks around my leg and that was me doing as much as possible. It doesn’t like sitting down for any length of time – still doesn’t like that (in front of the computer or driving) so I just make sure that I get up and move around. My knees as okay now (normal signs of age etc. and will never be as good as they were) – I know that when my muscles get tired that is when I get twitchy about the knee – can feel that the knee is weak and that is when I completely rest it. Watch out for the ankles too, as they might start to compensate for the walking weird etc. – it’s all linked in.  2012 was the last operation. I just used the exercise bikes at the gyms since it got me out the house and I could use the other machines. We are Highlife members which is excellent value for money. The Fort William gym is excellent as is the pool. All the aqua classes very good since there is minimal weight on knee. I was very concerned about becoming a blob when not active so embraced things I wouldn’t normally do. With the Highlife it means that wherever in highland region we were I could access their facilities which was awesome. Hope this helps and speedy recovery.