TKR

[oldhikerQ]

Hello all.
Has anyone here resumed backpacking after a total knee replacement? Had my ACL replaced (second time) in August 2022. PT was “challenging” and it never felt stable. Went to ortho 2 with new mri and he insisted on X-rays as well. Last image showed knee bone on bone over more than half of inside of the knee joint. This ortho said that i should have had the tkr surgery instead of another ACL. All of the associated pain and rehab time was a waste.
In any case, I’m finishing week 2 post surgery, starting outpatient PT in 2 days.
Is there any hope for me to get back on the trail? If it mattters, i just turned 70 a couple of months ago.
Thanks in advance for your thoughts.
old(former?)hikerQ

[Gogd]

My left knee had four surgeries in my youth, was been problematic for about half of my younger life. Keeping the quads well toned really helps, so in my later years not to much a problem.

1. Develop your quad strength.
   As the recovery allows, start you straight leg lifts from on your back, and progress to leg presses at the gym or stairs where you can find them. High school stadium steps are a great choice, as the step rise is less straining that standard stair flights.
2. You may need a patella brace.
   The orthopedist will do some diagnostics after the surgery; one is checking for how loose the ligaments and tendons are. He'll tug your leg about in several directions, and may even tell you why he is doing this. In any case you will be able to tell for yourself if there is slop in the joint or not, just by the way these manipulations feel. If so, you may want to look into a Patella Brace. Patella braces come in a spectrum of designs. They range from a simple neoprene legging that covers the leg from slightly below to slightly above the joint, to more robust designs with Velcro closures and padding around the knee cap window. It'll have a hole (window) that is positioned to capture the knee cap. Patella braces should fit somewhat snug, but just enough so the device doesn't fall out of line. Its purpose is to assist keeping the patella tracking properly though the range of joint flexion. This will help preclude inflammation caused by a wandering patella. I suggest getting the lightweight sock type AND one of the more robust ones to compare and decide which works for you. It is worth the investment - you may be using this thing for many years into the future.
3. Ice, Ice Ice! And NSAIDs (Harlan surely will make some sort of comment here!)
   Speaking of inflammation - you probably already know of this from your prior procedures: Ice after activities, even if its just walking. If the doctor suggests hot compresses, ALWAYS immediately follow up such sessions with ice to evacuate accumulated fluids in the tissues caused when heat is used locally to dilate the vascular system. Inflammation causes longer term complications and tissue damage. On hiking trips, try to camp near a lake, where you can cold soak after the walk. Likewise carry your preferred NSAIDs, just in case.
4. Don't bother with hinged knee braces or ace bandages.
   This kind of knee brace is designed to reduce football and soccer sports leg injuries - you will not be having someone knocking you sideways and taking out your ACL. If your knee is so compromised that you feel you must resort to one of these appliances, you should consider dialing back the type of activities you do, going forward, as you may need to get more than 15 years out of that prosthesis. As for ace bandages, and other compression type support items: if you are applying it tight enough to provide physical support it also will impede circulation, and potentially cause significant inflammation issues on the lower portion of your leg, due to the restricted circulation. The exception to the no compression items rule would be support hosiery for us geezers with circulation issues. This sock will minimize the pooling of fluids in the lower part of the leg, which is often an issue after knee injuries.
5. The biggest issue likely will be age related vigor, recovery rate and expectations.
   Coming back from a protracted inactive period typical of when you were last active until you are cleared to resume your normal lifestyle can present a significant challenge to getting back in the saddle. It may take three months or more to achieve a fitness level we used to attain in three weeks, back in our 20s. Regardless, some folk just don't rebound or lack the will to push through. It will be a big effort! Whatever the case, initially schlep that pack around the neighborhood before you get into the backcountry only to discover you can't get back out.

Ed

[oldhikerQ]

Thank you for your insight, Ed.
I'm familiar with the diagnostics that you described, as they were done before and after both ACl1 and ACL2. Don't think that they will be part of the total knee replacement rehab? I have a patella brace from the ACL surgeries, so i will make that part of my backpacking kit. As for cooling, i wonder if the cooling wraps would help to cool the joint if i can't find a suitable soaking site. Thanks for the thoughts on recovery exercises as well. There will definitely be some walking on the neighborhood wilderness trail and day hikes before schlepping the pig into the back country.
Again, many thanks for taking the time to respond to my questions.
Cheers,
Greg

[Harlen]

God Wrote:

Ice Ice! And NSAIDs (Harlan surely will make some sort of comment here!)

Yes I will::
Ice, Ice, Ice, and NSAID yerself, you icy bugger! You forgot the all-purpose, cure-all, Medicinal Brandy!

100_1781 (2).JPG

Roughly equal parts whiskey and Brandy [*leave the dogfood out of it-- ruins the taste."]

100_1782 (2).JPG

Final product, and it cures what ails ya.


Now for a serious note for you oldhikerQ. My father pounded his knees to jelly in competitive tennis, but an arthroscopic surgery fixed one knee almost perfectly, but the other was a lost cause, after about 4 surgical tries at it. So the lesson I guess, is that the operations are worth a try. I really hope your's is successful. The other salient point may be the mindet/pain management effort you can do in the event of a non-perfect result. We have two friends with plantar-fasciiitis foot issues. One of them has not resolved the pain or damage to his feet, and yet continues exploring a "mind-over-matter" method to manage the pain. He tells me thgat it really works, and get him through his days work as a tradesman. My other friend, is non other than our HST compatriot Phil/wildhiker. Last he spoke of it, he said something like: "I'm only good for 5 mile days with a pack on." Phil is also about 70 years young, and so I hope he will weigh in on his method of pain management, since he continues to do the very thing you are hoping to carry on doing oldhikerQ. We wish you luck, Ian.

[giantbrookie]

Ed sums it up pretty well. The bottom line with mobility-threatening issues such as major knee operations is that in most cases one can train to build up the supporting muscles, particularly the quads and that the older one gets the longer recovery/rehab is needed and one's energy to do so tends to wane.

I am a relatively young 64 but have sustained multiple injuries to my knees and I had two operations on my right knee in 1978 and 1998. The vast majority of humans do not practice rehab training the way pro athletes do, but for those of us who want to maintain mobility, we should. I find that the time I spend in the gym has increased as I've aged because I have more things to repair.

A little note about knees; because we usually have one bad one and one better one, it is important to work on exercises that isolate one leg at a time. This is why I find one-legged quad extensions at the gym most helpful. They have kept my knees held together since 1978. If we do normal two-legged training, we will favor our bad side and the rich will get richer and the poor will get poorer--ie the strong side will really get built up and the weak side will be atrophied. I recall playing basketball after my first knee injury (in 1977, one year before my first operation) and there was an enormous disparity in size between my huge left quads and my shrunken right ones. Even when I began serious weight training doing 5 times as many reps on the right as the left, the disparity still showed because I favored the knee playing basketball. Because I don't play basketball too much (very bad idea at age 64) and my left knee has been banged a lot over the last 40+ years things are pretty much even now so I work my quads evenly in the gym even though I do them one-legged. Note that most quad extension machines have more bend than you should subject your tender knee to. Orthopedics and sports rehab folks will tell you that it is the last few degrees of straightening out that are the most important whereas starting with a big bend puts a lot of grind on the joint. I also set the machine for a small range of motion for quad extensions. If one has a manual home set up as I once had, it is a simple pivot, rather than a pulley system, so it starts at very little weight and only goes to full weight when the knee is straight (so it's actually better than the pulley machines at the gym).

Anyhow I think if you really hit the gym, you'll return to backpacking. Going forward putting the gym time will become increasing important for maintaining mobility. But you can turn the gym experience into an end in itself, too. Yeah I work on general strengthening and rehab while I'm in there, but as hard as I work, I have fun doing it, and when you really heft the weight as an old guy you get a lot of attention in the gym, too.

[wildhiker]

... our HST compatriot Phil/wildhiker. Last he spoke of it, he said something like: "I'm only good for 5 mile days with a pack on." Phil is also about 70 years young, and so I hope he will weigh in on his method of pain management, since he continues to do the very thing you are hoping to carry on doing oldhikerQ. We wish you luck, Ian.

Hi Ian,

Actually, when it comes to pain, I'm a wimp! I'm also lucky that I've avoided major joint problems. I credit this to my nerdy youth reading books while my athletic friends were wrecking their joints. The only persistent pain I've had that affected hiking and backpacking has been a couple of bad bouts with plantar fasciitis, which is inflammation in the connective tissue on the bottom of the foot that evidences in stabbing pain in the heel. This puts a crimp on walking. Stretching and warming up the foot with mild activity helps. Advil helps with the pain. Then it's just dialing back activity while waiting for it to heal. I had a bad case in the right foot in 2020 that took a whole year to heal and a minor case in the left foot last year for a few months.

-Phil

[freestone]

I have had arthroscopic surgery on both knees back in the 90s with excellent results but the surgeon warned me that osteoarthritis of the knees was inevitable and he was correct, that's what I now have now. I thought my knees were shot about 10 years ago but a round of PT gave me new life. PT was not on the knee but the hips. All the exercises prescribed were to strengthen the hips and gluts not the knee joint. Weak hips translates to added wear and tear on the knees and in my case they were correct. I was amazed at the difference but age is catching up again and my knees are sore but have not been back to the doctor with thoughts of a TKR. I was told that if the knee pain wakes you up at night, then it's time. Not there yet but I'm not exactly jumping out of bed either! Pain management? Advil and Tylenol taken at the same time, an IPA before dinner, a good night sleep and a happy marriage all work wonders.

[Gogd]

Addressing pain management:
When the source of the pain is due to non-moving body parts (i.e. migraines, gastrointestinal issues, and in my case legacy of a head trauma that put me in a comas for 6 weeks back in my early 20s) learning mind over matter pain management techniques are important, as these afflictions are with you for the long run, and the pain can be "loud" enough and persistent such that you'll end up an addict if you fall back onto pain meds. It is really quite amazing how much your tolerance to pain can improve with such training. But I would not use that approach or standard prescription pain meds to push me in volitional, physical endeavors, as skeletal/muscular sources of pain are nature's way of telling you to back off, else risk further debilitation.

Ed

[oldhikerQ]

Thank you all for the thoughtful replies. Just finishing week 1 of the post surgery outpatient PT. Both my Ortho PA and physical therapist (who has her doctorate in PT) assure me that i am doing well in mobility, flexibility and strength at this point in my recovery. Once PT clears me, i will get to the gym and out walking.
Hoping that I have a few more years left wandering the high Sierra.

[Harlen]

Sounds good Q, We wish you luck with your recovery, and on next summer's backbacking trips.