Knee replacement

Tombo wrote:Anyone had any experiance with getting a knee replacement as it relates to rock climbing? Looks like I'm not to far off on one.

My dad is 60 and follows me up stuff with a replaced knee. He's able to do more with less pain since having his knee replaced than he was before that. Granted, he's not doing all day epics, huge approaches, or anything too difficult, but he will get out and climb just fine with it. There's days where I think his fake knee is better than my reconstructed one.

As best as I can tell, this is the longest thread on MP regarding knee replacements, so although it is old, I’ll tag on to it and maybe it can be revived as a continuing resource for us ”senior” climbers facing a knee replacement.  As I think someone mentioned, there is a good knee replacement thread on Supertopo but that thread is locked.  

I have severe tricompartmental osteoarthritis with trashed menisci and all sorts of other issues, but at least my ligaments seem intact.  I’m scheduled for a FKR (or FKA as its sometimes called in the med literature) in several weeks using the Medacta MyKnee protocol (which uses 3D printed cutting blocks based on a CT) and getting a cemented GMK Sphere implant.  ACL and PCL will be sacrificed.  My doc tells me that this system/implant is not designed for sustained athletic activity involving repeated or weighted striking (e.g., carrying a heavy pack in rowdy terrain) or for maximizing flexion (e.g., high steps and rock overs).  At first I just accepted these limitations as the cost of relief and the price of a lot of time in the mountains, but then I thought, there’s gotta be more to it.

I recently stumbled onto a website for a clinic that claims that the Stryker Mako robotic arm protocol (which also guides cutting based on a CT) and a cementless Stryker Triathlon implant, with proper PT, can allow a patient to return to full, unconstrained athletic activity, such as distance running, weightlifting, and aggressive downhill skiing.  Although I haven’t found anything on the Stryker website making similar claims, I did find something indicating that the Triathlon implant is designed to provide up to 150 degrees of flexion.  (There’s a Nextgen implant designed to provide up to 155 degrees of flexion!).  I’ve waded through dozens of scientific articles trying to sort out what might be the best protocol and implant for rock and alpine climbing, and based on my layperson’s appraisal, I’d say the data is mixed at best.  There does seem to be decent support for the idea that cementless implants (which rely on the bone growing into the implant) are superior to cemented implants in resisting loosening, which seems to be a problem for highly active patients, but that’s about it.   

So, does anyone have any experience or with these competing protocols and implant designs with regard to climbing?  Also open open to pm if you want to take a discussion off-line.  Thanks in advance.

Thanks for those that reached out to me via pm.  To assist others that are considering a knee replacement, I ended up having a FKA using the Stryker Mako robotic arm protocol and an uncemented Triathlon CR implant (which retains the PCL; ACL is sacrificed).  In short, I was persuaded by the Stryker promotional material on-line and conversations with two docs who use the Stryker system that this combination would give me the best chance at returning to climbing, mountaineering, and skiing in full max mode (for a 65 year old, anyway).  However, the doc that did the surgery made sure that I understood that there is no clear-cut empirical evidence that any one protocol or type of implant is superior in patient satisfaction than another.

I did a good month’s worth of PT-assisted pre-op exercises, and since my surgery almost 4 weeks ago now I’ve been hitting the post-op PT really hard, up to a few hours every day.  I’m walking normally, although my surgical leg is still too weak to climb stairs.  My flexion is 115 unassisted and 123 assisted (with lots of pain) as measured by the PT.  I’m shooting for 130 for my six week follow-up appt with the doc, and although it’ll require a lot more painful stretching, I feel hopeful I can get there.  Knock on wood, I would like to end up with 135 flexion,140 ideally (as mentioned in my earlier post, the Triathlon is designed for up to 150).  Because I went with a cementless implant (which relies on the bone growing into the implant, rather than being attached with cement), based on my med team’s recommendation, I’m not hiking yet to minimize impact but I’ve been using a recumbent bike for about a week now and plan to move to a full spin bike this week.

I have to admit that I’m still a little unsure that all the pain associated with the surgery and the time and effort of all this PT will be worth it, given that my osteoarthritis wasn’t interfering too much in my climbing (my first love) — it was hiking and skiing that killed.  But thanks to those that posted earlier in this thread and others that have been overwhelmingly supportive, I’m feeling pretty optimistic.  If anyone facing a knee replacement feels like I might be able to help with their decision-making, pm me (I also did a fair amount of research into orthos in the Salt Lake City area).  It’s a heavy decision.      

I've had a full knee replace. Did the north face of the Eiger in winter 4 years after, so still having fun. However...... the knee never recovered full strength and the lack of a full range of bend is a serious problem particularly when getting over a roof, this can mean 5.8 becoming 5.10+ as my leg just can't bend enough and 5.8R is a very different thing to 5.10+R for me, so there have been a few surprises.

   Today is 5 weeks and 1 day post TKR and my wife measured a 127-degree range of motion today with a lot of pain going on.  I do PT twice a day, every day, with the pain right at my limit.   I also do several hours a day staying busy around the house.  The build out on our new van is a big part of the staying busy.  Yea, that is motivating!   I was just a 5.8 climber before the replacement and my goal is to still climb 5.8 after I heal.  The real challenge is to be able to squat to shit and my PT says that will take a 135-degree range of motion.  I am 77 and those goals are all I need to make me happy.

                                                                             Life is good,

                                                                                           Roger Brown

I'm looking at a partial replacement in both knees in the next year.  I only have issues on the insides of my knees so I am hopeful that I can avoid full knee replacements.  Has anyone had partial replacements and how was rehab and are you climbing again?  I can still climb but stepping up on small holds really isn't pleasant.

David — That’s awesome you climbed the Eiger in winter with a TKR; inspiring!  Do you recall what type of implant you had, and how far out from TKR were you when you climbed the Eiger?  

Roger — You’re killing it.  It does seem to me that a high degree of sustained pain tolerance for many weeks is necessary to get to 135-140 flexion, not to mention the work necessary to get the leg strong enough to rock over it.  I’m closing in on 135 now approaching six weeks out, but I still can’t walk downstairs unassisted.  For those considering TKR and wanting to get back at it, prepare for a lot of pushing to or past your pain threshold.  This should not be underestimated in making the decision for a TKR or continuing to deal with your current limitations.

Jan — I haven’t talked to anyone with a partial replacement, but check out the Stone Clinic website.  It has testimonials from athletes who had partials (including both knees) and returned to things like marathons and peak bagging within a year of their operations using Stryker cementless products.  Inspiring stuff.  Good luck. 

Yesterday was 6 weeks and 1 day out and my wife measured a134 degree of range of motion.  We use a 2 minute hour glass and run the full 2 minutes at maximum pain to finish the at home PT sessions.  This last stretch is done with foot flat on a chair and leaning into it.  Brutal, to say the least, but it seems to be working.  Still on twice a day, 7 days a week of PT and the way I understand it the next 6 weeks will be the hardest.  I guess this is when we will stop seeing much improvement and the goal now will be to keep what has been earned.  At least maybe the swelling will go down some and it won't ache as much.

  John-Keep posting your progress.  I only do around a half hour of PT per session and part of that is warming up on a Rower.  Up to a few hours a day of PT a day is really impressive and inspires me to hit it the Rower a little harder.  

   

Okay Roger, here’s an update.  Six weeks out: PT got my knee to 140 for maybe 10 seconds with significant pain; 125 on my own, but also with pain.  Still couldn’t walk up or down stairs without assistance due to weakness and also a weird patellar pain that really comes on with leg extensions.  Still going to the PT three days a week and doing home PT every day for 1-2 hours, and beginning to use weights (light, 30lbs max) for quad exercises.  Not much cardio, mostly due to my PT’s recommended rehab approach: flexibility, strength, then cardio.  Focused on strength.

Seven weeks out: No significant change in flexion, but finally could walk stairs, although stepping down off the surgical knee was more of a controlled fall than a true step.  First trail hike, about 2 miles in slightly rolling terrain.  It was slow, particularly going downhill essentially shuffling, but so good to get outside.  All of the thigh and lower leg swelling is gone, but immediate knee still puffy.

Eight weeks out: Not sure what my max flex is now, but satisfied where I am although I still work on flexion several times throughout the course of a day.  Basically can raise my surgical knee flexed as in a high step to just above mid-thigh.  PT says he doesn’t think he can get much more out of me, which is consistent with my doc’s view that after 8 weeks any flexion gains are likely to be very minor, but I’m determined to be able to bend my surgical leg so as to get my heel a fist-width distance from my arse (poor person‘s measuring method).  Doing 90-degree-deep squat sets with 55 lbs with little or no pain (but good pump).  Got in a few more hikes and starting to hit regularly an incline treadmill up to 20 degrees (walking), all sessions under 3 miles.

Jonesing to get on the rock (actually plastic at this point), but the doc told me to stay off vertical terrain until I’m ten weeks out, which I understand is because I have a cementless implant (perhaps a cemented implant may allow a return to climbing faster).  I’ve been hangboarding consistently since week three, and surprisingly (for an old guy) making progress, so I’m looking at the continued delay as sort of a forced training opportunity.  And the progress I’m seeing with my knee has me thinking of big mountains again — although I probably just jinxed myself!

The Blueprint Part Dank wrote: And he probably had the work done by one of the best doctors in the world. Most people are lucky if they can afford to get the repair done period, let alone by a top doctor. Eh, it's not so much about the doctor as it is the whole getting paid $750k annually to work with the best physical therapists in the world 50 hours a week thing. I feel where you're coming from. But A: do't be a negative Nancy, trying to be encouraging here, and B: it's not as much about the doctor as the therapy, sure, no one on here can afford to work so extensively with the type of PT's that the Broncos have at the ready. But with the information available online, paired with dedication to the exercises and an above average PT, similar results shouldn't be seen as impossible, hell simply believing in your own recovery has an effect in the effectiveness of the therapy. Cindy is asking for recommendations for a climber-friendly surgeon, so I don't think it's unfair to think she has the resources to Have. The. Work. Done. PERIOD. Save your bemoaning about the cost of healthcare for another venue before you change the direction of this thread.

I agree . It’s not about money nor “the best PT”. All PT costs the same within your insurance plan . Also , this is a very common surgery , you don’t need to spend money out of pocket for a special PT . I’m a PT on here looking at TkA results for athletes  , as I usually just  see old inactive ppl  (with low pain tolerance , much unlike climbers !) who just want to get back to waking and stairs  . And they do fine with little pain . Th asks everyone an above for making me feel not so worried about a TKA with climbing !