Knee Replacement

A snowHead

@johnE, Keep trying to increase the range of flexion. Daily stretches, after you have warmed up. You can still get an improvement for upto a year to 18 months. 110 is a nuisance as you are very close to normal function but about 10 degrees off. I try to get 120 for my knees. Any more increases risk of instability and there is not much you can't do ( at this point all the Yoga fans chip in!). You could talk to your surgeon about a manipulation, usually done if only get 95/100. I'd say if you got 120 chairlifts and low seats would be quite alot easier. The other point , perhaps worth making, is that on-the-couch at 6 months i may get 110 but its is "tight" to achieve the range from 105 to 110.If that is how it feels keep going with the stretches as that part of the range from 105 to 110 gets "softer" and requires less effort as the scar tissue matures.110 should be enough to cycle. Get on the bike and warm up then lower the seat till it just nudges the knee and cycle slowly using the bike to gently push the knee a bit further - dont be too aggressive with this, if you have to hitch your hip to turn the crank you've lowered too much. Get the physio to check your patella mobility. A stiff patella ( side to side and especially cranio - caudad, which means in the line of the leg) can restrict flexion quite a bit. Hope that helps a bit. Jonathan Bell

A snowHead

Thank you for your feedback @Jonathan Bell,. It is appreciated a lot, especially that flexion will continue to improve upto 12-18 months. My biggest improvement occurred after 2 months. Even at 6 months there is still some pain from the knee, but it is decreasing.

I’m back home now and really enjoyed my ski trip to Les Arcs. Though I did take it easy, only skiing for 3-4 hours per day I did ski for 10 days out of the 12 day holiday. The lifts became easier as the week progressed as my confidence increased and I learnt how to get on the lift. Most of the skiing was on smooth, hard packed red pistes though I did a few blacks and some small mogul runs. It all went well. In fact walking was more a problem, especially steep rough downhills, but this will improve with practice and time. I fell a few times, including one occasion when the patella hit the ground (gently as most of the impact was taken by the arms) with no problems.

It has got easier to get to 110 degrees but getting further is proving very hard. Before the operation I had restricted extension not even getting to within 15 degrees of straight. My surgeon said that the best he hoped for was straight and 110 of flexion. I will, however, keep working on it.

The stationary bike is a good idea. I bought one and have been using it now for, perhaps, 4 months. I try and do 20 minutes a day lowering the seat every 5 minutes. Every few weeks I find I can lower the seat a bit more. Since I’m not doing it for aerobic fitness I keep the load very light but vary the speed doing some slowly and some rapidly. The suggestion about dropping the seat so that the knee rises above it is good. Thank you @Jonathan Bell. Strangely I find pointing the toes down at the top of stroke makes it easier. No idea why.

Next trip is to Gressoney for some ice climbing in a couple weeks. Then another two weeks skiing at Easter and back to Kalymnos for some rock climbing in May. I’m happy with the replacement and really am getting back to normal activities.

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@johnE,

Great to hear you could enjoy skiing.
The reason pointing toes can help is that the calf muscle passes across the back to the knee, so if tight would restrict movement. Perhaps do some calf stretches aswell!

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Folks I'm just back from 5 days in Flims / Laax for my first real test of the new knee off and on piste - did full days every day, had crusty off piste to deal with, sugary heavy articifical snow below 1400m, ice, moguls, powder and all conditions in between. New knee did absolutely stunningly well, no pain at all. Also threw in a 6km tour just to be sure I'd completely smoked my legs entirely on the last day. I couldn't be happier with the new knee at all, brilliant for me.

Now my issue is a bakers cyst in my "good" knee, my doc is talking about an arthroscopy, or aspiration, or steroids....its in its original condition, I really don't want to operate on it but possibly no choice......having older joints sucks..

Anyway, snowHeads is much more fun if you do.

Had a TKR almost exactly a year ago. End stage OA after 2 severe knee traumas 20-30 years ago, was still somewhat active but main reason to get it done was chronic pain leading to poor sleep. Skied on my old knee in jan 2023, and wasn't fun....turning and loading the knee and hitting bumps was like have a knife stabbed into me knee. Surgery and rehab went well. I was highly motivated and worked hard in the initial post-op period - lots of cycling on a turbo (start off cycling backwards is a good tip), lots of physio. Ice and compression help a lot. Managed to be out walking in the hills at about 3 months (slowly with poles) and did some munro's at about 4 months post-op. Did some long cycle rides - 100Km + in a day from about 3 months. I now have about 120 degrees flexion, it is pain free and minimal swelling. Manage full days out on hills walking and done some climbing. Skied 2 seperate weeks in january. Absolutely fine for skiing- pain free and managed full days without any problems. Did both icy on piste and some steepish off piste -early january without any problems.

2 things:

1). the low chair lift issue - as mentioned earlier can cause some anxiety when you realise your knee is going to be pushed to flex more than you are happy about. Always coped by rolling partially to my side if needed - but you have to adapt and best if not on a full chair.
2). My main concern is a slight fear of the big wipe out or someone skiing into you. I am a pretty gung-ho individual where nothing much stops me/worries me - but I have been surprisingly worried about the consequences of a big crash - which on a normal joint may sprain some ligaments, but with a TKR could lead to catastrophic failure/fracture and disability. I have skied much more carefully than before and it is in the back of your mind that the consequences of a big wipe out are potentially much more significant. I have been surprised by my anxiety over this as it would not have expected this.

Overall I have had a positive experience from a TKR - certainly skiing is fine - but I did put a lot of work in post-operatively, am pretty thin and fit and am highly motivated

The whole experience has been interesting and my advice is probably finding physio who is motivated and will work with you to what you want to achieve is as important (or if not more important) as finding a good surgeon. I very much went into having the surgery with the aim to getting back to a lot of activity (climbing/walking/skiing/cycling) - and I think I have achieved this, but the physio input has been invaluable.

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It has been just over one year since my total knee replacement and I feel I should give some feedback.
First of all the replacement has been a complete success.

Skiing is back to normal and for the first time in over a decade done with no knee pain. The Skimojo may be helping a lot here.

I walk upright, with little limping (what’s there results from my broken back 50 years ago). I can walk 8 to 10km in rough terrain. Hopefully as my fitness improves this will be extended. Initially, I did need some observation from my wife to make me walk properly. I would encourage other patients to be observed while walking and concentrate on a correct gait as much as possible.

Since my walking gait has improved I no longer have pain in my left hip.
I stand upright and am able to squat with hips below knees and do full lunges on both legs
I can rock climb, ski and cycle and generally enjoy leading an active life style
I can kneel.

There is still some discomfort walking downhill, especially steep rocky paths, but I take care and descend slowly and use hiking poles. I think this will improve over time.

Over the year I have continued to work on the knee flexion and extension. What has been a revelation is how by continuing to work on it flexion has continued to improve. When I stopped physiotherapy after 4 months my flexion was 110 degrees now it is 120 degrees, only slightly less than the left leg. I found using an exercise bike with the seat dropped as low as possible was good for range of movement and strength (and CV). I would advise any other knee replacement skiers never to give up with the range of movement, but to keep working on it. I aim to have both legs equal in the next 6 months.

One thing I did notice was that over the initial period after the operation I did very little exercise and as a consequence lost general fitness. This is taking some time to build up again. Perhaps a fitness programme could be developed by the physiotherapists for patients during the first months post operation that is complainant with recovery.

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Thanks for the update @johnE,

After all it is free

@johnE, great to learn of your really positive progress. I'm with you on the challenges of walking downhill and getting off low chairlifts . Exclamation

There isnt much evidence that you wear it out by being active.
In fact those that are more active do better.
Approx 85% of knee replaced will be fine in 25 years.
I have done many knee replacements to help people get back skiing, hiking, tennis, riding bike/horse.
Id say do whatever you feel comfortable doing
Jonathan Bell

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This is an encouraging thread. Thanks for the input from patients and from Jonathan Bell. I have quite a few friends who have knee and/or hip replacements (it's my age, they've had cataract ops too) and some have really poor flexion though they are generally "pleased with" the surgery. My observation is that they don't do nearly enough physio. Few of us do enough exercise, stretching etc, so that doesn't surprise me. I'm the same. My hips are pretty good, I think - good ROM and no pain, but knees definitely creaking especially long-injured left knee. I'm very impressed with @johnE's ability to lunge on both knees. That must have taken a lot of work. I can lunge, awkwardly, with my dodgy left knee forward but absolutely not the other way round; it feels - and sounds - scary. The rate I am going my knees and hips will outlast my heart, so I'd be surprised if I end up having that surgery, but it's good to know how life-changing it can be.

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@Origen, Lunges didn't actually take that much effort once I had decided I could do it (as with kneeling). I have done them all my life. Like you I found having the "good" knee forward slightly harder (I say good but that is the one with the ACL repair and is weeker due to the spinal injury) which I put down to spending all my effort on the replaced knee.

I was also inspired by @Jonathan Bell's, post to keep working on flexion. Too many Youtube videos were saying 6 weeks/6 months was as good as it gets. I know they were just trying to get the patient to get on with it early but I found them depressing.

Also the encouragement and help from my wife was invaluable. From commenting on my gait, to accompanying me on walks, to actually bending the leg, to pressing it straight, to measuring it, to giving feedback. In effect it was multiple physio sessions every day. I doubt if I would have managed on my own.

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Thank you to johnE & Jonathon Bell for inspiring me to push the rehab. I had a TKR in May with the next one scheduled at the end of September. My surgeon has suggested it might be better to give next season a miss but defo 2025/26. I have used Mojos for years and will continue to use them. Thanks guys. You've made my day!!!

@johnE, all sounds good news. Glad to hear it, and I’m sure you’ll enjoy the benefits when you get back to Les Arcs this winter.

You know it makes sense.

@fvlover,
Do as much pre op strengthening as you can it pays a big dividend in early post op period.
If too sore look at a Compex F1 to stimulate the muscle.
And… if there are some pounds to shed now is the time to do it. Reduces complication rates.
Jonathan Bell

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@Jonathan Bell, big thanks for your input to this and threads around the same subject.

Like most healthcare matters, I suppose, there are many uninformed opinions and myths going around. To have a qualified and experienced opinion on here must’ve given many readers encouragement and inspiration to ‘do the right thing’.

Intuitively, having originally trained as an engineer, the ‘use a TKR joint too much and it’ll wear out’ theory felt credible. Very reassuring to learn that the vast majority of patients who are more active enjoy better long term outcomes. Just what I wanted to hear. snowHead

A snowHead

@PeakyB, thank you. I started posting because aside from being a keen skier health forums seem to frequently attract people with extreme/ poorly evidenced views. Many are sufferers and are just looking for a way to navigate their problem safely and effectively but the discussion and advice can be over influenced by woo woo. The quality of discussion on here is actually good compared to some places. I’m happy to provide some snippets and hopefully help others make better decisions.

A snowHead

61 yo had right knee replaced 11 months ago. Surgeon was not keen on me skiing but when I said I was going to do it anyway, he said def not for at least 3 months!

3 months and 1 day after the op I skied. For 6-ish weeks I took it pretty easy, slowly building up time/vert, and by two months was skiing full days with no probs. Ended up with a 64 days season Smile

. I avoid pounding down bumps (ski in control!) and serious hardpack/ruts doesn't make my knee feel great. Otherwise skiing is essentially pain free.

Recovery wasn't too bad. Sleeping for a couple of weeks after surgery was the worst thing. I saved my strong drugs for night time! I did spend a lot of time in the gym, etc working on recovery, and am generally in pretty good shape. I've still never managed to get beyond 135 degrees flex, and some days it is still stiff. I have just started working with a physio again to try and improve. I've also had some fluid on knee pretty much since the op. So far the surgeon has refused to drain because of the risk of infection. I hope that might be feasible soon as I'm sure it would help with bending.

Very happy I had it done. Hopefully left knee will hang in for a year or two before I go for #2!

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@gortonator, encouraging to read. Thankyou!

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@gortonator, That's good to hear. Had TKR on left knee in May. And the right one in 4 weeks... Will really work on flex on both and it would be good to be back on skis (with Mojos) at Easter but certainly 2026. PS I'm 73

Anyway, snowHeads is much more fun if you do.

I tend to say that skiing will be fine at 6-8 months.
Why?
Some will just be a bit slower.
Anyone who gets their faster can tell everyone that they did better.
You need to be very strong to ski safely
Swelling can be greatly perpetuated by going for it too soon

Help!!

Knee Replacement

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