Total Knee Replacement and want to Run not walk my race
Hello, I am a brand new member. I have had two total knee replacements (same knee, left) in 4 years. Believe it or not the first replacement/hardware) was too large for my frame. I have had my new knee for 11 months and my very special orthopedic (who is race supportive) told me I could RUN as tolerated. I got injured and had to have a Bakers Cyst which ruptured repaired. I am two months off that surgery and currently running in water and trying to achieve my key race goal (1/2 IM in Kona Hawaii, June 5th). Does ANYONE know ANYONE that has had successful running with a knee replacement???? My first surgeon said no way not ever, second surgeon was like "you go girl". But.......sore knee after sore knee.
I did 4 sprint tris right before my last surgery ( Dec. 2)and did "ok, I got 1st Place in my Age group, but not many in my age
"....but still, I was THRILLED!!! Obvious limp at finish line. So big question is Nemo is helping me a lot with files that support running in water and I am doing it, can't seem to get my heart rate up. Does anyone have any success stories??
Anyone doing Race the Base next Sat. Feb. 26 at Los Alamitos Marine Base, reverse tri, 5k run, 12 mile bike and 400 meter pool swim (where the wet seals train)
PS I can fast walk a 13 min. mile but that kind of sucks, will do if that is all I have. Would love to meet any of you and hear any of your war stories
I don't have any friends (hopefully Nemo) but am up and going on my profile
Comments
Hey Linda- I know plenty of patients who run after having total knee's. Definitely a realistic goal.
however, it's going to be all about what you're doing for your knee when you aren't running that's going to determine that comfort level. by that I mean stretching, strengthening, soft tissue work, shoe selection, work on technique. 4 years is a small window for 3 procedure so the amount of atrophy was likely huge. When you lose muscle mass you also lose coordination and efficiency so in essense, you're starting from scratch. That's where people typically get in trouble. too much, too soon, and not enough recovery built into the program or attention to form and foot wear (which has likely changed dramatically since the surgeries).
soooo... what's your current program look like??
Officially our academy says no running.....but.....
It could cause premature plastic wear, loosening, etc....
If it was me (n=1)
1. Good cushioning in shoes (to dec. plastic stress)
2. Have a PT watch you run on a treadmill for biomechanical analysis (correct abnorm .pronation/supination to dec. stress on components)
3. Rehad the hell out of your legs......muscles (esp quad) will be weak
4. Might need soft knee sleeves for support if feel you knee gives way to either side (PT could see this)
5. Run only 3 days/wk........Could Powerwalk the others if desired
6. Probably plan on alittle run/walk during longer races (i.e. run 3'/walk 1')
Just some thoughts....
BTW Im an orthopedic surgeon
just cc'ing this here:
@Linda- sorry our answers were kind of vague to your original question.
To the best of my knowledge there is no one inside EN who's currently active in the forums and running with a TKR. So while we can't help you out there, where we can help is problem solving all of the aches/pains that you're going to encounter on your comeback. The reason you don't see many runners post op is that there are a LOT of roadblocks and it requires a solid team to help you through it (ortho, massage, PT, etc).
While the new joint effectively gives you a new and smooth bone surface to play with, it doesn't change any of the muscle imbalances or contractures that led to the joint degeneration in the first place. In other words, any mechanical/form issues are still there, as well as, any alignment issues in the feet and hips. With that in mind, there are a lot of things that can be causing pain. The more specific you can be, the more help we can provide in figuring out where it's all coming from.
The good news:
1. I have had and continue to have extensive PT 2-3 times per week
2. I do lots and lots of stretching and quad strengthening, have all the gadgets at home as well as doing them at PT
3. I have been really careful integrating "running", don't do long mileage and don't try to go to fast.
4. I have been "running in water" at least 3 times a week
5. I am tiny (5'2" 100 pounds) so no real WEIGHT on the knee joint
Bad News:
1. I run even when the pain is excruciating
2. No matter how much work I do I CANNOT get my quad strength anywhere near where I know it needs to be, it basically turned into Jell-O
3. Right before the baker's cyst surgery I was caddying for my husband (golf) slipped and fell, my bad leg went underneath me and I literally fell back with my head touching it on the ground beneath me (I tore two of the four quad muscles, 2-3 cm tares)
5. My orthopedic surgeon delayed my cyst removal by a month so I could somewhat recuperate from the tares and tried to get a tiny bit of PT in (to again try to strengthen my poor quad)
6. The accumulation of the major surgeries and the quad tares destroyed just about all my quad strength that had already been severely compromised (due to the back to back TKR's)
7. I have never had my shoes evaluated and know my muscle imbalances are huge.
8. I have rather severe bone density issues (genetic) and am just beginning infusions of Reclast
9. My calf and hamstrings are excruciatingly tight and take two-20 minute stretching sessions a day just to get some relief (my calf feels like a huge Charlie horse most of the time).
OK, you say, "what the heck is she doing trying to do triathlons"? To be honest, I would have been so down in the dumper if I did not have this to look forward to that it basically saves my emotional sanity, just having it as a goal. I see myself curled up in a fetal position just thinking about the prospect of never being able to do them. I don't mind fast walking the race in June (70.3 IM Kona). I hope I can get some real improvement by then. I love my surgeon but he is so swamped I really don't get the time I need to try to get to the bottom of all this. He did order a nucluer bone scan with contrast, having it next Monday. However, his PA is a long distance cyclist and gives me lots of encouragement, well when I say lots, I mean twice when I have come in for post op visits. I have a hard time "holding" onto my dream but can't give it up.
I was totally bone on bone and had" bowing in" of my knee (not sure the medical terminology for this but it was bad) by the time I had my first TKR (by the way my right knee is perfect), left knee totally arthritic. Muscle imbalances are huge, my right leg has been compensating for years as well as my lower back.
Michael, I need to find a specialist that can watch me on the treadmill, although I love my PT (she graduated from USC with a PhD) she doesn't specialize in running, knows her stuff but still.
Leigh, I think it was your Youtube that you sent to Nemo with all the drawings on your calf (if so it was incredibly helpful and I am beginning to do that technique), the only thing I don't own is the stick, have everything else and more.
Soooooo, hopefully this is not so overwhelming that I stump you or make you want to throw up your hands_
Any advice is going to be a relief+
Linda - Two comments
1. Here is a link to the Runners World Forum, where there was a discussion about running after knee replacements. At least one individual claimed to have been successful at it ("Gary"), but most just had to give it up.
2. I'm reminded of a guy I raced against/with a few years back, Even Evensen (his real name!). He was qualifying for Kona frequently after age 50, and then was hit by a car while biking. Broke his pelvis, required multiple surgeries, had pins in his bones, etc. I responded to an online request for help with medical bills, and got a phone call back from him 8 months later, with thanks and an update that he was training for IM CDA the next year (O6). During the race, I saw him pass me going up the first big hill there, and called out to him. We talked a bit about his recovery, and then he motored on. I caught him on the run, as he was shuffling along at 10-11 min/mi, ending up 3rd or 4th. I had already qualified for Kona before that race, and so he got the roll down to Hawaii. His only goal had been to come back and participate, and he got that bonus. On the Big Island, I passed him again early on the run - he was walking. He walked the ENTIRE WAY there, with a smile on his face, so glad just to be able to participate at that level again despite his physical deficit.
My point: do what you can with what you've got, and you may be surprised with the result and how you feel at the end.
Here's a quote from that Runner's World thread:
"If you sit on the couch all day everyday and never move, your "new" knee will last forever. Of course, if you are just going to sit on the couch, why bother having it replaced?"
short on time today and just saw this, but will get on the response tonight/tomorrow morning with some ideas. thanks for the extra info! very helpful.
some thoughts and questions:
1) From a range of motion perspective- where are you at?? did you get back to full bending/straightening versus your other leg or is it mostly there or not at all? if not, which direction is the most limited??
The reason I ask is primarily in regards to the straightening (extension) direction. That will have the most impact on run mechanics down the chain and will effectively force you to overuse your quad by limiting your abilty to push off with your glute and hip muscles.
2) what kind of soft tissue release stuff is/was your PT doing?? if it were me, I'd be attacking those hamstrings. tight and overworked hamstrings are the number one cause of bakers cysts (they grow as a result of friction/irritation between the tendons behind the knee- there are 3 hammie tendons crisscrossing back there and the cyst grows in between them). With the bow-legged part, I'd expect the inside hamstrings and adductors to be exceptionally tight versus the outside which can cause all kinds of anterior knee pain.
Due to the chronic timeline of the symptoms, I'd check out instrument assisted soft tissue release. they're designed to help break of up soft tissue adhesions/scar tissue and work wonders on contracted tissue. Here are links to the two bigger groups. They have providor maps so you can see who is in your area:
grastontechnique.com/
www.astym.com/
3) the big problem with having a weak quad while running is that you don't have the strength to really get off of it. as you move through the running cycle, you have to push all the way off and extend the leg. By shifting the force through the back of your leg, the front of your leg can relax and focus on it's job of shock absorption. Without that, it has to pull double duty as you land on the leg and then have to push off it.
my guess is that you've been doing a variety of leg lifts with ankle weights, leg weight machines (straightening and bending), step ups/downs, etc. have they had you doing any kind of chair squats or wall sits- stuff where you strengthen the muscle by stretching it instead of shortening it??? (eccentric exercise).
4) have you ever heard of kinesio tape or has your therapist tried it with you?? it's a supportive tape that helps maintain alignment and supports the muscles. I'm a big believer in this stuff. Much more dynamic than the traditional and rigid tape/strappings I usually do for acute injury. The best part is that they have an awesome web site that is easy to understand and provides video so that you can do it yourself without having to be a doctor. If you look through some of the instructional stuff there are several video's for knee techniques. Might be very beneficial to give your quad and knee cap support during the recovery process.
kttape.com/
5) Shoes and feet. Not sure where you are located but are there any running specialty stores that could watch how you run and check your current shoe set up to make sure you are in a pair that is right for you??
During the recovery process, your feet will likely change. Initially, a shoe that is a mixture of stability and cushioning will probably be the best fit. But...if you have flat feet or bunions or overly tight ankles, this will shift the shoe type more towards stability than cushion. Best to let someone evaluate and help you choose. As you start to decrease muscle balances, this may very well change but in the mean time, having the right level of support is key.
6) Knowing that you still have strength and mobility goals that need to be reached before pain free running becomes a reality, let's talk specifics about your current training week: we have 3 days of water running? what else are you doing out of the pool?? biking 3 days? any days off?
If it were me, I'd limit my running to three pool running days for the time being without any land running. At least get the green light from the bone scan (pretty sure I read that somewhere earlier or in another thread??)
I'd make one day my "long run" and be in the pool deep water running for it. It's non-weight bearing and run specific so you can safely ramp up the volume and focus on technique. Start working your way up towards that 90 min-2 hour long run goal for your 70.3. (here are some deep water running links that Nemo pulled together including a technique tips endurancenation.us.dnnmax.com/Resou...fault.aspx
The other two days I would add some intensity in the form of shorter intervals. It will be a good way to boost the training stimulus without frying the muscles on land.
Leigh, again, I do apologize for such a delay on getting back to you. I knew I had a nuclear bone scan study scheduled so wanted to wait for the results and got them yesterday. I am waiting to hear from my orthopedic surgeon (who ordered the scan). My PT is getting married this weekend so I have not wanted to bother her with some of the questions that I knew she could answer. Before I type out my "results" section on my scan I will: attempt my answers to your very in-depth and great questions.
As you know this was my 2nd TKR on same leg, due to unresolved healing from the first TKR
1.When I completed my PT after my 3rd-4th month PO, I had a 138 ROM, which was pretty outstanding, after the ruptured cyst PT I was back to about 130, then all the problems began.
2. Because I ended up with the DVT's from the post cyst surgery, she had to be very careful with the deep tissue.
3. I do a huge variety of leg lifts with ankle weights, light let weight machines step ups downs. Etc.
4. Just a bit of a blue type of tape that really helped with the swelling and edema I had, again the DVT's I was having significant swelling and edema. So was and still wear the constrictive stockings, both knee high, above knee, and recovery compression tights.
Because I started having the severe and almost debilitating pain (after I ran too soon WITH the ok from my ortho) I knew something was REALLY wrong, which is why he ordered a Nuclear Medicine Triple Phase Bone Scan Knees with Whole Body Scan. Long and the short of it I am going to type word for word what the findings and Impressions were:
Findings: The flow study demonstrates increased blood flow to the left knee. Immediate blood pool images demonstrate diffuse hyperemia involving the femoral component of the left knee prosthesis. Delayed skeletal phase images demonstrate intense localized activity in the distal left femur with greater activity in the lateral condoyle compared to the medial condyle. There is low-grade but diffuse increased activity along the tibial plateau. Diffuse low-grade activity is present in the patella.
Whole body scan demonstrates minimal activity in the lower thoracic spine and mid lumbar spine likely degenerative (a side note here, I do have degenerative disc disease so this was no surprise)
IMPRESSION: 1) Abnormal triple phase bone scan of the knees demonstrating increased blood flow and increased activity in the femoral component of the knee prosthesis. This raises the possibility of loosening or infection. Consideration might be given to a repeat Indium white cell scan. (A side note, I had this EXACT study done when I started having problems with my first TKN and the white cells were normal as they are now).
2) Probable degenerative changes in the thoracic and lumbar spine (as a side note an MRI for my lower back was completed yesterday and do not have results.
I realize this is TMI, I have no idea what this is going to mean for me until I speak with my surgeon. I have limited ALL running and am only doing pool running. I doubt I am going to get a "green light " for running. I am hopeful I will get a "green light for walking", meaning walking the run portion of the 70.3.
I am sure I have strength and mobility goals that need to be reached, I am sure I need a mixture of stability and cushioning and a best fit for my shoes.
I would appreciate any "Thoughts" you might have, have you ever heard of this happening TWICE?? I don't really even know what "increased blood flow" or what "diffuse hyperemia means". I realize you are a very busy person. I also realize you have already put a lot of time into my previous questions. Cannot tell you how much it has meant to me to know I have an entire VILLAGE supporting me. Any words of wisdom would be appreciated.
This is a hug
, this is embarrassment for going on and on with this whole drama
, Linda
Linda,
Strongly strongly strongly recommend ZERO land running till you follow up with your surgeon. Will likely result in more tests to determine if the prosthetic is still moving.
As far as people requiring multiple replacements, I've seen it more frequently over the past 5 years, mostly due to the younger age and increased activity levels of these patients. One important note is that while TKR's give you a new joint surface to work with, they do not fix all of the biomechanical abnormalities that lead to that initial degeneration. Therefore, it's very possible to damage the new joint in similar ways to the original knee bones.
My advice is to do whatever it takes to get this knee calmed down and reduce pain. if that requires not even pool running and decreased time on your feet to let it heal...then so be it. Can totally relate to your upcoming race and desire to run, but at this point...I would stand down a bit as we're talking life impacts. There are only so many of these that you can have before you start to dramatically lose function and on round two, the chief priority should be full recovery, not speedy return to sport.
Keep us posted.
Hi Leigh, I have and thank you again, this week is full of future tests (immodium) or something like that but will definiely keep you posted. Can't thank you enough,
HI all, found out today that I will be having indium injections (something fancy about tracing around white blood cells) and scanning over the next two days, kind of a complicated process but should know "something" be end of week. Only biking and small amounts of swimming' mostly upper body and just some core stuff. Tryiing not to hit a panic button, getting strength from everyone elses wonderful attitudes and courageous stories. So grateful for the Medical Help Forum !!. Would love to "give back" if anyone has any "shrink" needs....Thinking of adding a "forum" for shrink/psychological stuff that may arise in this realm of tri land