Knee replacement at two years...

[Pax]

Thought I'd do an update, here are the two original threads:
http://forums.teamestrogen.com/showthread.php?t=54544
http://forums.teamestrogen.com/showthread.php?t=55776


Saw the doc for my two year knee replacement checkup last week and got good and bad news.

The good is that the implant is solid and doing exactly what it's supposed to do. It is growing into the bones perfectly and shows no signs of distress.

The bad news is since my knee is so full of scar tissue from the five previous surgeries, my mobility is permanently compromised (you can still gain some increased range of motion in the first 18 months). I'm at 104 degrees of flexion and 5 degrees of extension; what that means is at 5 degrees extension I have a slightly impaired gait (I limp often since I can't straighten my leg all the way), and bike riding requires about 117 degrees of flexion so when I attempt it I end up tearing scar tissue loose. All in all it's better than before the surgery, but I sure wish I'd had a better result.

Thanks to you gals who were so encouraging as I walked this new path, much appreciated.

[Catrin]

Pax - so sorry to read there is permanent impairment but that there is good news as well. It's been very encouraging reading of your journey along the way. I think it's helpful for all of us, especially with broken bits, to be aware of and cheer for each other in our journeys.

[Pax]

Thanks, Catrin. And I agree, we're all getting older, and seeing what others paths look like may in turn help someone else. It's been a huge help having the support of my online friends as I sat at home month after month, cut off from all my daily norms.

[emily_in_nc]

Well, I sure am sorry you didn't have "perfect" results, Pax. Riding a bike sounds icky, when you put it that way!

I know my step-father had a close-to-perfect result in the first knee but a much less good in the second, so you truly never know. A lot of it has to do with your particular anatomy, of course. When my step-dad came back after his second knee surgery, he said that the surgeon called it "interesting". Not something you really want to hear wrt your surgery! :eek:

[Pax]

Well, I sure am sorry you didn't have "perfect" results, Pax. Riding a bike sounds icky, when you put it that way!

I know my step-father had a close-to-perfect result in the first knee but a much less good in the second, so you truly never know. A lot of it has to do with your particular anatomy, of course. When my step-dad came back after his second knee surgery, he said that the surgeon called it "interesting". Not something you really want to hear wrt your surgery! :eek:

Emily, I was sitting a the bar area in a local pub back in FL and the guy sitting next to me saw my scar, then showed me his. He was one with a perfect result, loved it and wished he'd done it ten years sooner.

I've had people ask me "should I have it done" and I always reply I am NOT the person you want to be asking because I will scare the hell out of you.

[Sylvia]

The bad news is since my knee is so full of scar tissue from the five previous surgeries, my mobility is permanently compromised (you can still gain some increased range of motion in the first 18 months). I'm at 104 degrees of flexion and 5 degrees of extension; what that means is at 5 degrees extension I have a slightly impaired gait (I limp often since I can't straighten my leg all the way), and bike riding requires about 117 degrees of flexion so when I attempt it I end up tearing scar tissue loose. All in all it's better than before the surgery, but I sure wish I'd had a better result.


I have no idea if this would help or not, but would shorter crank arms help? And by shorter cranks, I don't mean going from 170mm to 165mm but maybe down to 152mm or 145s or shorter.
I ride with 145mm cranks and a very setback seatpost like this one (http://www.ebay.com/itm/Nos-Sakae-Ringyo-SR-MT-100-adjustment-seat-post-pillar-26-4mm-250mm-80s-alloy-/112280023871?hash=item1a2469333f:g:8xgAAOSw5cNYLZAg). I had Mark Stonich at BikeSmith (http://bikesmithdesign.com/Short_Cranks/index.html) design shorten a pair of crank arms for me a while back and he did a great job!!

Or maybe a pendulum crank (http://www.getcycling.org.uk/details.php?id=460)

[Jean_TZ]

...snip

The bad news is since my knee is so full of scar tissue from the five previous surgeries, my mobility is permanently compromised (you can still gain some increased range of motion in the first 18 months). I'm at 104 degrees of flexion and 5 degrees of extension; what that means is at 5 degrees extension I have a slightly impaired gait (I limp often since I can't straighten my leg all the way), and bike riding requires about 117 degrees of flexion so when I attempt it I end up tearing scar tissue loose. All in all it's better than before the surgery, but I sure wish I'd had a better result.




Pax, based on my experience you might recover your range of motion:

I injured my knee playing racquetball. After major surgery on the knee my knee froze in a bent position, probably due to inflammation. I underwent two manipulations under anesthesia to break the resulting scar tissue free. Despite several months of physical therapy, I was never able to regain full range of motion. After a year, I had more knee surgery in an attempt to fix the problem, but it did not help.

For many years I could not fully straighten my leg, I walked with a limp, and I needed to wear a knee brace. Then I discovered biking. After one particularly arduous ride into very strong wind my knee was extremely painful and I could barely walk. But to my amazement, the next day my knee felt great, I could fully and easily straighten it, and I didn’t need the knee brace.

Bottom Line: I have found over the years that biking is the only thing that keeps my knee free from pain and fully flexible - BUT, I have to set up my bikes for spinning (knee slightly ahead of pedal, easy gear and ~90 RPM) as opposed torquing (knee behind pedal, hard gear and low RPM) or else I end up hurting the knee.

Hope you too find a way to regain full knee mobility!

[Pax]

I have no idea if this would help or not, but would shorter crank arms help? And by shorter cranks, I don't mean going from 170mm to 165mm but maybe down to 152mm or 145s or shorter.
I ride with 145mm cranks and a very setback seatpost like this one (http://www.ebay.com/itm/Nos-Sakae-Ringyo-SR-MT-100-adjustment-seat-post-pillar-26-4mm-250mm-80s-alloy-/112280023871?hash=item1a2469333f:g:8xgAAOSw5cNYLZAg). I had Mark Stonich at BikeSmith (http://bikesmithdesign.com/Short_Cranks/index.html) design shorten a pair of crank arms for me a while back and he did a great job!!

Or maybe a pendulum crank (http://www.getcycling.org.uk/details.php?id=460)

Wow, thank you so much!! I asked at my lbs about shorter cranks and got a "well, I don't think that will help". Sure wish shops would consider hiring an older person who has experienced difficulties with mobility, there's a HUGE market of us out there. I'm going to take your links in with me and show the guy, see if they can be fitted to my bike. Thank you!!

[Pax]

Pax, based on my experience you might recover your range of motion:

I injured my knee playing racquetball. After major surgery on the knee my knee froze in a bent position, probably due to inflammation. I underwent two manipulations under anesthesia to break the resulting scar tissue free. Despite several months of physical therapy, I was never able to regain full range of motion. After a year, I had more knee surgery in an attempt to fix the problem, but it did not help.

For many years I could not fully straighten my leg, I walked with a limp, and I needed to wear a knee brace. Then I discovered biking. After one particularly arduous ride into very strong wind my knee was extremely painful and I could barely walk. But to my amazement, the next day my knee felt great, I could fully and easily straighten it, and I didn’t need the knee brace.

Bottom Line: I have found over the years that biking is the only thing that keeps my knee free from pain and fully flexible - BUT, I have to set up my bikes for spinning (knee slightly ahead of pedal, easy gear and ~90 RPM) as opposed torquing (knee behind pedal, hard gear and low RPM) or else I end up hurting the knee.

Hope you too find a way to regain full knee mobility!

I had some scar tissue tear loose on the 'bent at the gym, it felt glorious after it stopped throbbing. I am starting to think my very conservative doc is wrong about not riding, my knee felt more fluid whenever I tried. They are concerned about me tearing scar tissue and it reforming, impairing my gait even more... but at this point I can't imagine it could get a whole lot worse, I can't even put on socks without laying my leg on the bed.

[Sylvia]

Wow, thank you so much!! I asked at my lbs about shorter cranks and got a "well, I don't think that will help". Sure wish shops would consider hiring an older person who has experienced difficulties with mobility, there's a HUGE market of us out there. I'm going to take your links in with me and show the guy, see if they can be fitted to my bike. Thank you!!


Yeah, I don't think bike shops will typically know much about this , I spent a lot of time researching this just to get this dialed in for myself. So I'm glad if I can help someone else as well. :)

In your signature, it says you ride an Electra Townie 7D, so I googled it but couldn't tell what type of cranks it used, although it appeared to be a single chain ring.
Typically cranks come in a 130 BCD(road) or 110 BCD(mountain bike or BMX). The shortest road cranks, that I know of come in 145mm length (which is the size I ride). These are the Origin8 145mm (https://www.amazon.com/Origin8-Triple-Alloy-Crankarms-Silver/dp/B002I7MAKG/ref=sr_1_1?ie=UTF8&qid=1486326177&sr=8-1&keywords=Origin8+145mm+crank+arms) that I have on one of my bikes. Cobb cycling also sells a 145mm crankset (http://www.cobbcycling.com/product/crankset/). In addition there are a number of BMX cranks that come in sizes all the way down to 90mm. They typically take a single chainring, but some can be modified to take a double.

Another possibility would be crankshorteners, you could try those out to perhaps get a feel for what size cranks you might need. Scroll down 2/3rds of the way down on this page (http://tandemseast.com/parts/cranks.html) and you can see the Tandem East shorteners. Another type of crankshortener would be these Ride2 shorteners (http://www.ebay.com/sch/i.html?_from=R40&_trksid=m570.l1313&_nkw=crank+shorteners&_sacat=0). If you go with crank shorteners, be sure to get ones that will fit the width of your cranks.

It would definitely be worth talking with Mark Stonich at BikeSmith design. Many of the smaller cranks and shorteners are designed for kids, so they will probably be designed with their weight and strength levels in mind. He would better be able tell you if these would be appropriate for your application. I wouldn't want to steer you towards a solution that might be a safety issue.

[Pax]

Thankfully a friends husband is the lead trek mechanic at another lbs, I'll see him at their home where he's not pushed to sell their brands and see what he can do with this.

Really appreciate all the links and info, Slyvia.

[Pax]

Sylvia, I emailed Tandem East yesterday and they got right back to me. The shorteners will work for adults, no problem! Very excited, thanks so much (again), this gives me hope.

[Jean_TZ]

I had some scar tissue tear loose on the 'bent at the gym, it felt glorious after it stopped throbbing. I am starting to think my very conservative doc is wrong about not riding, my knee felt more fluid whenever I tried. They are concerned about me tearing scar tissue and it reforming, impairing my gait even more... but at this point I can't imagine it could get a whole lot worse, I can't even put on socks without laying my leg on the bed.

The key thing for me when biking was (and is) to use a comfortably fast cadence with low force. To minimize scar tissue reforming, take anti-inflammatory med (like Advil, etc) after a work-out.

[Pax]

I still ice and take two advil every morning, I think if I can start to ride again, I'll just shift that regimen on those days to after I ride.

I've been going back and forth with a very nice fella in the UK about those pendulum pedals, they seem like a great choice as they accommodate the bad leg so nicely...and are designed with disability in mind. They are spendy at $210 for the one plus $24 shipping, but if it can get me mobile it would be worth it.

[Jean_TZ]

Shorter cranks would help you cope with your reduced ROM. But I don't see that they will help you regain full ROM since they won't facilitate stretching of the scar tissue and muscles. (Note: I have no medical training, only experience with the same problem you are having. Maybe a search for "range of motion" and "scar tissue" might lead to some insight as to possible approaches to fixing the problem.)

[Pax]

I think the shorteners (you can move the pedals as ROM increases) may work, loosen the joint up by riding and just getting used to the circular motion, then moving them out on detent, that would add some stretch.

[Jean_TZ]

I think the shorteners (you can move the pedals as ROM increases) may work, loosen the joint up by riding and just getting used to the circular motion, then moving them out on detent, that would add some stretch.

Hmm, are you talking about something like the adapters discussed here:
https://www.cyclechat.net/threads/retroflex-crank-adaptor.197097/

I've never heard of adapters like that before. Kinda clever. Sounds like they could provide good therapy and help you with your ROM.

[Pax]

Yes, very similar, Sylvia posted links above. I just have to decide which style I want to go with.

[Pax]

Wow, if you have three minutes, check out this video, such a simple fix and it makes all the difference in the world! I can't wait to try these out... Sylvia, I owe you many beers.


https://www.youtube.com/watch?v=eheXyo9_atU&list=PL_SlucDIg03OhMduxMnGxDbQEVdibxg8c

[Jean_TZ]

Hope they work for you! One final word of advice - those gismos will put your feet further apart so you might have to reset (ie, lower) your saddle height a tad.

[Pax]

Thanks.

[Sylvia]

Sylvia, I emailed Tandem East yesterday and they got right back to me. The shorteners will work for adults, no problem! Very excited, thanks so much (again), this gives me hope.

Cool!! I use their shorteners on my spin bike. Just be sure to get the correct width for your cranks. I think they have a wider version and a narrower version. And it is true they do increase your Q factor (https://en.wikipedia.org/wiki/Q_factor_(bicycles)).

There is one other type of shortener you might be interested in but I've never tried them. The Thorn crank shorteners (https://www.sjscycles.co.uk/componentstandem-specific-parts/thorn-crank-shorteners/?geoc=US) almost look like they might provide a little better adjust ability. From the pictures, You it looks like they slide a bit, thus allowing you to adjust the distance, but I might be making assumptions. See what you think, and contact them if they interest you. If these do work the way I think, if you adjust them past the length of the crankarm, be sure that you have plenty of clearance when the crank arm is closest to the ground. I don't know the area you ride or if you could make sudden turns, but I wouldn't want to see you catch it on anything.

Oh and one other option... Adjustable cranks (http://www.hscycle.com/Pages/adjustablecrankset.html), but they are pretty pricey.

I'm so glad I've been able to be of help!! I spent a TON of time researching this stuff for myself, and met some interesting people along the way. I really found that cycling people are some of the best!! If you click on the "Gary fisher beater bike" link below, you can read about some of the stuff I was trying to sort out. You may have to do some similar things. Feel free to ping me, since I've been down this path before.

[Pax]

Yesterday I picked up the letter from my doc to get a temporary handicapped hang tag for my car... I alternately want to barf or cry. Sure hope the new crank things help out some.

[Sylvia]

Yesterday I picked up the letter from my doc to get a temporary handicapped hang tag for my car... I alternately want to barf or cry. Sure hope the new crank things help out some.

Pax, I know it's tough, but try to avoid allowing yourself to go there if you can. You are taking the first step in trying to sort this bike thing out.
And there are a lot of options from what you have seen. I went from not knowing the difference between a hub and a bottom bracket to learning a ton of stuff about bikes. I took it one step at a time and sorted out each piece of the puzzle as I went. I was amazed at how much stuff was available for tweaking and modifying my bike. I found a ton of stuff by searching various phrases using google and searching through bike parts for sale on ebay. I'm not saying you will have to do the same, but for me I needed to because no one person had all the answers I needed. Just take it one step at a time and focus on that one step. Try not to get scared or discouraged by imagining where this might or might not go. It is a journey, and it might be short or it might be long and it may or may not end up where you think. I don't regret my journey for a minute.


And about the handicap placard, I graduated from red temporary tag to blue permanent a few years ago, even though I have always been disabled. I pushed off getting one for as long as I could. It wasn't until I got in a cycling accident a few years ago where I fractured my tibia and (according to my doc) likely got a small tear in my meniscus, that I got my first placard. The problem was I just didn't want to wear that label, but the problem wasn't the label it was all the associations that go with it. All the associations that weren't me and never have been. And aren't anyone else either.

Hang in there!!

[Pax]

Thanks, Sylvia. My doc has been trying to get me to use a tag since 2009 and I keep refusing, but there are days now where I stay home rather than go out because of the distance in the parking lots, so it's time. Red placard coming up.

[Jean_TZ]

Pax, for additional info about pedal extenders and other means to accommodate the knee problem, you could check out the "Adaptive Cycling" forum at BikeForums.net:
http://www.bikeforums.net/adaptive-cycling-handcycles-amputee-adaptation-visual-impairment-other-needs/

[Pax]

Thanks, Jean, I'll check it out.

[ny biker]

I had some scar tissue tear loose on the 'bent at the gym, it felt glorious after it stopped throbbing. I am starting to think my very conservative doc is wrong about not riding, my knee felt more fluid whenever I tried. They are concerned about me tearing scar tissue and it reforming, impairing my gait even more... but at this point I can't imagine it could get a whole lot worse, I can't even put on socks without laying my leg on the bed.

Re: scar tissue -- I do know several people (including my own self) who had to tear some scar tissue after knee or ankle surgery to regain range of motion, with no regrets due to additional scar tissue forming. In some cases it was done by the surgeon or PT, but also one friend did it accidentally when he fell while trying to use a treadmill after partial knee replacement. In all cases it was necessary for a good recovery from the surgery. Of course these are just anecdotes, not science. But a second opinion might be worthwhile.

I hope the shorter cranks work out for you. As for the handicapped tag, if it gives you more freedom to get out and do stuff, I think it's worth it. And you can always choose not to use a handicapped space if you feel up to a longer walk.

[Pax]

Rode the recumbent exercise bike at the gym this evening, sore as hell from the awkward position but my knee feels a little better.

My wife made a good point about the hang tag, it makes more work for her when "it's too far to walk" in the parking lot, because I stay in the truck while she runs into the store. She doesn't mind but said some help now and then when I'm having a bad knee day (most days) would be welcome.