Recent data shows that as many as 47% of people surveyed have delayed seeking relief from their joint pain due to concerns with the post-operative process. Although I have no definitive proof, my guess is that a greater percentage of cyclists avoid surgical intervention despite the significant limitations of joint deterioration for fear of the inability to regain their active cycling lifestyle.
With advances in medical technology and post-operative rehabilitative care this need not be the case. By asking the right questions and making educated decisions you can return to cycling after Total Knee Replacement, and likely at a higher performance level and with greater enjoyment than prior to surgery!
In a recent installment of this series, it was suggested that not all knee injuries require a hiatus from riding and most can be managed while maintaining some level of cycling fitness. But when all conservative modalities have been exhausted, knee joint deterioration has progressed to severe, and the pain and loss of function leaves you with the inability to perform daily activities (let alone ride a bike), Total Knee Replacement may be the only available option.
With the help of Zwifter Seron Eaton (see his ZwiftPower and Strava profiles) who has successfully returned to cycling after undergoing Total Knee Replacement surgery, this article will explain the questions to consider. With Seron’s experienced-based answers and informative research, you can gain the knowledge required to make an educated decision when considering Total Knee Replacement as a cyclist.
With Seron’s consent, the answers to many of your Total Knee Replacement questions can be found below.
How long did you suffer with knee pain and did you delay surgery because it would interfere with your cycling lifestyle?
I had knee trouble and arthritis for the good part of 20 years, and after trying all other therapies (bracing, cortisone injections, platelet rich plasma), it was on to the replacement. I put it off as long as I could and riding was definitely a factor.
When did you know it was time to undergo total knee replacement surgery?
The level of discomfort from arthritis was debilitating. I couldn’t stand for 15 minutes, walk in the grocery store, or do the dishes without severe pain. The level of disability works into your head and the growing depression is real. When I wouldn’t want to do chores, run around with the kids, or pedal my bike, I knew it was time.
How important was the ability to return to an active cycling lifestyle in the decision to undergo surgery?
Being able to ride comfortably and with the same ability was paramount.
Was finding a surgeon who could provide you a level of confidence that you would return to cycling important and was it difficult to find?
I’d been going to the same Orthopedic clinic for many years and felt confident in the reputation of their knee specialist who had performed at least 12,000 replacements. The doc was sure I would return to a full cycling life with little loss of ability.
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Did you require a specialized surgical procedure or implant?
Nope.
When were you able to resume cycling post-surgery?
I was able to begin pedaling a bike within weeks after the surgery and started to ride outdoors at three months out. With three months of Zwift I felt pretty strong and well on my way to riding without worry.
Did you have to change your Zwift setup?
Nope. The knee took to it like riding a bike.
Did you receive Physical Therapy treatment and for how long?
I did home PT for about a month, and continued to progressively work at home and on the bike for another 6 months with PT consultations to keep things moving forward (see the Brigham and Women’s Hospital Total Knee Arthroplasty Protocol).
When was your surgery and at what level are you cycling now compared to pre-surgery?
My surgery was in January of 2019 and I was riding well within 6 months. My volume is now higher than before surgery and my cardio is the best it has been in 20 years. I can pedal and sprint to my heart’s content. Now I don’t even think about my knee.
Are you pleased with your decision to undergo Total Knee Replacement surgery?
I’m ecstatic! It’s fantastic! In many ways, I feel reborn, able to chase the kids, do chores, and ride. I’m forever grateful to my surgeon’s skilled hands, awesome technology, and Zwift, otherwise the pack would have left me to the wolves before too long.
Do the Research to Best Make This Very Difficult Decision
While the decision to undergo Total Knee Replacement surgery is not one you should make without considerable thought, research, and preparation, it need not be avoided purely for the fear of never being able to ride again. Knee replacement is a major surgery and the rehabilitation is extensive and demanding, but when all other options have been explored, it quite possibly may be the best decision you could make. It was for Seron. Ride on!
Was it the correct decision for you?
Have you undergone Total Knee Replacement and returned to an active cycling lifestyle? Tell your fellow Zwifters about it. Comment below!
I just had knee replacement this week. I wanted to put it off until the end of the summer, but the pain became overwhelming, so I moved it to early June. The initial pain after surgery was excruciating, but is now more manageable. I’m hopeful to be back cycling in a couple of months. Thanks for the article!
I was diagnosed with psoriatic arthritis several months before I shredded my medial meniscus on a 4 mi run in 2012. In October 2012 I had arthroscopy and medial meniscus removed. I still had pain which only worsened over the years even with the injections however I had been training for a 500 mi ride across Texas raising money for a Veterans group and I was determined to go. I told myself those men suffered for my freedom and I will make it happen; I did. Then I could no longer work 12 hr shifts or even go to the store. January 25, 2016 I had a partial replacement with Robotics and PT in my home for 2 weeks then 3x a week at facility and 2-3x a week at home. I used my bike on a regular trainer as well (didn’t have my Kickr then) I also live by myself. On April 1st I did a solo ride and that’s history. Speed and watts improved then started Zwift in Feb 2018 Now my right knee is beginning to give me a little grief so I know the future (68yrs young) Lol
Best decision ever ! FYI my IRL bike is an Emonda SLR di2 so I’m not slow 🙂
LOVE LOVE ZWIFT ( Madone etap)
Ortho surgeon here – enjoyed the article, and agree with all that was said. Cyclists actually make the best patients!
Had my TKR three years ago. Was on the bike after 12 weeks . Done 13000 Km since. All good. Even done some racing.
Had a total knee replacement 8 weeks ago. On week 6, I put my seat up one inch to bike on the trainer. It is still up about a half inch because flexing is slowly coming. I velcro my foot to the pedal for the first couple miles then I can clip in. Cadence was really slow at beginning in the 50’s and is finally creeping toward 70’s. Every knee is different and it was my third surgery on that knee. I was unable to bike January – April so I will be happy when more cardio conditioning takes place. Thanks for the article!
In 1968 I had 3 surgeries to remove torn meniscus from both knees. At the time removal was the only option. I was inpatient for nearly a week. The pain was severe. When able, I returned to playing hockey, casual cycling and jogging. Jogging evolved into marathons,10k and other races. For more than 30 years, I was fine, but as I approached 60, the pain became more severe. I was in Boston like Chris and consulted 3 surgeons. Any would have been a good choice. My history was with Mass General Hospital so I went there. I had bilateral replacements 4 months apart in 2008-2009. Inpatient was only 2 days. I started PT at their Sports clinic, since I lived nearby, after discharge. PT was hard and it seemed to be more painful than the surgery. I was rigorous about staying with the rehab plan. It’s been 12 years now and I’m riding irl and Zwift without pain. I’ve done charity ride from 30 miles to century and 2 day events for 175 miles. I know technology and technics have improved, but I’m riding pain free.
Total knee replacement can be a game changer for anyone that is ready for it. I had my left knee replaced in Nov 2010. And it got me back on my bikes again. Which was bittersweet, as I crashed 9 months later breaking my back (T9 burst fracture, 6 level fusion required). I had put it off a lot longer than I should have out of fear.
So when my right knee was toast last year, I didn’t put it off and that was a much better decision and outcome. Oct of 2020 was my right TKR. And I was back on a bike in 2 weeks. 9 months later, I’m not as strong as I had been, but I’m also 10 years older than I was for the first one. And I’m on a good path to say I’m fully recovered in almost every aspect.
Seek an experienced surgeon that does LOTS of knees. Seek a PT that works with LOTS of knees. Do everything they ask of you, do all of your home work exercises. And never stop moving…
I had TKR surgery almost exactly 9 years ago. My knee was in really bad shape after multiple injuries and surgeries, including meniscus shaving and meniscus removal surgeries over the prior 30 years. At the time, cycling was still bearable, but walking was not. Long story short, I have since returned to high levels of low-impact exercise, including ultra-distance walking events. I thought the article missed a trick in not asking about the longevity of a knee replacement. Early models were said on average to last 10 years, and (I believe) even modern ones last on average only around 20 years. I also believe that although a second TKR is possible, it is more destructive to the surrounding structures, and two TKRs is usually the limit. There are two implications of this: (1) don’t rush into a TKR at too early an age; and (2) take good care of your TKR – don’t abuse it, and monitor it for discomfort, swelling, etc. You CAN damage it, and unlike a biological knee, it doesn’t self-heal!
My TKR is Tuesday. I have been feeling awful on the bike for almost a year. I’ve been getting PT and cortisone shots for 12 years. I am optimistic about the surgery but worried I won’t love the bike as much anymore.
I was diagnosed with athritis in my right knee around 2010 when I went in for arthroscopy for what i thought was torn cartlidge repair. Was informed that I’d need a half knee replacement in the near future. This was the reason i took up cycling in 2011. Got up to a reasonable level of fitness culminating in training for the Mallorca 312 2020 edition. Then covid lockdown hit. Still managed a couple of +150 mile rides that year when it became apparent that the event was cancelled. Anyway, the knee finally and all of a sudden gave up on the last weekend of August 2020. Earlier that year I’d had an MRI scan to confirm that arthritis had pretty much destroyed the joint and elected for a Conformis performance TKR to be performed Feb of 2021. This was ultimately pushed back to April 2021 due to Covid de-prioritising non-elective surgical procedures.
So ended up going from cycling to a good level (for a +50 something) not cycling for around 10 months, losing performance and gaining weight.
I’ve just about got close to the where I was before the enforced hiatus.
I’m back in this coming Monday to have the same procedure on my left knee as unsurprisingly, it’s following the same degenerativepath. This time, on my terms and with planned recovery out of season so that I can continue to pull back as much performance as possible before age becomes a factor.
I hope to be turning a pedal on the trainer after several weeks and have a Mallorcan cycling holiday booked for late April next year.
I’ll be more determined to work on the recovery and physio this time round for sure.
Key learning point for me – do not put off the inevitable if you have an opportunity to get things fixed.
Also, really improved with the Conformis replacement.
Peace-out
Darren Salmon
https://www.strava.com/athletes/11965311