Total Knee Replacement (TKR) for Endurance, Adventure, Action Sports Athletes

First of two total knee replacements goes down tomorrow. The hardest part for me as a life-long alt-sports athlete, is that there just isn’t much data out there to give any accurate insight into what TKR means for those of us with a lot of life left on the other side of the procedure, and not just life, but RIDICULOUSLY ACTIVE life! I want to race in more ultra-endurance MTB races, I want to successfully get up El Cap, I want to get barrelled out of my mind, I want to still ride Downhill/Enduro, I want to spend many more days at the skatepark – all of it! So, I’m hoping to track my journey in case you happened to land here as someone with a similar profile looking for some answers and hope as to what is still possible post-TKR.

Day Before Surgery: It’s been a very reflective day thinking back with a ton of gratitude on all the years of fun that this knee has brought me. So many epic adventures across so many sports means I ran through my miles quickly, and at 46 y/o I’m staring down the face of replacing some of the body’s hardware. My biggest hope is that this is the start of new adventures, new beginnings, new chapters of even bigger adventures that still lie ahead. I’m simply not done yet. I have a ton left to do. So – I’ve set some big goals that resonate with me and give me a carrot to chase, and I’m going to dig in and rehab like a beast. Here’s to starting a new journey!

Last trail walk on the old knee

SURGERY DAY: Surgery Day actually didn’t start today. I’ve been doing all the pre-op instructions, weird gels in my nostrils and belly button, prehab exercises to strengthen my quads, stretching, focused hydration, etc. I didn’t sleep much last night out of anxiety, and for about 10 mins around 1:00am I wanted to back out of the surgery for fear of the saw cutting through my femur and tibia. I found reassurance in my doctor’s track record and the fact that I spent a lot of time over the last few years seeing multiple doctors, getting multiple opinions, patient testimony from others. I’ve gotten to a point that I can’t continue doing the things I love even close to the volume I want to, and always with pain, so it just HAS to be time. I think that’s important. I’ve definitely waited until the internal voice said – it’s time, dude. Do it. SO – this morning I took my weird anti-bacterial bath and my wife and I arrived at the Surgical Center at 6:00AM for a 7:30 scheduled surgery. I had my intake, took some meds, chatted with the doc and the anesthesia team, and before I knew it I was headed into la-la land. I got an IV, nerve blocks in the knee, and in the back. The only thing I actually felt was the IV. They gave me a sedative before the nerve blocks and I didn’t feel a THING. Actually, I was completely oblivious to the entire procedure and woke up comfortably in the recovery room. After about 10 minutes of coming back to the conscious world, I felt like I was at a 7 or 8 on the pain scale. It was one of those pains that you’re trying to get away from, but just can’t. I was shivering and the nurses brought me four warm blankets which helped immensely. I took one of the harsh pain meds that I’m trying to take as little as possible of, and within 10-15 min I started to feel much better. I was able to get up and use the walker very tentatively, make it through my three-step challenge for discharge, and I was out the door soon thereafter. I had AMAZING staff helping at the Surgery Center, and I was incredibly grateful for that, and for my wife who was there keeping me in great spirits.

Since getting home, I’ve been using my ice therapy/compression machine religiously throughout the day as prescribed, I’d done some “gravity-assist” straightening exercises, some “within reason on surgery day” bending exercises, and getting up regularly to move around. I’m able to move across rooms fairly confidently with the walker and I’m surprised by how much body weight I can support (but I’m not pushing it). I’ve found that crutches are helpful to get in and out of our powder room to use the bathroom, and I reserve the walker for the rest of my movements.

The biggest point of gratitude has my family and friends’ support already. My brother came down to help through the weekend, my wife and kids have been insanely supportive, and my friends have been bringing food and sending inspirational messages. That in itself, at least for me, gives me that huge oomph to push through any pain and get back to 100 (or 110!)% and enjoy life with all these awesome people around me!

TLDR Surgery Day Bullet Points:

  • Do your prep
  • Hydrate well
  • Follow instructions
  • I’m able to do a lot more than expected
  • Enlist your support crew
  • Ice, Ice, Baby
  • Move!
Just about time to go under!

Day of Surgery Walker Usage

Day after Surgery:

Last night the pain came on. It was rough making it to the morning and the next dosage of Tylenol. But, I made it. Luckily, as athletes we can endure some pain in our lives. Today my knee feels more stiff, swollen, and the bruising is really starting to show, but I’ve been able to do all my sessions on the ROMtech bike, I can stand with crutches and bend to about 90 degrees, and almost get straight extension. I am having ENORMOUS difficulty laying on the floor and doing unassisted straight leg raises. Those seem impossible right now, but my wife has been giving me a bit of assistance through it so I’m still getting the quad strengthening in. Doing glute squeezes as well. I’m feeling some clicking in my knee which is kind of strange, but hoping that’s just part of everything going on in there. All in all a good day. It’s amazing how much of the day is taken up with PT, ROMtech, icing, getting up to move around, etc. It requires a lot of attention, but this is the way to get back stronger than ever, so I’m in!

2 Days Out:

Ok, NOW the pain really came on. Last night it felt like the top of my tibia
was literally on fire. I ended up having to succumb to taking one of the
oxycodone pills, which helped out. That was the only one that I needed to take
all day and was able to manage pain via Tylenol the rest of the time. I got a
little ambitious today on the ROMtech bike and tried to move out to the 3rd of
6 positions for the virtual crank arm length. Too much, too soon, and I felt a
horrific strain in my knee and a feeling like my kneecap was yanked out of
place. I hit the emergency stop and ended the session. In essence – today was
the worst day so far. But, I got through the rest of my PT, iced religiously,
and I’m adopting the “hit a speed bump, let’s just keep driving”

3 Days:

Last night my gut started feeling toxic. Acidy. Almost ulcery. I’m worried
that all the laxitives, antibiotics, steriods, pain killers, etc all put
together and introduced into my system are not being welcomed. Once I woke up
and ate, I felt better. I got my ROMtech sessions in but kept it on the 1/6
setting and felt really good. I’m starting to raise my straight leg off the
floor on my own showing some quad strength coming back. A bit later in the day
I had my first official PT session where they did some electro-stim work and
massaged some of the edema. The rest of the day felt awful, and I was in a lot
of pain and feeling super stiff and more swollen. I was really glad to talk to
the PT, however, and let him in on the exercises I had been doing and get
feedback on how far I should be pushing things. I’ve been working into the
“grimace zone” for some of the range-of-motion and leg lift
exercises, and the PT told me at this point we want to challenge, but not
further stress or injure. He explained that everything is like a frayed rubber
band at this point in healing and you don’t want to tear it even further. Right
now is about healing and smartly regaining range of motion/strength/ensuring
scar tissue doesn’t form where it will inhibit later down the line. I stayed at
fairly high level of pain through the night, couldn’t get through my fifth
session on the ROMtech, and ended up taking another narcotic for pain last
night. Not stoked on that, but I slept better than I have any other night, and
I know good sleep is one of the best things of all for recovery.

4 Days:

Woke up having slept better than any other night, and with a motivation to
regain nothing but a positive outlook on all of this. I’m going to get
stronger. I’m going to do the things I love. This is a new beginning. Felt okay
on the ROMtech in session one this morning, and it has progressed now to 8 min
passive and 4 min active pedaling.

As the day has worn on (almost 1pm now), I’ve stayed positive and gotten
through my PT motions, but I’m admittely in a bit of a mental cloud and really
concerned with the instability feeling on the inside of my knee. Ugh, but
whatever. Keep driving.

Night report – slept about 3 hours. Feeling like my knee won’t ever heal.
Letting negativity slip in. I’m tired.

5 Days:

Today I’m choosing to smile again. Not really. But telling myself that and
forcing positivity on me. I feel like something has happened with the inner
side of my knee, as if a ligament is off, or as if I did something to knock the
implant loose in my tibia or something. I feel like all the “parts are
bolted on halfway” and it’s rattly and weird and strange and frustrating.
I got through the first ROMtech session this morning without issue but the
second, on the lowest setting, I felt that familiar yank on the inner knee and
it threw me into a world of doubt. Ugh. Just want to feel better on a
consistent plane, but as my bro reminded me, progress is a wavy line. Peaks and

Afternoon: Talked to the doc and sent an image of my knee and where I’m feeling the “yank” (image below). He said totally normal at this stage post-op. Made me feel a lot better.

Night Report: Another night of very little sleep, inability to find a comfortable position, swelling in knee and ankle. Just how it is. Keep pushing on.

6 Days:

What a DOOZY. I woke up feeling tired/tight having not slept well again. I started coming around a bit in the morning and made my way through the prescribed regiment (ROMTech, some range of motion exercise, extension work) until going to my PT appt in the afternoon. At PT I worked about eight different exercises for range of motion, quad strengthening, extension, and then headed home. I was feeling particularly exhausted, in pain, and just needed to sleep. I decided to take one of the Tramadol pills and knocked out on the couch for a bit, only to be woken up by a delivery soon thereafter. I couldn’t fall back asleep, and a couple of hours later in the day we had some friends come by. I was in the room on the ROMTech bike catching up with our friend and my wife, and suddenly I felt super hot, sweaty, lightheaded, and like I was going to puke. I remember saying to our friend that I was embarrassed that I thought I would throw up while she was there, and then my wife went for a bag for me. The next thing I knew, I woke up with the paramedics at the house. Apparently I had passed out on the bike, and my wife, her aunt, and our friend had been trying to get me to wake up for about five minutes. They had rubbed ice all over me cause I was sweating profusely, and were slapping my face, calling my name, and no response. I started to come to, and the paramedics checked all my vitals and said I was normal, but should take a ride with them to the hospital. I respectfully declined, feeling confident (perhaps foolishly) that it was due to the Tramadol, and stayed home. The rest of the night I was in a cloud, had some insane dreams, and just feel like I’m coming down off the experience. I want to say, on a side note, that this was another piece of evidence for me that EMS/Firefighters are some of the most noble and honorable professionals out there. They were super professional and caring, and really took the time to make sure my family and I were alright when this happened. Huge gratitude.

7 Days:

Today I slept in a little bit more, took it a lot more easy, and listened to my wife’s PT regiment. She said I’m an idiot for still trying to do too much, and that today she was going to take over and make sure I only did what was the smart amount towards getting me right. We reduced the number of times on the ROMTech bike to 3x, and kept it in the first position, and worked some range of motion and extension throughout the day, but with assistance and not pushing. Today is like a recovery day from yesterday, and I think that’s the best approach. I will say that I felt a LITTLE bit of positive healing today, like it’s starting to come back in line. I’m excited to feel some progress. Now I just need to not muck it up!

8 Days:

Today the ROMTech bike has a resistance setting. It’s 6 minutes passive, 4 minutes active pedaling (no resistance), 4 minutes with resistance (I’m guessing somewhere around 30 Watts) and then finish with one minute of active, no-resistance. I’m shooting for 4x on the ROMTech today and doing my range of motion/leg extension exercises. I’m also going to begin getting up even more frequently, maybe every 45 min or so, and continue to ice when I’m down. So far (mid-day) the day is going really well.

10 Days:

Yesterday, after much frustration, I realized that the healing process isn’t going to plan at all. I’ve continued to push through intense pain in my range of motion exercises and kept feeling the sharp, localized, burning, stinging sensation right at the point where my MCL attaches to the tibia. It finally dawned on me that I have been battling through what I believe to be a separate injury that occurred on the ROMTech bike on the first or second day post-op. I 99% sure I’ve torn my MCL (hopefully slightly) which means I’m going to have a real battle moving through exactly the exercises I need to in order to beat the six-week window to regain range of motion from the knee replacement. I’m feeling pretty defeated, frustrated, and in pain, but none of that is going to help. Instead, once again, I’m choosing belief that I’ll get through this and I’ll do everything I can to get there. Once again…let’s gooooo!

Day ? 12? 13? Something like that.:

I’ve backed off ANY form of getting close to where my MCL gets aggravated in my PT. I’ve reduced the ROMTech sessions to 3x per day and stayed at level 1 of 6. I’m icing like crazy. And I’ve adopted between now and tomorrow morning when I see the doc again as “No Worry” time. I’m frustrated, pissed, hurting, disgruntled, and it’s just the way it goes. However, worrying isn’t going to do me any good, and even if I really am facing an inability to get through full range of motion, my PT says I’ll be able to recover even beyond the six-week window that is the target to fend off scar tissue formation. It will just hurt more, take longer, and require more determination. Sweet.

Today through the day I think I’m actually feeling a little bit better. Worth noting.

Day 14:

Awesome day today. I had my post-op visit with the doc and had the chance to really go through all of the concerns/feelings/frustrations/pain/fears that I’ve been feeling, and he reassured me that I was on track, he didn’t feel that I had torn my MCL and rather I was experiencing a lot of pain in one of the capsules where they move everything around during the surgery, and that I could continue pushing my PT. Which I did. I went to PT after the doc appt and knocked out 3×10 straight leg raises unassisted, got my knee to 90+ degrees hanging off the table, did some calf raises, and some short arc extensions. I also got to level 2 on the ROMTech bike today. I was definitely tired in the evening, but super glad that I have the green light to remove some of my worries.

Day 15:

Today I’m sore from yesterday. Didn’t sleep well last night, feel like I’m a little more swollen than before, and I’m experiencing that stinging pain that I thought was an MCL tear. However, I’m seeing it as the result of a positive, hard workout the prior day, and today I’ll go a little lighter and let things calm down. Rock and roll.