Osteoarthritis in knees

[Dan Morinary]

Thanks @dbeattie, that sounds positive.

 

[velovoice]

I have osteoarthritis both knees, first spotted by xrays & MRI when I was 11. Arthroscopy left knee 6 years ago (age 42) removed most of the cartilage. I do not recommend surgery if you can avoid it - its only value was that it made me take the post-op physio seriously! And it was physio that "saved" me and kept me cycling. (A custom bike that actually fit me, didn't hurt either!)

Addressing muscle weakness/tightness/imbalances may be the single most helpful thing you can do for your knees (takes pressure off the joint, ensures good tracking, etc). Prolonged standing/walking/stairs will probably always be a problem for you but exercise does help.

Pilates can help too if it's the right mix. It's hard to get "circuit" Pilates classes outside London, so beware those offering exclusively matwork or Reformer work, as they may overwork muscles that are already quite strong from cycling while not engaging the counter-acting muscles that often don't get a look-in from cycling but are essential to get engaged and working properly if your joints are to be well supported.

No idea what part of the country you are in but if you can afford to go private, I highly recommend the physios at Balance in Clapham and also Nicole Oh who practices in Putney and Blackfriars (as recommended by @vickster in other threads - thank you @vickster!!)

Oh and that "you're too young for knee replacement" is total bollocks in this day and age. The materials used now will outlast you. My mother suffered for decades being told she was too young and "come back in 10 years". At age 60, the orthopedic surgeon said "OMG, why have you not come in sooner?" and she burst into tears and wailed "because you all said I was too young and not to bother you!" My sister had both knees replaced at age 52. The orthopedic surgeon and Xray technician said her knees looked like they belonged to someone in her 80s. She followed physio to the letter and went off on a walking holiday 6 weeks post-op and was back to high alpine hiking/climbing just a few months later.

Also don't believe any surgeon who says "if you have knee replacement, you'll never cycle again". (My surgeon told me this, scared the sh*t out of me -- see above comment about the arthroscopy making me take physio seriously!!) Quick Googling will turn up cyclists who had bilateral TKP and were doing 200km audaxes within 6 months.

Good luck!

 

[Dan Morinary]

Thanks @velovoice, I moved out of London many years ago! Will definitely do some research on pilates.
I was shocked when told I was too young for replacement, as I know 3 people younger than myself have undergone the op.
Cheers for very positive and informative reply. Planning on cycling, camping & hill walking, good to hear positive things.

 

[vickster]

There are plenty of cycling focused physios outside London too. Google and the phone are your friend

If you go down the surgery route, find a surgeon who only does knees and does a lot of TKRs and even revisions

 

[Dan Morinary]

Thanks @vickster, I've entered a whole new Google world of knees!
Cheers for really helpful replies.

 

[velovoice]

There are plenty of cycling focused physios outside London too. Google and the phone are your friend

If you go down the surgery route, find a surgeon who only does knees and does a lot of TKRs and even revisions

I would also add, when surgeon "shopping", find one who has some idea of what post-op progress should look like. Many surgeons lose interest once the surgical wound has healed and have no idea of the rehabilitation that follows!

 

[velovoice]

FWIW, there is an orthopedic surgeon from Cambridge who comes on the annual Fridays Tour. I don't know much about the focus of his practice but if you're anywhere near Cambridge, I can certainly ask!

 

[PK99]

Cycling and swimming are the best exercise for knees. Also important to have all of the muscles working as they should. If cycling is your main sport, find a sports physio who has a special interest in cycling, they should be good with knees too as a result

You probably could find a surgeon to do a knee replacement if considered a candidate, but you'd have to pay (around £8-15k a knee depending on type of implant, surgeon, hospital etc)
You might even find one on the NHS but they prefer not to do in the under 60s as you're likely to need some sort of redo/revision as they don't last forever

A friend in his 70s needing a new knee has been told he would have to give up cycling as it would wear out the knee.

I should add that he rides long club rides 3 days a week. Ctc 50/60 miles on weds. Easy club rid on Saturday 25/30 miles, ctc day ride on Sunday 50/60/70 miles. Not all that every week as he time trials on summer Wednesdays

 

[velovoice]

A friend in his 70s needing a new knee has been told he would have to give up cycling as it would wear out the knee.

Was this the NHS? I hate to say it (because the NHS is a wonderful thing, in principle if not always in practice - another discussion entirely!) but T/PKR on the NHS does not make use of the latest/best materials. The advice given by NHS professionals is often, well, a bit "dated" as a result. So their policy is not to do ops on 'young' and/or active people. The difference in materials (and therefore robustness and longevity) if you can go private is like, well, 20th century versus 21st.

 

[vickster]

My knee surgeon who operated recently on @PK99 is expert in TKR, both NHS and private. Whether he uses the same materials I don't know

@velovoice can I send you a PM shortly, would just like to pick your brains

 

[velovoice]

My knee surgeon who operated recently on @PK99 is expert in TKR, both NHS and private. Whether he uses the same materials I don't know

@velovoice can I send you a PM shortly, would just like to pick your brains

Absolutely.
In case it's any use to anyone, I just found a blog post I wrote 18 months ago about my knee history.

 

[Dan Morinary]

@velovoice
I'm up north but, as a good friend has just undergone replacement, I have a good idea of reputable surgeons and physios.
Interesting blog post, will check out links. Thank you.

 

[PK99]

Was this the NHS? I hate to say it (because the NHS is a wonderful thing, in principle if not always in practice - another discussion entirely!) but T/PKR on the NHS does not make use of the latest/best materials. The advice given by NHS professionals is often, well, a bit "dated" as a result. So their policy is not to do ops on 'young' and/or active people. The difference in materials (and therefore robustness and longevity) if you can go private is like, well, 20th century versus 21st.

It was NHS at the SWLEOC centre of excellence.

 

[kingrollo]

Don't be blinded by the scans - it can be possible to have severe OA but not no pain - and a little OA but be in agony.
You need to build up the muscles around the knees.
I had OA in my hip, I declined surgery - but worked with a great physio on the NHS - it took me 18 months, but I am now back on the bike and pain free...

 

[Alan5616]

A friend in his 70s needing a new knee has been told he would have to give up cycling as it would wear out the knee.

I should add that he rides long club rides 3 days a week. Ctc 50/60 miles on weds. Easy club rid on Saturday 25/30 miles, ctc day ride on Sunday 50/60/70 miles. Not all that every week as he time trials on summer Wednesdays

I firmly believe that the NHS needs to get it's act together when it comes to matters orthopaedic. So much conflicting advice. Gym work, and cycling, have helped defer my knee replacement indefinitely. According to my knee x-rays, I shouldn't be able to walk!!