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How do I avoid knee replacement?

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I'm almost 51 and I've had knee problems for as long as I can remember. I was diagnosed with osteoarthritis, and I had arthroscopic surgery in 2003 for a torn meniscus and some general clean up inside my left knee. That helped a lot and I was able to toss my cane and walk with no limp, no more lockups, etc.

For pretty much the entire time since then, I've rotated through various pain meds (vioxx, celebrex, ibuprofen, naproxen sodium), but they don't really seem to do much for me any more, and I'm worried that I'm causing myself more damage than benefit.

Last year, somewhere around October, I was walking around in so much pain that I went back to my orthopedic guy. He pretty much told me that I had almost worn out my cartilage and a full knee replacement is the next step. I asked for alternatives, and was given a physical therapy clinic. My first visit there, the guy basically told me that I wasn't going to gain anything with physical therapy and that I should have the knee replacement done. I pressed him, and he gave me some exercises to do with one of those rubber bands.

I called the orthopedic guy again and asked what else there was, and he signed me up for a Euflexxa study that I've been on for several months. I'm not actually sure whether I got the Euflexxa or the saline, but I have been riding my motocross bike regularly since the start of the study - not sure if it's the Euflexxa or the physical activity that is making me feel better. I don't want to stop riding! I certainly do pay a price though. By the end of the day (3-4 hours of on and off riding) I get stiff enough that I have a hard time walking, and the next day I hobble around pretty badly. Luckily I've been recovering in time to ride again the next weekend! During this study, I'm only allowed to take acetaminophen, and it does seem to have some benefit...

So, questions... 1) Am I correct in assuming that motocross and total knee replacements are incompatible? 2) Any ideas how long Euflexxa and similar treatments can last? How many injections can be given? 3) What else should I be considering to make sure I can continue to ride?

Thanks!

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First of all let me just say that I am not an orthopedic surgeon, but I am a nurse who specializes in orthopedics. For the last 3.5 years I've done post-op care for hundreds of total joint replacement patients. For many the decision to have the surgery was based on wanting to be pain free in their day-to-day lives, but for many others it was based on wanting to get back to doing the activities/sports that they loved like hiking, biking, skiing. When you say motocross are you talking about racing? Hitting the triple jumps? Or are you talking about more recreational riding? I've had plenty of patients who ride motorcycles after these types of surgeries, although most of them ride primarily on the road.

Knee replacement shouldn't mean having to give up offroad riding. For sure you'll have to take an extended period off to recover/rehab, but you should be able to get back to riding. I would talk some more to your orthopod & also find another who specializes in joint replacements and deals with athletes & sports injuries.

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Theres a saying over at Glamis Dunes dot com...."With age comes a cage"....meaning get yourself a Polaris RZR "S" model and keep on keeping on. While not better than a dirt bike (at least not a KTM), it's the next best choice.

I can tell you from previous posts that Dr Mark will suggest you give up the off road riding after a knee replacement.

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I can tell you from previous posts that Dr Mark will suggest you give up the off road riding after a knee replacement.

Yes, that's what I saw when I did a forum search. I'm going to stick with the euflexxa as long as I can. I ordered some books on myofascial pain along with a theracane. I've had some good luck with one of those foam rollers too...

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Doc Mark will tell you no riding if you get a TKR. I had alot of Docs tell me to get a TKR. Doc Mark performed a tibial osteotomy on me that opened the joint space back up. I no longer have pain when walking and doing anything. I can jog on a treadmill, or on grass pain free. On concrete, I can feel the pounding when running, so I don't do that. Riding is pain free too!

Do you have any bowing in your leg? Got an x-ray? If so, post it and have Doc Mark take a look.

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I'm curious as to why no offroad riding after total knee replacement? I will probably have to have one sometime in the future. Why can you still ski and do a lot of other physical activity? If I just trail ride and no track's and generally just take it easier, I don't understand why it is not recommended. I'm not trying to jack the thread and I'm sure OP would like to know also.

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I'm curious as to why no offroad riding after total knee replacement? I will probably have to have one sometime in the future. Why can you still ski and do a lot of other physical activity? If I just trail ride and no track's and generally just take it easier, I don't understand why it is not recommended. I'm not trying to jack the thread and I'm sure OP would like to know also.

There are 2 ways to perform a total knee replacement--save the pcl or cut it out. The ACL is cut in both types. So you are left with only one of the 2 ligaments left that control the translation of the tibia on the femur. It kinda boils down to 2 things. Loss of knee flexion, and the possibility of component damage of dislocation. The knee without the PCL relies on the shape of the implants to maintain the knee in a reduced (articulating) fashion. Some implants have a plastic post that helps maintain the the relationship. Low level activity is fine for total knees, but once you start subjecting the components to jarring stresses, something has to give. The ligaments aren't there to absorb the shock like they normally would do, so, the risk on one component sliding back or rotating out from under the other is always a risk.

THE PRIMARY REASON TO HAVE A KNEE REPLACEMENT IS FOR PAIN CONTROL. If you want to keep doing the things that you are know there are some things you can do:

If you are fat, lose weight

Physical therapy will help some people

Joint disease isolated to once compartment of the knee may be treated with a partial knee replacement, or an osteotomy can be performed that "unloads" the affected compartment

Viscosupplementation: "gel shots" help some people, and if it puts your replacement off for 6 -12 months thats good. They also can be repeated every 6 months as well.....

Corticosteroid injections: most will say you can't have these more than every 3 months........

Esten, didn't you have an achilles issue?

aj

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There are 2 ways to perform a total knee replacement--save the pcl or cut it out. The ACL is cut in both types. So you are left with only one of the 2 ligaments left that control the translation of the tibia on the femur. It kinda boils down to 2 things. Loss of knee flexion, and the possibility of component damage of dislocation. The knee without the PCL relies on the shape of the implants to maintain the knee in a reduced (articulating) fashion. Some implants have a plastic post that helps maintain the the relationship. Low level activity is fine for total knees, but once you start subjecting the components to jarring stresses, something has to give. The ligaments aren't there to absorb the shock like they normally would do, so, the risk on one component sliding back or rotating out from under the other is always a risk.

THE PRIMARY REASON TO HAVE A KNEE REPLACEMENT IS FOR PAIN CONTROL. If you want to keep doing the things that you are know there are some things you can do:

If you are fat, lose weight

Physical therapy will help some people

Joint disease isolated to once compartment of the knee may be treated with a partial knee replacement, or an osteotomy can be performed that "unloads" the affected compartment

Viscosupplementation: "gel shots" help some people, and if it puts your replacement off for 6 -12 months thats good. They also can be repeated every 6 months as well.....

Corticosteroid injections: most will say you can't have these more than every 3 months........

Esten, didn't you have an achilles issue?

aj

Yes AJ, I had surgery on Wednesday, surgery went well the achelies wasn't ruptured but tore a piece of bone off my calcaneus "not sure I spelled that right". The bone was in one piece so they re-attached with 7 titanium screw's. They also sliced upper part of calf muscle to alleviate stress on achelies. I am layed up now with cast for 4 to 6 week's. I am hoping to get cast off and start re-hab and try to salvage some riding this summer as I have stated before. Probably won't be able to race any enduro's this summer, but still hope to trail ride with friend's and family. Thank you AJ for all your comment's you have been helpful, at very least just to talk about it.

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Yes AJ, I had surgery on Wednesday, surgery went well the achelies wasn't ruptured but tore a piece of bone off my calcaneus "not sure I spelled that right". The bone was in one piece so they re-attached with 7 titanium screw's. They also sliced upper part of calf muscle to alleviate stress on achelies. I am layed up now with cast for 4 to 6 week's. I am hoping to get cast off and start re-hab and try to salvage some riding this summer as I have stated before. Probably won't be able to race any enduro's this summer, but still hope to trail ride with friend's and family. Thank you AJ for all your comment's you have been helpful, at very least just to talk about it.

An avulsion injury should heal faster than a tendon rupture.....don't push it too fast, and good luck......aj

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Nicely done AJ.

Tell me again, how many years do you owe the Navy?

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Nicely done AJ.

Tell me again, how many years do you owe the Navy?

3.....can't remember if I told you, but I'm getting stationed in Chicago....should be fun, right? 👍

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It sure beats Afganistan. You will be eating dinner with your kids every night. If you are at Great Lakes, then you will get a good slice of community practice, only you won't have to be in charge of collections. I envy you.

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Do you have any bowing in your leg? Got an x-ray? If so, post it and have Doc Mark take a look.

First off, sounds like you're doing great! That's very cool...

I do have a little bit of bowing in my left leg. Looking at the x-ray pictures and judging by how my knee feels and acts, the medial side of my knee seems to be worn more than the lateral. It feels like things are looser on that side - the tendons seem to "twang" a bit like a bow string sometimes. When I sit down or stand up, there is a point at which the left knee gets quite painful, then things shift a bit and the pain reduces considerably. I have lost flexibility in both knees, but the left side is much more obvious - I don't think I can move my knee the last 45 degrees towards my butt. I have been spending quite a bit of time with a foam roller and have been trying to work out the kinks with my fingers on both the front and the back of the entire knee area. Using the foam roller on the back of the knee and up into the biceps femoris has really helped reduce stiffness and pain, but I still can't extend my leg fully. Also, FWIW, I'm having some pretty severe cramping in my sartorius muscle after riding. I'm guessing this has to do more with dehydration and/or electrolytes, but I figured I should mention it anyway...

I'll see if I can get a copy of those x-ray pictures that I can post...

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"I do have a little bit of bowing in my left leg. Looking at the x-ray pictures and judging by how my knee feels and acts, the medial side of my knee seems to be worn more than the lateral."

If your lateral meniscus hasn't been "harvested" there may be a solution here.

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THE PRIMARY REASON TO HAVE A KNEE REPLACEMENT IS FOR PAIN CONTROL.

I think I can deal with the level of pain I have for quite some time. I have more problems with stiffness/lack of mobility than I do with pain. My son and I are planning to build a hot tub in the back yard this year. Hopefully, that will help!

👍

If you are fat, lose weight

Physical therapy will help some people

Joint disease isolated to once compartment of the knee may be treated with a partial knee replacement, or an osteotomy can be performed that "unloads" the affected compartment

Viscosupplementation: "gel shots" help some people, and if it puts your replacement off for 6 -12 months thats good. They also can be repeated every 6 months as well.....

Corticosteroid injections: most will say you can't have these more than every 3 months........

I wouldn't say that I'm fat, but I weigh about 230. (I'm 6'5") I'm very interested to learn more about the partial replacement. I just looked up osteotomy, reminds me that my left leg has always been a bit shorter than the right. I wore a 1/4" lift for a while, but I got back aches, plus I started spending time in bare feet and sandals, so I got rid of the lift and have been mostly happy ever since. Funny thing, because of the hip tilt, I have a bit of a shoulder tilt the other direction, plus I took a tumble a couple years ago and tore my right shoulder tendons, so the right shoulder really looks like it's drooped down! You can actually see it in this picture:

4352804654_b11d430662_o.jpg

(Why couldn't I tear the left shoulder so that I would look even???)🤣

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A "partial" knee replacemnt is a knee replacement. Those have have knee replacements, partial or total, need but trade in their CRFs for Harleys. The "partial" is not an answer for the guy that wants to ride offroad. Its either an osteotomy, or tough it out.

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If your lateral meniscus hasn't been "harvested" there may be a solution here.

Hmm, now that sounds interesting... I had an arthroscopy done a few years back; it was the medial meniscus that was cleaned up. I even have a video tape of the operation around here somewhere.

How long does it typically take to recover from this kind of procedure?

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trade in their CRFs for Harleys

Eeek!!!! No way. No Harley for me... Maybe a nice ZX-10 or something...

Preparing to tough it out...

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Guys are back riding in three to six months after an osteotomy.

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I was off the bike for 6 months, but I have Rheumatoid Arthritis, so my bones don't heal like other peoples. My pain was all on the medial side, as this was the cartilage that was destroyed. Doc Mark opened that baby up and made my leg straight again. I'll try and dig up the pics of my bowed leg, the original x-ray, and the post surgery x-rays and post them here.

Doc, PM me about Houston SX.

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