Knee 2.0

My knee first started to complain over 20 years ago while we were living in New Zealand. We did a 4 day backpacking trip and when we finished up, I could barely bend my knee to get on the bus for the lift home. After some rest, I regained my normal range of motion. From that point on, I had no problems cycling, but did have to use poles when hiking, and usually had some swelling, ROM issues and pain after multi-day hikes. I saw a PT there who pointed out that I couldn't fully straighten my leg. He gave me some exercises to try to get the leg straight, but despite working hard I could never get it fully straight. Fortunately, the straightening issue wasn't noticeable to casual observers or causing me problems. However, I did have occasional give-way and pain issues with the right knee. When we returned to the US, I saw a few doctors before finally finding one who diagnosed loose bodies in the joint. Basically there were pieces of cartilage that had broken off that were moving around and randomly pinching something. I had arthroscopic surgery to remove the loose bits and cleanup some more that was about to break off. I then went years with no pain. 

But then a couple of years ago, I started having severe pain again. A local sports medicine doctor gave me steroid injections, which really helped. I was able to get these every three months. But every time I went in, he said a joint replacement was in my future.  This worked well for three years. Then about a year ago, a short time after my latest shot, the pain came back much earlier than after other injections. So I finally went to see a knee replacement surgeon in January, 2025. 

X-rays showed almost all the cartilage behind the knee cap was gone and I had bone rubbing on bone. He cautioned that if this continued, the knee cap might be worn too thin for the standard replacement with a plastic button the back of the kneecap. He also suggested doing it while I was strong since the recovery should be better if I went into it strong. 

We scheduled surgery for March 11. I started pre-hab with a physical therapist to improve strength where I could. I continued my winter activities, with a bit of fat biking and lots of snowshoeing. I had signed up for the snowshoe race on Mt. Washington, so I did lots of long snowshoe hikes all winter. I joined several group hikes where we tried to pack down and groom trails for fat biking. When fat biking, I started to notice a little pain when pushing off after a stop. I'd not had any significant pain before with cycling, so this almost reassured me that it was time. Do it before it impacts my main activity.  Up until then, it was primarily weight bearing activities that resulted in pain. Despite that, I still did 8-10 mile snowshoe hikes all winter, with some cycling when conditions allowed.

For the Mt. Washington event, there were 3 different races: nordic ski, fat bike and snowshoe. John was doing the fat bike race. I chose the snowshoe event. The race starts with 4km on the flatter Great Glen trails, before heading 6km up the auto road, finishing at treeline. The fat bikers and skiers get an easy ride/ski back down the hill. Snowshoers stay much warmer tromping back down hill, since it's a bit more effort than coasting or skiing down. Between my warmup and the descent, I ended up with close to 20km for the day. 

This was two days before my surgery! My anesthesiologist friend said, "Leave nothing on the table." 

We headed up To Dartmouth for my surgery. John got out for a ride while I was under. Once I woke from surgery, they had me walk down the hall and try some stairs. I had some pretty significant pain, but kept it under control with ice and drugs. 

Once the bandages came off, I got my first look at how long the scar would be!

And here is what the new joint looks like

 

I started back to PT later that week. John drove me down and took work calls in the car while I did PT. He was surprised when I came out with a skateboard! I was to only to use it in a chair, to slide my foot back and forth to work on regaining bend!

I ended up picking up a pedal-sizer device with 90mm long cranks that allowed me to do the bending exercises in my preferred motion! 

To see my activities in the first weeks... Play the videos.

At some point I sat on the trike in the basement and pedaled backwards very slowly!

Despite doing all the PT exercises multiple times a day, my bend was still pretty limited. I got up to 110, and then seemed to plateau. We ordered a set of 155mm cranks from Paul for my fixed gear bike that I mounted on a (non-smart) fluid trainer, pedaling with no or minimal resistance. My friends know how much I hate riding indoors. so this was a real challenge. I watched The Pitt, which is the best drama I've seen in years. It kept my attention in a way that I could spin along without dying of boredom. 

After one month, the surgeon said I could ride outside. Before any of this was planned, John had signed up for the Traka in Spain. The doctor said to go and ride and have fun. I rented an e-bike there. I bought some crank shorteners to bring over. They brought the cranks down to 145mm, enabling me to get over the top of the pedal stroke with the limited bend I had. We had a great time exploring and not overdoing things for either of us leading up to the race. 

This bike was awesome for climbing. The motor kicked out at 25km per hour, so I had a little trouble keeping up on the flats, but no problem on the big climbs!

John was well rested for the race, but given the prep in cooler conditions, not totally prepared for the heat on race day. 

We had spent most off the winter fat biking and snowshoeing and had no warm rides. The week in Spain was quite mild, but it then turned brutally hot on race day. I did an easy spin myself and then headed over to the finish. The only shade was at the top of a stadium, so I hobbled up to the shade with a cup of ice and iced my knee while I waited. John came in strong, but felt he could do better with a less crazy lead-up, so we are planning to go back next year!

After a week, I bid farewell to my lovely e-bike and we flew to Ireland for another week. My sister-in-law loaned me a non e-bike to ride for the week. The crank shorteners were great, since I could mount them on any bike I rode. I'd been aware of such devices because they are used on tandems for child stokers. They allow for 4 different lengths of shortening in 20mm increments. 

We tried to keep the rides flatter and shorter, since I was back under my own steam. 

We headed out to Duckett's Grove, one of our favorite spots for photos

John helped out when crossing the river was more of a challenge on the bike!

The summer was a bit rough for me. I still had pretty significant pain and lots of trouble sleeping. My PCP suggested edibles to help with sleep! 

I continued doing PT, easy rides and such, but my bend just didn't improve. One of the other things I hadn't fully been prepared for, was how much leg strength I lost. It hadn't really hit me that they would be cutting into muscle and that I'd lose so much muscle mass as a result of that trauma, but comparing the two legs, it was quite noticeable. And my speed and endurance definitely reflected that. Sadly a few of my friends were less than supportive. I didn't want to impact anyone's training or enjoyment, so I'd suggest riding together on rest days, but for some that was too much of an ask. Fortunately most of my friends enjoyed my company enough to make the speed sacrifice!

I did consult with the surgeon about lack of progress with bend. He suggested manipulation under anesthesia, but the risks didn't seem to offset potential rewards. My PT discouraged it and suggested we could get more bend. With lots of manual therapy and pushing really hard, I could get a bit more in a session, but not on my own. At some point, I went to see another doctor about other options. I'd found a few things on the internet, but he and others said they wouldn't help. It was well past the point where a manipulation could be done safely. In fact he said it was already past that point, when the original surgeon suggested it. He did put me back on anti-inflammatory drugs and a nightly icing regimen. He also said given my level of activity before the surgery, he wouldn't have done it. Opposite opinions from the two surgeons! His recommendation for folks was to wait until the pain was severe.

In retrospect, I'd agree. I'm seeing more and more research into options other than replacement. If I could go back it time, I would NOT do it. At 9 months, hiking, the activity that had caused pain, is still a real; challenge. And cycling... well...

Anti-imflammories and time and short cranks seems to have helped. We moved crank shorteners around quite a bit, but at some point decided to bite the $$$ bullet and buy new cranks for all the bikes. I tried ordering some custom cranks shortly after the surgery, but they were outrageously expensive and had to be custom made and would take forever. An internet search will likely find these. My experience with the company says PASS.

 

I then found some short cranks, ready to ship, made by Paul. As mentioned above, I installed these on the bike I had on the trainer and at some point bought a second set for my travel bike. 

The tandem was a big challenge but we found Bikesmith who shortens cranks. We just needed to find a set of cranks that would work, since the hollow tech Shimano cranks we had already couldn't be shortened. Co-motion came through for us, finding a set in an old parts bin that would work for shortening. I later stumbled upon some shorts cranks for DaVinci, so we have now 150mm cranks on both tandems. We also got a set of single bike cranks from Bikesmith that had already been shortened. These are on my winter bike. 

John later found some really nice cranks from Rotor that we put on another bike. He was so impressed with them that he ordered a set for his travel bike, but they arrived after new tariffs were put in place and so he got a big bill for the tariff. Rotor prices now include the tariffs for USA purchases. Power Meter City also carries Rotor cranks in the USA with prices that include tariffs already and since they are US based may ship faster. 

So... many $$$ later and now all my bikes now have short cranks. I suppose it's a sign that I have too many bikes! I also have a few sets of 165mm cranks to sell.

More time has passed and I'm slowly getting back into my old routine... almost. I've ramped up my distance a bit, but still not fully back to my previous levels. I've also been able to do group rides, getting faster and almost keeping up with folks. And most significantly, I'm no longer avoiding climbs! A few weeks back, I led a club ride that included an optional super steep out and back climb. I was surprised when everyone took the turn. I had planned to skip it, but then decided to give it a go and slowly made my way up! And now I'm seeking out more climbs.

So here's to a less stressful 2026!