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knee replacements and hill walking

Re: knee replacements and hill walking

Postby HalfManHalfTitanium » Mon Sep 24, 2018 3:32 pm

Alteknacker wrote:
skiker wrote:... given the shambles of health care here, I wouldn't venture that ours are better. :roll:


Hmm. We've unfortunately had quite a few visits to hospitals on a variety of fairly serious matters in the last few years (an inevitable concomitant of passing 3 score, sadly), some private (because I was insured through my job before I retired) and some on the NHS.

Our experience of the NHS is that it has been uniformly superb. I've just had a rotator cuff arthroscopy, on the left shoulder, which I had to wait no longer for and so far is going just as well as the one I had on the right shoulder a couple of years ago as a private patient.

My very brief and minor experience of health care in the USA was that most of the time was taken up with admin and checking that you had enough money to pay.


I totally agree with Alteknacker - the NHS care and advice is "superb". The single most important thing of all, which I forgot to mention in my previous advice because it is so obvious. The key to hill-walking with knee replacements is follow the medical advice, do the prescribed physio exercises religiously - and if unsure about anything at all, ask for further advice. Despite the pressure on them, NHS staff are always (in my experience) more than happy to take the time to give detailed, specific advice.
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Re: knee replacements and hill walking

Postby skiker » Wed Sep 26, 2018 1:50 am

My very brief and minor experience of health care in the USA was that most of the time was taken up with admin and checking that you had enough money to pay.


Yep. That'd be the state of health care in the US.
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Re: knee replacements and hill walking

Postby RocksRock » Wed Sep 26, 2018 10:37 am

Don't knock them too much........only time I needed hospital input over there, and after swearing I had insurance cover, which I did, the very nice female doctor wouldn't charge me anything as I was on holiday and it was a shame to be ill...............turned out her mother was a Brit! :clap:
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Re: knee replacements and hill walking

Postby RocksRock » Wed Sep 26, 2018 11:36 am

I'm at the stage now of talking to the surgeons to fix up a replacement on my right knee - they are as bad as each other on imaging, practically bone on bone, so there is nothing to do except replace them :(

I'm told that replacement knees can feel mechanical rather than natural and feel "not really mine". I'd be very interested to hear how folks on here have found it.

I'm also interested in kneeling after replacement. I don't enjoy housework anyway but gardening is a pleasure so kneeling to weed and plant is something I like to do. Does it ever feel really OK or will it go on being painful?
And how soon is climbing walls and dodgy stiles a safe possibility?

Apart from that there are a few hints I have found useful, which might help others starting on this road.
- starting with encouragement, the physios remind me that it is 9 years since I first consulted them over the knees and only now are the knees forcing me to surgery.............I say that proves physios are brilliant. :clap: ........ they say it proves I have done my bit with the exercises and gym work...... :) you choose!
- everyone, manage your weight, the more you keep it down the longer your natural knees will stay asymptomatic and the longer they will last.
- I have to lose 5 kg before surgery - make sure your GP records your weight when you first consult her/him and enters that weight in the referral letter to surgeon, otherwise surgeon may record the weight he sees and then make you lose 5 kg off that when you’ve already lost 4kg :wink:
- Don't lug huge loads around unless it is essential - less load on knee = less pain and less deterioration
- Use poles in both hands, especially downhill, but uphill as well will help - spreading your bodyweight across two poles and two knees halves the load on each knee and reduces the damage (and pain) each step causes.
- Ice the knee thoroughly after all exercise - essential to keep the swelling down every time............ see demo and Ice it Away device at clairepatella dot com for help
- See a physio or similar and get exercises tailored to your specific problem
- Once you have an exercise programme do it religiously every day...... we only get out what we put in
- I find a couple of trips to the gym weekly helps – recumbent bike and rower are ideal cos it exercises the muscles above and below knee without putting weight through them. I keep off the cross-trainer and treadmill
- Keep range of motion of the knee to the max before surgery, there are specific exercises to help...
- Surgical techniques are improving all the time but the best surgeon's work can be ruined if we do not comply fully with the rehab program. Strict compliance reduces rehab time and gets a much better result.
- look after your tendons and ligaments: good strength in them will also get you a better result quicker after replacement. My physios begged me to forswear hills this summer just in case of a slip and a torn tendon/ligament complicating matters further. It has been very hard indeed with the beautiful weather but I've complied because I want the better outcome quicker!
- finally orthopaedic surgery is getting ever more specialised, with surgeons often specialising in only one joint. You need a specialist in knees, so politely insist that's who you see. If your local hospital doesn't have one, NHS does give you the right to a second opinion etc so insist. The National Joint Registry (England & Wales) will tell you how many of which joint each NHS surgeon does per year - good guide to experience. Scottish Arthroplasty Project should provide this when it is up and running.

Final encouragement: I recently met a gent who had had total knee replacement three weeks previously. He walked in using only one crutch and admitted that he did not need it all the time at home……he must have re-habbed really hard but he was getting out what he had put in….."
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Re: knee replacements and hill walking

Postby HalfManHalfTitanium » Wed Sep 26, 2018 4:24 pm

"Apart from that there are a few hints I have found useful, which might help others starting on this road.
- starting with encouragement, the physios remind me that it is 9 years since I first consulted them over the knees and only now are the knees forcing me to surgery.............I say that proves physios are brilliant. :clap: ........ they say it proves I have done my bit with the exercises and gym work...... :) you choose!"


I think it proves both.

"I'm told that replacement knees can feel mechanical rather than natural and feel "not really mine". I'd be very interested to hear how folks on here have found it."

Never noticed this - I think mine is great.

"I'm also interested in kneeling after replacement. I don't enjoy housework anyway but gardening is a pleasure so kneeling to weed and plant is something I like to do. Does it ever feel really OK or will it go on being painful?
And how soon is climbing walls and dodgy stiles a safe possibility?"


Walls and stiles - fine, as long as the moves are simple. Most scrambling (grade 1) OK. Kneeling still feels 'odd' to me. I had to do a kneeling move on the small "step" on Beinn a Chroin - felt weird, but not actually painful.

If i need to kneel, I tend to kneel on my real knee, and bend the artificial one so my foot is still on the ground.

But it is all very individual...
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Re: knee replacements and hill walking

Postby RocksRock » Sat Sep 29, 2018 7:30 pm

@HMHT..

its good to know that you feel "at one" with your replacement. It was an issue I had not thought of, so was taken aback when I saw it mentioned somewhere............. Aye, I kneel on the good one now and keep the grotty one with foot on floor - it works well enough for gardening, though what happens when they do the other knee is anybody's guess..

As to stiles, well I can think of some that may well be out of bounds - those ones with tiny narrow gaps for the toes are my bugbear just now, along with the ones that have verticals projecting upwards above the top step on both sides of the stile - I can't swing my duff knee over them...... lairds please note :wink:

I'm hoping to see the surgeon in the next two weeks so times may get interesting. GP is suggesting not to do it till next spring, on the basis rehab will be easier if there is nice sunny weather. I can see his point but it may mean losing nearly another whole season and at 72 I my not have that many left in me :( ............................when did you get yours done? and how, if at all, did season affect your rehab?

atb

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Re: knee replacements and hill walking

Postby HalfManHalfTitanium » Mon Oct 01, 2018 2:12 pm

RocksRock wrote:@HMHT..

its good to know that you feel "at one" with your replacement. It was an issue I had not thought of, so was taken aback when I saw it mentioned somewhere............. Aye, I kneel on the good one now and keep the grotty one with foot on floor - it works well enough for gardening, though what happens when they do the other knee is anybody's guess..

As to stiles, well I can think of some that may well be out of bounds - those ones with tiny narrow gaps for the toes are my bugbear just now, along with the ones that have verticals projecting upwards above the top step on both sides of the stile - I can't swing my duff knee over them...... lairds please note :wink:

I'm hoping to see the surgeon in the next two weeks so times may get interesting. GP is suggesting not to do it till next spring, on the basis rehab will be easier if there is nice sunny weather. I can see his point but it may mean losing nearly another whole season and at 72 I my not have that many left in me :( ............................when did you get yours done? and how, if at all, did season affect your rehab?

atb

rocksRock


Sorry for the slight delay in replying – just been having a weekend in Wales including a stunningly beautiful walk on Cadair Idris – TR to follow.

I had the knee done in January 2015 when I was 51. I’m now 55 and heading for replacement of the other knee. Metal knee is going strong, no problems of any kind.

Before having the knee done I did walks with gritted teeth, just tried to concentrate on the views and ignore the pain. But after doing Beinn Alligin (https://www.walkhighlands.co.uk/Forum/viewtopic.php?f=9&t=58344), I kind of knew it was my last big hill walk - I thought perhaps for ever.

The knee op gave me a completely new lease of life.

For the first three months I just did the physio exercises religiously, and nothing else. After a few weeks I walked around the local park. I did my first gentle hill walk, Stiperstones, about four months after the op. Then in July I did Striding Edge as a “test” and I was surprised to find it that the knee was totally fine. A couple of months later I did a week of walking in Braemar including several Munros and it was great - here's one TR https://www.walkhighlands.co.uk/Forum/viewtopic.php?f=9&t=77096.

Since the op, I have not attempted favourite but more full-on scrambles like Bristly Ridge, Tryfan or Curved Ridge – but I would not rule them out. If I had had one more fine day in Skye last year, I would have had a bash at Gillean. Knee was fine on the stony terrain of Banachdich and Bruach na Frithe (https://www.walkhighlands.co.uk/Forum/viewtopic.php?f=9&t=72538).

I’m also hoping to get back to the Himalayas some time, but it would have to be a “supported” walk with porters eg Stok Kangri or Mera Peak, I would not do self-sufficient again, as it would involve me carrying a big pack. By the same token I would probably not try UK wild camping far from a main road any more, due to the pack carrying.

Hope that helps! – feel free to ask any other questions if it will help at all.

Tim
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Re: knee replacements and hill walking

Postby Moder-dye » Mon Oct 01, 2018 3:49 pm

Cheers for that detail of your progress.

I'm 11weeks post op and just suffering from the consequences of doing too much too soon. This weekend my knee has blown up massively to be as swollen and stiff as immediately post op.

Unlike you, just doing the physio and no more for the first 3 months, I've been doing the required physio, plus extra strengthening and mobility physio, riding my turbo trainer and some local flat walking up to an hour. Didn't over do it with anything specific or an incident, things have obviously just come to a head.

So, I'm currently sofa bound with ice and hoping the swelling goes down soon. And I'll be doing little more than the essential physio for some time as recommended by my surgery team. That's me told....
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Re: knee replacements and hill walking

Postby Moder-dye » Mon Oct 01, 2018 3:55 pm

HMHT, just for reference to not doing any wild camping far from the road anymore, what would you think of as far from the road?

I've been a bit shaken with my set back this weekend. I was really doing well, but if that swelling happened after a day in the hills when wild camping it could easily be practically impossible for me to get back to 'civilisation' under my own steam.
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Re: knee replacements and hill walking

Postby HalfManHalfTitanium » Tue Oct 02, 2018 2:23 pm

Moder-dye wrote:HMHT, just for reference to not doing any wild camping far from the road anymore, what would you think of as far from the road?

I've been a bit shaken with my set back this weekend. I was really doing well, but if that swelling happened after a day in the hills when wild camping it could easily be practically impossible for me to get back to 'civilisation' under my own steam.


Hi Moder-dye

Swelling and pain –

I’ve not had any serious swelling or painful incidents with the knee since the op.

I don’t exercise, so I don’t know what it would be like to challenge my knees in that respect. I’ve never done training or fitness activity apart from walking itself, except years ago when I was training in preparation for high-altitude stuff in the Andes.

Sometimes, odd things hurt more than others. I was fine with the very steep and rocky descent off Cadair Idris (https://www.walkhighlands.co.uk/Forum/viewtopic.php?f=16&t=84637) on Saturday, but on Sunday we did the old railway track and bridge to Barmouth, one of my favourite scenic walks, but the regular movement on the level track made my knee (the non-replaced one, but it’s due for a replacement) a bit sore by the end of the walk.

On Cadair, I found that descending steep, deep heather, even when overlying hidden, uneven rocks, was easier on my knees than the stony trodden path. Similarly, I find, when descending, that many of the constructed tracks of stone slabs on the popular routes in the Lakes are hard on my knees these days, and I often walk on the grass alongside, a bit naughty really.

I’m looking at those gel things you can put inside boots, maybe they will help with the impact when descending, although they might well be just a gimmick. I think getting the right boots is important, I am lucky that mine fit really well.

Wild camping -

I like the odd wild camp, and my favourite spots are the head of Haweswater (the Rigg, and the little bays and peninsulas a bit further on) and, near Lud’s Church in the Staffordshire Peak District. Both are within a couple of miles, probably less, of a road.

I agree that I would not want to sleep alone a long way from civilisation any more. I’ve not tried any genuinely wild camps in the middle of big hills since my op. I would not want to carry a pack with tent, sleeping bag etc into the middle of the hills.

I’ve done wild camps with my kids (now aged 19 and 16) but I make them carry the heavy stuff! My son has quite got into it: he had a great time this summer with his friends, wild camping in the Berwyns and the Rhinogs.

But for solo walks in big hills, I only do day-long hill walking. Grey Corries is the biggest walk I’ve done this year, and that level of walk is typical of most years. My after-walk treatment regime is simple: beer + comfy bed.

On day walks, I keep rucksack weight to an absolute minimum – a bottle of water, a sandwich, map, compass and (very small) camera, plus axe and crampons in winter. I also take my mobile but have never used it; it’s heavier than my camera!

Sorry – rather random thoughts!

Tim
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Re: knee replacements and hill walking

Postby Moder-dye » Tue Oct 02, 2018 2:34 pm

Thanks for that reply Tim. The barmouth railway is lovely, though I've only cycled it with my son.

Sadly, to my own detriment it would seem, I am someone who trains/exercises whether it's walking, cycling, weights or yoga. I've not been able to run for some time and miss it. I think I need to take a leaf out of your book though :wink:

Prior to my op I'd been doing a lot of cycling and bikepacking to get my fix which meant I could get away from it all for camping without a load on my back. I doubt the rigour of scrabbling about camping will be going down well for sometime though, unless i turn to hammocking!

Good to know you are managing some good routes and have some strategies in place to ease the way. :clap:
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Re: knee replacements and hill walking

Postby HalfManHalfTitanium » Wed Oct 03, 2018 7:53 am

Moder-dye wrote:Thanks for that reply Tim. The barmouth railway is lovely, though I've only cycled it with my son.

Sadly, to my own detriment it would seem, I am someone who trains/exercises whether it's walking, cycling, weights or yoga. I've not been able to run for some time and miss it. I think I need to take a leaf out of your book though :wink:

Prior to my op I'd been doing a lot of cycling and bikepacking to get my fix which meant I could get away from it all for camping without a load on my back. I doubt the rigour of scrabbling about camping will be going down well for sometime though, unless i turn to hammocking!

Good to know you are managing some good routes and have some strategies in place to ease the way. :clap:


Thanks Moder-dye - it sounds like you are a lot fitter than me.

Overall, that fitness will help you more with knee recovery than anything else!

So, I would not worry about the odd setback.

Tim
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Re: knee replacements and hill walking

Postby RocksRock » Thu Oct 04, 2018 7:26 pm

@HMHT I:m really glad to see how you have been able to get back to what you love, even if you feel wary of some more demanding scrambling etc. I have no expectations of getting to big hills cos I mostly never did - came to it late and living many many miles form decent sized hills I had to choose what I did rather carefully, but hey, what you guys can do I maybe can do to..........

The reckoning starts tomorrow when I have an appointment with the chosen surgeon. Could be interesting and as that stable of surgeosn all specialise in sporty type things and do them themselves, I'm sure that our need for a hill fix will be well understood (although the lassie taking the booking asked what my sport was and couldn't quite make out about hill walking!. I should have explained cross country skiing without snow.)

Thank you for the encouragment, it is very much appreciated and I'll let you know how it goes.

ATB
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Re: knee replacements and hill walking

Postby HalfManHalfTitanium » Fri Oct 05, 2018 7:29 am

RocksRock wrote:@HMHT I:m really glad to see how you have been able to get back to what you love, even if you feel wary of some more demanding scrambling etc. I have no expectations of getting to big hills cos I mostly never did - came to it late and living many many miles form decent sized hills I had to choose what I did rather carefully, but hey, what you guys can do I maybe can do to..........

The reckoning starts tomorrow when I have an appointment with the chosen surgeon. Could be interesting and as that stable of surgeosn all specialise in sporty type things and do them themselves, I'm sure that our need for a hill fix will be well understood (although the lassie taking the booking asked what my sport was and couldn't quite make out about hill walking!. I should have explained cross country skiing without snow.)

Thank you for the encouragment, it is very much appreciated and I'll let you know how it goes.

ATB
Barbara aka RocksRock


Good luck! I'm sure it will go well.

By the way, I should have mentioned - the most important thing of all is attitude. Some people think of themselves as invalided or hampered when they have a knee replacement. I chose to see it as adapting to a new stage - different, but better than trying to walk through the pain.

The difference is that I take it slower, take more time to sit quietly and experience the hills, and try sometimes to capture that in photos. Taking more time means I enjoy the serendipitous things - a burst of sunshine lighting up a hillside, a spotting of some wildlife, spending a hour looking at the summit views. I actually enjoy that more than completing some tricky scramble or multi-munro epic walk.

You'll be fine.

Tim
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Re: knee replacements and hill walking

Postby RocksRock » Mon Oct 08, 2018 6:13 pm

@HMHT Well Friday came and it was misty headlights while driving weather om my way there; by the time I came out from the appointmtment it was all sunshine, blue sky and twittering birds, so good omens!

He looked at the MRIs, listened to the story, and agreed yes they are shot and we need rid of my knees and to put in one of his replacement ones! The really good news is that as I can extend the leg to completely flat (which apparently is the critical bit if your sport is walking) and the muscle strength and bulk is fine, he says that with the replacement and the rehab I should be able to get back to unrestricted walking. :D :D :D

So we are plotting for sometime after Christmas, precise timing to be negotiated a bit later. He's a really interactive sort of guy, so the physios are being kept in the loop too, which I really appreciate. It seems to me the best chance is a team effort. And yes, attitude. I have usualy got enough of that to see me through most stuff and a friendly doctor when I run out of it, so hopefully............maybe by later next summer/early autumn I can go up a nice little hill.

The lesson from this is that the work the physios and I have out in over the summer has got the knee, which I couldn't flatten completely, improved so that I can...... those exercises really do work.......

ATB Tim and thanks again for support.

Moder-dye - I hope your knee is improving and not so swollen, stiff and painful, good luck

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