Tag Archive for: knee replacement

On the Road Again

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To say that I’ve had a little agony over not running would be an understatement. I certainly don’t want to do anything that’s going to impact the new joint in my knee; on the other hand, my frustration continued to grow over the inability to exercise as hard as I want to exercise. I did what I always do: I looked at the research. Here’s what I found.

Total Knee Replacement and Revision Rates

I decided to look at the most recent research on revision rates in people who ran or started running after total knee replacement. Revision is the word used to describe replacing the original knee replacement because it has loosened or gotten worn. I wanted to see the most recent research because the prosthetics themselves have evolved over the years, as have surgical techniques. There were two research papers that were large enough for me to help make a decision. The references are both open access if you want to read them.

The first study was a meta-analysis of research done on the difference between low physical activity and high physical activity in people who had total knee replacements. While the focus was not on running alone, there were no differences in revision rates in over 4,000 subjects who participated in high physical activity versus low physical activity over a follow-up period of 12 years.

The second study was a cross-sectional study of over 4,000 people who had total knee replacement or total hip replacement. The researchers used online questionnaires to determine activity modes and intensities, postoperative characteristics, revision surgeries, and the Commitment to Exercise Scale and Brief Resilience Scale. The patient-reported follow-up reached five years.

Of the 549 subjects who described themselves as runners before knee replacement, 65 subjects either returned to running or started running after the surgery. After the follow up, 6.2% of those who took up running again required revision surgery while 4.8% of those who didn’t run required revision surgery. The results were not significantly different—about one person. The prevailing recommendation from physicians was to stay active, but don’t run.

On the Road Again

I made the decision to start running again on July 1st. The research that I found was sufficient to give me the confidence to know that if done properly, a return to running can be safe.

What does that mean? Start slowly. While I like to think I’m running, I’m actually talking about a very slow jog. One of the reasons that I decided to return to running was because my fitness level had reached rock bottom, in my opinion. I also know it’s going to take some time.

I began with 20 seconds of jogging about every five minutes. On the day that I wrote this, I did 30 seconds every four minutes. And that’s about the way I’m going to progress: slowly. I’m not interested in running continuously anymore. I got used to a combination of walking and running before the replacement and before my knee got so bad I couldn’t run.

The Bottom Line

I’m glad that my irritation level got high enough to check the research on revision rates after knee replacement. Perhaps it was really more about gaining confidence that, after a year and a half of recovery, the healing of bone to prosthetic was at a point that could support running as I’ve described it. I’m not suggesting that anyone else should do it without checking with their physician. This is my decision and my decision alone. I’m basing it on the best information available today. However, I’d recommend walking or jogging over tennis or pickleball, which include a lot of side-to-side movement; even golf with its twisting motion would be more problematic. You should definitely resume exercise after knee replacement, but talk to your doctor first and make a plan to get where you want to be.

No matter what health, weight loss, exercise, or nutrition goal you set, basing it on the most current scientific information is the best that you can do. I’ll keep you posted on my progress.

What are you prepared to do today?

        Dr. Chet

References:
1. The Knee 2022; 39: 168–184
2. JAAOS Glob Res Rev 2023;7: e23.00019

Knee Replacement Update

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It’s great to be back! I hope your 4th of July holiday was great. Spending some time in Nashville with a few thousand of my closest friends just before the 4th, one of the questions that I was often asked was “How about an update on your knee?” I’ll tell you how I’m doing, but before I do, I just wanted to let you know that Paula will be getting her left knee replaced later this month and probably the right one next year. My knee was bad because of the 20-degree sideways deviation of my lower leg. Paula’s knees are much worse due to arthritis, and she’s really going to benefit from having them replaced.

As for me, I think the thing that surprised me the most was the length of time it took to gain the confidence in the knee to return to full mobility. I had reached the range-of-motion target within a few weeks. Strength I’m still working on. But the fine muscle control necessary for side-to-side movements, turning, posture, and especially balance took at least a year. That doesn’t mean I was inhibited from walking, climbing steps, and doing yard work, but walking downstairs, moving quickly side to side, and even turning sharply is not always there yet. I feel like I’m at about 95% right now.

I’m also terribly frustrated. I’ve been using the recumbent bike, elliptical trainer, and upright bike to exercise. I’ve also been walking outside when the weather permits in the winter and most days of the week now that it’s summer, but for me there’s nothing like running. Could I go back to it, even in some limited capacity? We’re told we can’t run after a knee replacement, but is that accurate? I’ll tell you what I found on Saturday.

Next Wednesday is the next Insider conference call. You have plenty of time to sign up for an Insider membership so you can participate. Get your questions answered and listen to the answers to other Insiders’ questions. Sign up by 8 p.m. on the 19th and you can participate live or listen to the rebroadcast at a later time.

What are you prepared to do today?

        Dr. Chet

Wait a Minute!

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It was a beautiful day in Grand Rapids on Thursday: 65 degrees, hazy sunshine, no wind, and a perfect day to take a kid to the park. Riley likes basketball (as is required of all children in the Midwest); he can’t hit the rim with the net at 10 feet, but that didn’t stop him and three other kids his size. Attempts were many, but baskets were few, and they didn’t seem to care.

Naturally I had to give it a try. I tried from 10 feet to the right of the basket, but my shot fell two feet short. Whoa! Tried again, and watched the ball sail under the basket. So in spite of having a three-month old knee, I tried a jumpshot—and stumbled a little as I landed. Yikes. My balance, spatial awareness, equilibrium, and power all seem to have left me in the past few months.

I sat down on a bench and pondered, “How do I get back from this far down?” I never expected things to get this bad so quickly; or has it really been even longer? I haven’t attempted anything like a jumpshot in a while. Then a phrase Riley likes to say popped into my head: “Wait a minute!” I already know the answers: Eat less. Eat better. Move more.

Moving more may mean going back to working on balance movements; spatial awareness may mean standing tall, closing my eyes, and touching my nose with my index finger. Neural pathways have to be awakened. They’re still there, just dormant.

There may be no NBA in my future, but I’ll get back to hitting that 15-foot baseline jumper this summer. Lucky for me, I have a built in practice buddy who’s always ready to play. Grandkids are the best!

What are you prepared to do today?

        Dr. Chet

Happy New Year!

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Where did the time go? It seems like we were just beginning the year, and now it’s New Year’s Eve. I wish you all the best in 2022, and I’ll be there with you.

Have a good time tonight, no matter how you ring in the New Year, but be safe if you travel anywhere to celebrate. Let’s start off the New Year without any additional health or accident issues.

Knee Update

In short, I was ignorant about how painful knee replacement would be. I worked hard at prehab, but nothing I could have done would have prepared for the pain. I expected to be in pain for few days. But when I called the nurse at the surgeon’s office to find out a timeline on the pain, her first comment was, “The first two weeks will be the worst pain you’ve had, and you’ll regret the surgery. Then things will get better.”

I really don’t remember anyone saying that. In retrospect, when they break three bones in five places and use a hammer and screws to replace the pieces they discarded, it makes sense. So if you’re considering knee replacement in 2022, let me be the first to tell you that knee replacement will be just about the worst pain you’ll intentionally get; the first day will be excruciating, the second worse, and then it gets a little better every day.

Do I regret it? Not a chance. The pain will subside in the coming weeks, and then I can get back to moving the way I want to move. Later I’ll go into more detail on how the surgery went and how the rehab process is going, but for now, I’m just going to focus on recovery. Thank you for all the prayers and well wishes. I read every one of them. I’ll resume the Memos soon. Until then:

What are you prepared to do today?

        Dr. Chet

Prehab Is Over

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One of the tests I took in preparation for surgery was to measure my levels of Staphylococcus aureus. In this case, they tested the nasal area, a common area for this serious pathogen. The test came back at zero. I was pleased because for the past three years I’ve been taking a Bacillus probiotic called Bacillus coagulans. You can check out the research by reading this Memo from 2018. It doesn’t mean I couldn’t get an infection, but zero is a good starting point.


Now on to Surgery

I’ve stretched and strengthened my legs about as much as I can in preparation for my knee replacement. My core is as strong as it ever has been. I’ve gotten as fit as I can within the limitations my knee has given me. As I said a while ago, the more pain you put in before the surgery, the less you’ll have after the surgery.

We’ll put that to the test beginning Monday afternoon. Many, many surgeries have been cancelled here in Grand Rapids because the hospitals are overrun with COVID patients; if I had not prepared by being a regular exerciser and doing the prehab, I might have had to spend the night rather than having outpatient surgery, and then my surgery might have been cancelled, too, but we got confirmation Friday that it’s on.

I’m really eager to get this done and get on with life; I’m ready for rehabilitation. My goal is to walk into the hospital and then to walk out. The medical staff probably won’t allow that but as long as I know I could, that’s fine with me.

Thanks for all the prayers and good wishes—keep them coming. I won’t write Tuesday’s Memo until I’ve recovered from the anesthesia and taken the first steps. I still plan on doing the Insider Conference call on Wednesday night so all Insiders will get the first-hand Dr. Chet version of the knee replacement experience.

What are you prepared to do today?

        Dr. Chet

Should You Take Essential Amino Acids Before Surgery?

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Tuesday’s study left us with a question: what could explain essential amino acids (EAAs) increasing, or at least preventing, muscle loss after total knee replacement surgery? Fortunately, another study examined those factors by obtaining muscle biopsies and blood before and after surgery.

Researchers recruited 41 patients who were having total knee replacement. After randomly assigning them to placebo or experimental group, the experimental group received 20 grams of EAAs twice daily, beginning seven days prior to surgery, until six weeks after surgery. Those in the placebo group were given nonessential amino acids. Muscle biopsies were collected from all subjects the day of the surgery and again either one or two weeks post-surgery with the determination made randomly. Blood was also collected for analysis at the same times as the biopsies.

The researchers found that the subjects taking the EAAs had a significantly increased amount of satellite cells, also known as muscle stem cells that can develop into muscle cells, compared to the placebo group; the ability to build muscle faster could help the recovery process. IL-6 and TNF-alpha were elevated post-surgery in both groups; however TNF-alpha declined by two weeks post-surgery in the EAAs group, which meant inflammation decreased. Based on the changes in cytokine production, inflammation after surgery decreased faster with EAAs than it did in the placebo group.

The researchers concluded that taking the EAAs seven days before surgery increased satellite cells on the day of surgery and promoted a more favorable inflammatory environment post-surgery. That could mean a quicker recovery from surgery and benefits during post-surgical rehabilitation.

The Bottom Line

While there’s more research necessary, I think the use of EAAs before and after knee replacement surgery is helpful. I would extend that even further; I think that EAAs may ultimately prove to be beneficial before and after any type of surgery. In almost every case, muscle tissue is going to be cut and thus will need to repair itself. We don’t know the benefits of EAAs on other connective tissue such as skin and ligaments, but because we’re targeting the key elements of protein with the EAAs, there’s little to no chance of any harm.

Based on these two studies, I think that 10 to 20 grams, spread out in two doses per day, would be the best approach. One important point: take the EAAs 15 to 30 minutes before eating anything or before working out. Those were the protocols used, and it’s the same that I recommend in Aging with a Vengeance for increasing muscle mass as we age.

I’ll be honest: it tastes weird. But I made sure Paula took EAAs before and after her recent carpal tunnel surgery, so you know I think it’s worth the effort.

What are you prepared to do today?

        Dr. Chet

Reference: J Appl Physiol (1985). 2019 Aug 1; 127(2): 531–545.