After giving some thought to the discussion I had with our physical therapist, I’ve scheduled my knee-replacement surgery. I’ve already been doing everything he recommended to rehab the knee: avoiding any high-impact exercise, using an exercise bike, stretching. His verdict is that none of those will help the problem. The compounding issue is that my lower right leg is roughly 14 degrees off center; if I wait much longer, it becomes more difficult to make the leg straight with knee replacement.

It helps that the surgeon my PT recommended happens to be the surgeon I’ve already been seeing. While the decision is made, the work is now moving to another level. Having been an advocate of surgical prehabilitation for a few years, I get to test it firsthand; I’ve already seen how much it helped Paula before her foot surgery and hip replacement years ago.

I have three prehab goals: to increase my fitness level, to increase the strength in my right leg, and to reduce my body weight a reasonable amount before the surgery. Concurrently, I want to train myself to endure more pain, because it will surely be needed after the surgery.

Prehabilitation Goals

Fitness

Due to localized muscular fatigue, I haven’t been able to push myself as hard as I want during high-intensity interval training (HIIT). As a result, I don’t feel I’m in the physical condition I want to be in, surgery or not. It’s time to double down. That requires cycling adaptive training and HIIT with longer intervals.

What do I mean by cycling adaptive training? It’s spending more time at a higher resistance—higher than normal but not as high as during intervals. The energy systems have to be trained to adapt to higher lactate levels. Fortunately, I’ve been doing that a little bit anyway. Now I’m on a mission.

Strength

Part of the problem is the muscle mass I’ve lost. My right thigh is just over an inch smaller than the left. I know I’ve been compensating because of the perceived muscle weakness in my right leg, and I’ve been limping more than I should.

I’m increasing my effort in leg-strengthening exercises. Nothing fancy, just squats, leg extensions, and leg curls. I’m using as much weight as possible and focusing on overcoming the natural inhibition arthritis pain causes. I’ve already noticed a difference in just a couple of days.

Body Fat

You’ve heard me complain about the fat we all gain due to aging. I can’t lose all of it, but I’m going to bump up the effort a little. Less weight going into surgery and rehab means less force necessary to overcome gravity later.

The Bottom Line

This is not the outcome I wanted, and I still think that the ideas around knee replacement could use some major innovation. However, we play the hand we’re dealt when we’re dealt it, not five years from now. I have things to do, and being mobile is important to those objectives. I’ll provide updates as time goes on as well as provide details on the prehabilitation program.

What are you prepared to do today?

        Dr. Chet