14ers and Total Knee Replacement

[ecarl65]

I love hiking (I've done maybe 10 14ers, haven't added them up recently) and biking, and have traditionally been very active. But I have been plagued with knee problems for years. I'm a 40 year-old male, tall, and played a lot of basketball and volleyball. At any rate, I had my third knee surgery 4 months ago and I think it was a mistake, I'm left with daily swelling, inflammation, and pain, just sitting at my desk. Exercise makes it much worse. I'm pretty sure 14ers are out for the foreseeable future.

They don't like to do knee replacements on people my age. So I imagine this is a question for sometime in the future. But I'm getting conflicting information on mobility and what can and can't be done after a knee replacement. I know no running or jumping. But how much hiking can I do? Is there anyone here with a TKR who can actually hike a 14er, or is that just asking too much? I'm exploring other options, but so far nothing is working (platelet rich plasma was awful).

Thanks.

[bergsteigen]

There will be others with first hand experience with knee replacements chiming in later, I'm sure. I've had plenty of busted legs and joints over the years and I'm a similar age. The best you can do now is see a real sports medicine physical therapist. Not necessarily what your doctor/surgeon recommended. If you live near Boulder, there are lots of good options (as long as you don't have Kaiser P). I've seen around 5 PT's over the past few years, and can tell the difference between a good one, and those that are just prepping you to walk from your bed, to couch, to car, to office desk and that's it. With the majority of the population being sedentary, most PT's don't expect you do do any homework. Mine expect me to push my limits at all times, and have to 'hold me back'.

[justiner]

Agree with what bergsteigen wrote. Another key thing to say to a PT, " I am completely committed to do whatever it takes"

[zoomie83]

1st hand experience. I had a total knee replacement in June of 2017, made a trip to CO in August of that year and started slowly; Mt Herman one day and Mt Rosa the next. I worked my way up to hiking Mt Evans and West Evans, albeit only from Summit Lake but I had no problems. Like Bergsteigen talked about, the key for me was "homework". I only saw my PT twice a week but EVERY day I did therapy at home. If you're willing to put in the work (and it sounds like you are) you should be able to hike whatever you want. Also, I made extensive use of hiking poles, especially on the descents. Good luck!

[dpage]

A guy about your age at my gym had a cadaver cartilage replacement. He had to travel to the Mayo Clinic from Colorado for the surgery. This link describes some of the possibilities.

https://aoshogdocs.com/too-young-for-a- ... placement/

[ecarl65]

Thanks for the ideas everyone. Keep them coming!

I've been through multiple rounds of physical therapy (and yes, I've also noticed the quality is highly variable). I've seen multiple doctors (it might just be standard chondromalacia/osteoarthritis, but there are atypical things going on that I thought might have made surgery worth it, to better see what's going on). I just tried platelet rich plasma injections and wow has that been awful (but I know it gets worse before it may get better). At any rate, I'm definitely willing to do whatever it takes. But at this point it's red and swollen and hot to the touch just sitting here. I have to ice and elevate just to get through a non-walking day. There is some weird catching and grinding and popping going on. I don't know if that explains the pain, if it's unrelated, or some combination. The doctor seemed to think the osteoarthritis was mild to moderate, it shouldn't explain the intensity of the pain. I might try cortisone (again) to calm things down, but I know that isn't a long term success strategy and produces its own problems. I've tried the gel injections and I'm not sure they really do anything.

A guy about your age at my gym had a cadaver cartilage replacement. He had to travel to the Mayo Clinic from Colorado for the surgery. This link describes some of the possibilities.

That's fascinating, thank you! I'm willing to go to Mayo if I felt like they could provide a better answer/solution. I'd heard of cadaver replacements for ligaments and tendons and maybe even meniscus, but hadn't heard of it for patellar cartilage. I've also be thinking of paying for crowdmed to see if they can explains some of the atypical aspects.

I'm in the south Denver area, so if anyone has any input on amazing PTs or diagnosticians I would gladly accept it.

1st hand experience. I had a total knee replacement in June of 2017, made a trip to CO in August of that year and started slowly; Mt Herman one day and Mt Rosa the next. I worked my way up to hiking Mt Evans and West Evans, albeit only from Summit Lake but I had no problems. Like Bergsteigen talked about, the key for me was "homework". I only saw my PT twice a week but EVERY day I did therapy at home. If you're willing to put in the work (and it sounds like you are) you should be able to hike whatever you want. Also, I made extensive use of hiking poles, especially on the descents. Good luck!

That's fantastic! I'm so happy for you! And happy that it's at least possible for someone to get to this level of hiking again someday. I know I won't be fast like I've been in the past. It'll be a loss, but I'd be plenty happy enough with just being able to hike again. I don't know how to say this other than hiking and biking are deeply meaningful for me and I've yet to find a replacement that comes anywhere near as close.

[benlen]

Before you travel anywhere out of Colorado, look up the Steadman Clinic and Vail Summit Orthopeadics. We have some of the best total joint docs in the world here in Vail.

Moreover, to Otina's point, you won't find many docs and PTs in the Front Range who get what you want to do. To have the best, come to the mountains where our docs regularly return the best athletes in the world to sport (Neil Beidleman and Lindsay Vonn to name a few.)

[Ron McFarland]

I have a friend age 65 who had a total left knee replaced in April 2017 at Porter Joint Replacement Center - you need a doc who only does replacement surgery. Surgery was followed up by 18 sessions of PT and additional sessions with a strength / flexibility / massage / body work PT person. At 8 weeks a hike around Washington Park was possible - at 10 weeks mt hikes of 1K vertical began with increasing elevation every other week. At 12 weeks a 4 day backcountry trip with llamas to a base camp with a 5 mile approach. Two day hikes with about 1+K vertical (one way) each were completed and then the hike out. Another overnight trip was completed too. Llamas mean no weight was carried - this makes backcountry access possible.

Ski season arrived and when it was over about 25 1/2 day sessions on generally smooth hand crafted man made snow were completed.

Regular use of ice and early AM training classes here in Denver with another PT shop kept body moving in all directions -- Bad news is other knee is stuffed and will be replaced shortly.

The docs always commented about waiting as long as possible and recommended a brace to help things along - I do know that in young people like you they do not glue the replacement in place because they know at some point it will have to be replaced.

Agree with reaching out to the Docs who take care of the pro athletes in Denver as their mindset is to keep you in the game.

Good luck

[ecarl65]

Before you travel anywhere out of Colorado, look up the Steadman Clinic and Vail Summit Orthopeadics. We have some of the best total joint docs in the world here in Vail.

Moreover, to Otina's point, you won't find many docs and PTs in the Front Range who get what you want to do. To have the best, come to the mountains where our docs regularly return the best athletes in the world to sport (Neil Beidleman and Lindsay Vonn to name a few.)

Thanks. I have gone up to see Dr. LaPrade a few times but at Vail Steadman-Hawkins. There was a rare knee condition separate from my more recent problems that I suspected I had. I found out he was a world expert in that area of the knee in which most doctors just say, "there be dragons" and leave alone. I didn't tell him my suspicions, just some of the symptoms and he poked and prodded and twisted and, sure enough, diagnosed that same issue. Having said that, that issue is not even on the radar of problems right now.

I did go see him again more recently. Although, to be honest, I mostly see and talk to his assistants and doctors in training. He did pop in for a few minutes. He seemed to just think standard osteoarthritis. Although he was a little stumped on some of the weird lateral tissue movements and snaps and odd anatomy. But, he just guessed that some of that was due to a portal problem from a surgery and kind of left it at that. His resident discussed typical osteoarthritis treatment.

Who knows, it very well could be just that. But whenever I ask doctors about some of the other, bizarre things going on they just kind of don't address it. I get it, people hate for their doctors to say, "I don't know." But not me, I just want to know their true thoughts on what's happening and if they're not sure about some of these things to tell me. I was prepared to just assume the standard OA diagnosis but then the most recent doctor said that the cartilage didn't look that bad. So, I don't know.

[ecarl65]

Agree with reaching out to the Docs who take care of the pro athletes in Denver as their mindset is to keep you in the game.
Good luck

Thanks so much for commenting! I find the good doctors who treat the pro athletes a bit of a mixed bag. The one I most recently saw is very science based (and conservative) and seems to care. I did see another one, however, who was rather brusque and dismissive. The vibe I was getting from him was more one of, "you're not a professional athlete and your living doesn't depend on exercise, so you don't matter." He actually did say, "just live with it." I didn't go back to him.

[Ron McFarland]

Have you had someone discuss the reports from MRI & X- Rays with you - this is not rocket science - a really good source for this is Dr. Yani Zinnis at Colorado Ortho at Rose Medical - he is not a surgeon, which means he looks for other ways to keep you going. Seems odd that no one can tell you the mechanical status of knee joint with you and help create a management plan- there is a solution waiting to be found

[peter303]

Jon Fielder mentioned in a talk this winter that he has had three joint replacements. And he is out skiing and hiking all overbthe mountains.

https://www.denverpost.com/2011/03/17/d ... n-fielder/