UKC

I'm up for a knee replacement in a couple of months or so and was looking for some information and experiences about the prospects for mountain walking and rock-climbing afterwards. There isn't as much info out there as I expected, and some of it is positively discouraging.
If you have had the op yourself I'd be very happy to hear your stories, positive or otherwise, or if you know of active climbers with knee replacements that would also be interesting. And if there are any professionals out there with information I would be happy to hear from them too.

Happy New Year anyway,

Bob

In reply to Bob Kemp:

The only advice I'll give (as a physio) is not to mistake hobbling more effectively for progress once out of hospital.

By that, I mean the tendency of many, once out and back at home, to backslide on doing the range of movement and strengthening exercises given to you by your physio. When asked why they haven't been performed regularly, such patients will sometimes argue that now they're home, simply by 'walking' more and doing more, that progress will ensue. It doesn't-It means that you're training for a stiff knee.

Sometimes the worst patients are the ones who ask for all the advice but end up cherry picking what they want to hear.
Stick religiously to the exercises given and actively manage anything that gets in the way of you doing that.
Having accomplished that consistently, anything else you add builds from that base, but it is not the base itself.

In reply to Bob Kemp:

I know of two mountain guides who've had total knee replacements, one Swiss and one French. The guy from Zermatt was skiing, rock climbing and summer guiding again the last time I saw him about 18 months ago. I don't know how long his convalescence was. His range of movement was slightly limited, ie he couldn't squat comfortably, for instance. However, having seen him not long before the op, the difference was impressive. The French guy only had it done a month ago and is getting around fine on crutches and reckons he should be able to climb by June.

In reply to llechwedd:

Thanks - some good points there. I think that getting my knee into the best possible condition beforehand is likely to be helpful too so I'm working on that.

- Bob

In reply to jon:

Encouraging - thanks Jon. I haven't been able to squat properly for a long time so I don't think I'll miss that. I guess that providing I can bend my knee a little past 90 degrees and exert some force through it for stepping up my climbing won't be any worse than it is now. Jumping off will be out of the question of course.

- Bob

In reply to Bob Kemp:

Can I ask how old you are Bob ??

My next knee op is a complete new knee, but I've been told I'll have to wait till I'm 60 odd before it's done. 11 years to go.

In reply to arch:

I'm 59, so just heading into the normal age range for knee replacements. The rationale is apparently that if you have a replacement earlier you will be very likely to need to return for a new one later. According to my consultant this is becoming less of an issue as the replacements get better and last longer. Always worth checking again with your consultant to discuss your current situation.

In reply to Bob Kemp:

Yep, that's pretty much what I've been told.



Best of luck and a speedy recovery.

In reply to Bob Kemp:

Hi Bob

As an orthopaedic surgeon (who does a fair number of knee replacements), I would agree completely with the advice about rehab after surgery given above. The rehabilitation is at least half of the issue.

I am a peripheral part of a research project looking at return to mountain activities of patients after hip and knee replacements. As you say there is not a lot of evidence about what is safe / advisable; unfortunately surgeons or physios then tend to default to advising against it.

I have had several patients who have returned to climbing after joint replacements. There are obviously some risks with this, but particularly after knee replacement they are probably small in the short term. The long term worry is about loading in marked knee flexion leading to loosening of the implant which would require revision. This is mainly a theoretical risk, as there doesnt seem to be any evidence about it. Which is another way of saying that if you decide to go ahead and climb you will have to deal with the consequences....which is similar to any decision to go climbing! There is also a small risk of fracture adjacent to the implant due to falls, which can lead to technically difficult problems in fixing the fracture. I personally have never seen a peri prosthetic fracture relating to climbing.

Essentially, at present there is a philosophical question about lower limb joint replacements that we cannot answer empirically .. ie should people be encouraged to return to full activities after joint replacement, or should they reduce their activities to "protect" their joint (even though the evidence that it does protect the joint is minimal, although there is some evidence that running damages joint replacements). In view of the lack of evidence, my view is that people with joint replacements can reasonably return to mountain sports providing that they think that the benefits of this are considerable, providing that they accept that some consequences cannot be foreseen.

I hope this helps

Regards

Glynne

In reply to glynne.andrew:

Thanks for these points Glynne - they've really helped clarify my thinking. I like your point that it's a judgement very much like those involved in climbing anyway. I've survived climbing after a hip replacement so I will use much the same approach as I did then - proceeding carefully but optimistically.

Cheers,
Bob

In reply to Bob Kemp:

I've had some very useful responses from different perspectives but nothing yet from people who've had knee replacements themselves. If anyone out there has first hand experience I would love to hear from you.

- Bob

In reply to Bob Kemp:

Hi Bob - my man in darkest Cornwall had this done last year and is back to walking with no problems and to climbing with some trepidation. I'll email you separately for your address and then email him for a direct comment. I am using what is called APOS therapy with some positive results. I know the knee linings are trashed but am trying to put off the evil day as long as possible.

Hope all goes well, Roger

In reply to Stone Idol:

Thanks Roger - got your email and will be replying shortly.

Cheers,

Bob