I'm not sure about this part, could you explain or give me an example?
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So, how is my new metal knee working out?
- Thread starter Dakine
- Start date
I'm not sure about this part, could you explain or give me an example?
@Monique
.....ya, I thought that after I typed it and but didn't think it wise to suggest body fat guidelines for a female human.
They tend to be a bit touchy about that and they are all different.
Disclaimer....the opinions in this thread only apply to my body, bodies vary and are assembled differently. No warranties, express or implied, are given regarding the advice in this thread. The product you receive may not look like the photos in this thread. Etc......
@Fuller
.....Your knee joint is held together by both a bunch of ligaments and the force of your weight.
When the knee joint isn't loaded axially in compression, all that is holding it from lateral motion are the ligaments and tendons.
A leg extension machine....
This exercise really stresses the joint because there is no axial compression helping to hold the joint together.
Same is true for a knee flexion machine.
Better is an inclined recumbent squat....
Here you are working your quads and a lot else with a compressive load on the joint which makes the joint more stable and isn't stretching ligaments unnaturally.
Using the flexion and extension machines with very light weight and doing 30 reps might be ok but that's not why I go to the gym.
I lift for peak strength and have seen guys who can press close to a ton on one of those machines.
The carriage typically weighs around 100 and I stack another 180 with plates.
That's 280 at 45 degrees or about 198 pounds if I was pushing it straight up.
I weigh around 170 so that is about 1.2 times my body weight.
Like pulling 1.2 g's in a carved turn.
I want to add two more plates but want to check with my surgeon first to see if that voids the warranty.
Real squats are great but that puts your back in play.
.....ya, I thought that after I typed it and but didn't think it wise to suggest body fat guidelines for a female human.
They tend to be a bit touchy about that and they are all different.
Disclaimer....the opinions in this thread only apply to my body, bodies vary and are assembled differently. No warranties, express or implied, are given regarding the advice in this thread. The product you receive may not look like the photos in this thread. Etc......
@Fuller
.....Your knee joint is held together by both a bunch of ligaments and the force of your weight.
When the knee joint isn't loaded axially in compression, all that is holding it from lateral motion are the ligaments and tendons.
A leg extension machine....
This exercise really stresses the joint because there is no axial compression helping to hold the joint together.
Same is true for a knee flexion machine.
Better is an inclined recumbent squat....
Here you are working your quads and a lot else with a compressive load on the joint which makes the joint more stable and isn't stretching ligaments unnaturally.
Using the flexion and extension machines with very light weight and doing 30 reps might be ok but that's not why I go to the gym.
I lift for peak strength and have seen guys who can press close to a ton on one of those machines.
The carriage typically weighs around 100 and I stack another 180 with plates.
That's 280 at 45 degrees or about 198 pounds if I was pushing it straight up.
I weigh around 170 so that is about 1.2 times my body weight.
Like pulling 1.2 g's in a carved turn.
I want to add two more plates but want to check with my surgeon first to see if that voids the warranty.
Real squats are great but that puts your back in play.
OK, the leg extension machine. I used to include those with the theory that I was "balancing out my quads" I never put more than 70 lbs per leg but I think your advice is sound. No more!
I have very little left of my meniscus (both knees) and it's a bit of a fine line between strengthening all those leg muscles and not injuring the knee itself.
Thanks!
I have very little left of my meniscus (both knees) and it's a bit of a fine line between strengthening all those leg muscles and not injuring the knee itself.
Thanks!
Better is an inclined recumbent squat....
Here you are working your quads and a lot else with a compressive load on the joint which makes the joint more stable and isn't stretching ligaments unnaturally.
Oh, man! We had one of those at my Taekwondo studio when I was a teen, and I never knew what they were called. We used it a lot, but being teens we had absolutely no consistent regimen or plan, of course. I loved it. I felt so strong! (I was so strong)
Unfortunately, this is 1.2 g on both legs, while in a turn you can easily get 2g on one leg.
For me, same weight, translates to 600 lbs on a leg press.
@Rod9301....I don't think that strength on a leg press machine translates exactly into peak skiing loads.
Peak loads in skiing don't last long and should occur when your skeleton is stacked to resist them.
That is why skeletal alignment is so critical to high performance skiing.
Still, you are on to something important.
Consider this....
Here is Lindsey acing her strength test with a claimed 485 on the bar (I don't see it).
Add her body weight and you are close to the 600 pounds you mention.
If she weighs around 150 all up she should be able to do a two legged squat at 4 g's.
That is the kind of leg strength it takes to ski at her WC level.
Professional athletes are not like normal people, they are much stronger for one.
I used to be able to do rack squats like Lindsey with four plates on a side.
That is 405 pounds when I weighed 165.
Not in Lindsey's league!
(I could also bench 265 which Lindsey couldn't get near)
Now. I'm a 72 yo geezer with a metal knee (and two hernia surgeries from guess what?)
I'm just getting to the point where I can really work my legs again but am unsure of my limits or the warranty on my TKR.
We are taking this slowly because sometimes my 18 yo brain fails to remember my limits.
That's the key point here, when you get older your limits change and you have to adjust.
My Rossi Hero Masters will eagerly put me into a 3g turn and I know how to get there.
That's something I'm trying to avoid!
Peak loads in skiing don't last long and should occur when your skeleton is stacked to resist them.
That is why skeletal alignment is so critical to high performance skiing.
Still, you are on to something important.
Consider this....
Here is Lindsey acing her strength test with a claimed 485 on the bar (I don't see it).
Add her body weight and you are close to the 600 pounds you mention.
If she weighs around 150 all up she should be able to do a two legged squat at 4 g's.
That is the kind of leg strength it takes to ski at her WC level.
Professional athletes are not like normal people, they are much stronger for one.
I used to be able to do rack squats like Lindsey with four plates on a side.
That is 405 pounds when I weighed 165.
Not in Lindsey's league!
(I could also bench 265 which Lindsey couldn't get near)
Now. I'm a 72 yo geezer with a metal knee (and two hernia surgeries from guess what?)
I'm just getting to the point where I can really work my legs again but am unsure of my limits or the warranty on my TKR.
We are taking this slowly because sometimes my 18 yo brain fails to remember my limits.
That's the key point here, when you get older your limits change and you have to adjust.
My Rossi Hero Masters will eagerly put me into a 3g turn and I know how to get there.
That's something I'm trying to avoid!
It's sunny and the snow is great but it is also sixteen below so it's time to wrap this writing project up.
Before we talk about the good stuff, yet another word of caution.
What can go wrong?
My surgeon isn't really happy about people skiing on his work but he is realistic and offers advice.
His #1 fear (and mine) is getting hit by another skier.
Your metal knee is very strong once the bone attaches well but your leg is till held together by your ligaments and tendons.
Specifically your MCL (Medial Collateral Ligament) and LCL (Lateral Collateral Ligament) provide lateral stability to the joint just like before the procedure.
Rip these up from a hit and you are in trouble.
I have been blindsided a number of times in my skiing career by out of control idiots.
This usually happens when it is crowded and there are a lot of newbies around who don't understand the skiers code.
I avoid skiing on crowded days and watch uphill like my head is on a swivel, I don't need any more hits.
Mechanically speaking, once the TKR is well grown in, it is very strong axially.
The reworks my doc has done have resulted from twisting crashes by very good skiers.
Of course, we all fear the death spiral where you get back and into a decreasing radius you can't get out of.
All I can say about this is to make staying forward even more of a priority.
And avoid excessive speed whatever that is.....
I thought a lot about binding release DIN setting.
This is a tough one for geezers because the recommended DIN goes down with age to levels inappropriate for a good senior skier.
At 5'6" and 165 pounds and over 50, my DIN for a type 3 is 6.5 and 8.0 for a 3+.
I ski centered and avoid bumps and most off piste so I set my skis to 6.5 or 8 when I was racing.
Many of my bad falls have come from a ski releasing when that was the last thing I wanted, pre-release is very dangerous.
So, I decided to not reduce my DIN settings because of the TKR.
If anyone else has other info, I'd like to hear it.
Then there is boot alignment.
I have very wide feet and a big calf so I ski a shell that is wide and short.
My bootfitter put me in Atomic B-Tech 104mm last shells and I use Intuition liners.
I have two pair of shells, one 90 flex and one 120 flex, that have been set up for my old knee.
I thought there would be some changes required with my new knee but, so far, alignment seems fine.
It may be that I want to de-cant my right boot (natural knee) because my bootfitter recognized that as my very strong side.
But, so far, skiing has seemed really natural and I want to put in more runs before making any changes.
So, finally about the skiing part.
My first day was in soft, cruddy conditions and I was full of anxiety.
I had no idea of what to expect yet was incredibly excited to hit the snow.
I first realized my world had changed when putting on my boots and walking across the lodge.
The boots went on easily and nothing hurt.
Walking in ski boots was problematic before, now it was nothing.
Which pretty much sums up the day, it was nothing.
No pain.
From the first few turns on my Fisher WC-SC's, my skiing was good.
I was no longer conscious of having asymmetrical technique, turns in both directions felt equal.
Totally fucking fantastic!
On the third day I skied with my buddy who was a PSIA Technical Examiner before getting a real job.
He has watched me ski for a long time and he said he had never seen me ski so well.
Music to my ears and I'm just getting started.
Christmas morn brought 14" of dense powder and I put on my FX-94's.
Best Christmas present I ever have gotten.......!
Carry on!
Before we talk about the good stuff, yet another word of caution.
What can go wrong?
My surgeon isn't really happy about people skiing on his work but he is realistic and offers advice.
His #1 fear (and mine) is getting hit by another skier.
Your metal knee is very strong once the bone attaches well but your leg is till held together by your ligaments and tendons.
Specifically your MCL (Medial Collateral Ligament) and LCL (Lateral Collateral Ligament) provide lateral stability to the joint just like before the procedure.
Rip these up from a hit and you are in trouble.
I have been blindsided a number of times in my skiing career by out of control idiots.
This usually happens when it is crowded and there are a lot of newbies around who don't understand the skiers code.
I avoid skiing on crowded days and watch uphill like my head is on a swivel, I don't need any more hits.
Mechanically speaking, once the TKR is well grown in, it is very strong axially.
The reworks my doc has done have resulted from twisting crashes by very good skiers.
Of course, we all fear the death spiral where you get back and into a decreasing radius you can't get out of.
All I can say about this is to make staying forward even more of a priority.
And avoid excessive speed whatever that is.....
I thought a lot about binding release DIN setting.
This is a tough one for geezers because the recommended DIN goes down with age to levels inappropriate for a good senior skier.
At 5'6" and 165 pounds and over 50, my DIN for a type 3 is 6.5 and 8.0 for a 3+.
I ski centered and avoid bumps and most off piste so I set my skis to 6.5 or 8 when I was racing.
Many of my bad falls have come from a ski releasing when that was the last thing I wanted, pre-release is very dangerous.
So, I decided to not reduce my DIN settings because of the TKR.
If anyone else has other info, I'd like to hear it.
Then there is boot alignment.
I have very wide feet and a big calf so I ski a shell that is wide and short.
My bootfitter put me in Atomic B-Tech 104mm last shells and I use Intuition liners.
I have two pair of shells, one 90 flex and one 120 flex, that have been set up for my old knee.
I thought there would be some changes required with my new knee but, so far, alignment seems fine.
It may be that I want to de-cant my right boot (natural knee) because my bootfitter recognized that as my very strong side.
But, so far, skiing has seemed really natural and I want to put in more runs before making any changes.
So, finally about the skiing part.
My first day was in soft, cruddy conditions and I was full of anxiety.
I had no idea of what to expect yet was incredibly excited to hit the snow.
I first realized my world had changed when putting on my boots and walking across the lodge.
The boots went on easily and nothing hurt.
Walking in ski boots was problematic before, now it was nothing.
Which pretty much sums up the day, it was nothing.
No pain.
From the first few turns on my Fisher WC-SC's, my skiing was good.
I was no longer conscious of having asymmetrical technique, turns in both directions felt equal.
Totally fucking fantastic!
On the third day I skied with my buddy who was a PSIA Technical Examiner before getting a real job.
He has watched me ski for a long time and he said he had never seen me ski so well.
Music to my ears and I'm just getting started.
Christmas morn brought 14" of dense powder and I put on my FX-94's.
Best Christmas present I ever have gotten.......!
Carry on!
.....the rest of the story, so far.
I had my 14 month checkup last week and the x-rays showed everything to be just as Dr. McGraw of GLOC wanted it to be.
All the parts are in the right place and there is no visible wear.
I'll get another check up in two years.
Dr. McGraw read this story and got a few laughs as well as supporting its technical content.
On the skiing front, after several sessions of skiing carefully on my slaloms, I got a sunny day and put on my stiff boots and my Kastle RX's.
More pure pleasure with no pain.
My mechanics are much improved and my tracks are obviously more symmetrical.
I really enjoyed the freedom I had previously lacked to shift my weight fore and aft.
Pure joy has come back to my skiing and I feel like a little kid again.
OK, now I have to bring myself down and recognize the reality of being a 72 yo with a TKR (and hernia surgery and cataract surgery).
I'm trying to remember that I need to act my age.
(Mostly...... I did manage to bench 185 a couple of times last week)
The TKR joint does not have an ACL and does slide around a bit and click sometimes.
This isn't a problem when in a skiing stance and being pain free is priceless.
Not everyone gets as good a result as I have but, in my experience, these folks weren't in good shape going in and didn't really work their rehab.
Meanwhile,.....see you on the slopes
I had my 14 month checkup last week and the x-rays showed everything to be just as Dr. McGraw of GLOC wanted it to be.
All the parts are in the right place and there is no visible wear.
I'll get another check up in two years.
Dr. McGraw read this story and got a few laughs as well as supporting its technical content.
On the skiing front, after several sessions of skiing carefully on my slaloms, I got a sunny day and put on my stiff boots and my Kastle RX's.
More pure pleasure with no pain.
My mechanics are much improved and my tracks are obviously more symmetrical.
I really enjoyed the freedom I had previously lacked to shift my weight fore and aft.
Pure joy has come back to my skiing and I feel like a little kid again.
OK, now I have to bring myself down and recognize the reality of being a 72 yo with a TKR (and hernia surgery and cataract surgery).
I'm trying to remember that I need to act my age.
(Mostly...... I did manage to bench 185 a couple of times last week)
The TKR joint does not have an ACL and does slide around a bit and click sometimes.
This isn't a problem when in a skiing stance and being pain free is priceless.
Not everyone gets as good a result as I have but, in my experience, these folks weren't in good shape going in and didn't really work their rehab.
Meanwhile,.....see you on the slopes
I have a 76 year old friend who had her knee replaced last year. She is not athletic, but is active and takes a long walk every day. She did not expect how difficult and unpleasant the immediate aftermath and rehab would be, and said she was never doing that again. But... she is happy with the end result, and now planning to get the other knee replaced!
Thanks for sharing your story and info Dakine. I was in a similar situation with my right knee (my "half leg"). I'm typing from the couch right now one week exactly since my TKR (Dr. Stephen Howell - Sacramento). Everything went very well in surgery and I'm just about off the oxy. Elevation and ice all day and night with hourly walks around the house and extension and flexion exercises (my extension is great. Flexion is challenging due to my vastus medialis being extremely pissed off and tight and painful like I've never felt). I'm 59 (will turn 60 in June), so I'm relatively young for TKR. My knee injuries started in 1980 when I was 22 and after four surgeries and declining function it was time. Doc Howell turned me down about 4 years ago. This time he agreed it was time. I'm 6'0", 193 pounds and was in very good shape prior to surgery. Can't wait to get back on a bike and in the pool. I have a surf trip to mainland Mexico planned for late March but I may end up just swimming and watching my boys surf. We shall see. I don't want to push it and set myself back. Plan is to get back on the water ski slalom course by June and back on snow November 2018. Lots of gym, bike, and pool in my future. I'll check back with progress updates in a few weeks.
Here is my before picture.... I had 30 years skiing on that hardware. I liked my ankle replacement so much I went and got a new left knee, 5 weeks ago. I hope to be skiing by next April. Thanks for your post.... good info.
It's been two weeks since my TKR. The staples are gone, I'm done with crutches, canes, etc., and I'm back to driving. It seemed like a shame to let the borrowed walker go to waste so I devised a new use for it to rebuild the quads and abs. Can't wait for next season!!!
I last posted on February 14th, 2018, one week after TKR surgery on my right leg. I started surfing (in pretty easygoing, point surf) at week 6.5 in late March, started water skiing in the slalom course at about week 10 (mid-to late-April), turned 60 in June, water skied about 5 to 8 slalom course sets/week until late-October, and now have two days on snow and have skied a lot of bumps already. At every "milestone" of starting back up with a sport/activity I always caught myself remembering: "Oh, yeah. My knee. I forgot about it. Feels great!".
All I can say is I'm super happy with how things have progressed and how this knee works. I think strength in my right leg is about 90%+. I can still get stronger for sure and am working on it. Now, my only pain comes from burning quads and sore muscles. No knee pain!!! If anyone has any questions for me about how I rehabbed, what I've done, what I'm doing, etc., fire away!
Jim
All I can say is I'm super happy with how things have progressed and how this knee works. I think strength in my right leg is about 90%+. I can still get stronger for sure and am working on it. Now, my only pain comes from burning quads and sore muscles. No knee pain!!! If anyone has any questions for me about how I rehabbed, what I've done, what I'm doing, etc., fire away!
Jim
Pulling 1.2 g in a turn is 2.4 times your body weight, most of the weight is on the outside ski
And 12 plates would be closer to what you need for skiing
Jim, if you would share:
1. How to pick a surgeon (We live in the Sacramento Delta so I am excited that you had your surgery in Sacto. Is Stephen Howell one of the surgeons you considered or the only one and why? We are in the Kaiser Permanente HMO. Is your doctor a Kaiser Doc? If not, is he affiliated with an HMO or other group?
2. How to pick a metal knee (if you have any insight on that) and, yes, I will read all that Dakine posted on this subject.
3. What did your surgeon tell you that you could expect to do and what you shouldn't do post surgery (my skiing friends said they asked if their TKR surgeon skied and he said "yes," but really was not really "an every chance you get kinda skier" like many of us are on this forum); and
4. yes, sharing your rehab regimen would be great.
I am three months post stem cell injections on my bone on bone knee and am not sure that I have had any improvement. So there is possibly a TKR in my future.
Hi Tim. I went with Dr. Howell based on direct recommendations from patients of his, a couple of visits with him, and reading about his technique of measuring/cutting/fitting. There is a good video of him on Youtube doing a demo of his method at a conference. He's not a Kaiser doc. I had to access him through a "direct-provider" set-up with Cigna HMO. He does most of his surgery at Lodi Memorial, which is a very nice, small hospital and not far from you in the delta. I had discussed TKR with another ortho that had done some meniscus work on me, but there just wasn't enough info about him online and I knew no one that had worked with him before, so I didn't have a good feeling about him doing the work.
I didn't select the knee product. Doc Howell did. I asked him about it and he said he was more concerned with service from the company rep and less with the hardware and that he was happy with several of the products. I honestly don't know which one I have. All I know is it works. Hopefully, I don't wear it out.
Dr. Howell and his PA (they are very much a "team") both said "go enjoy your new knee". No restrictions. Wouldn't have done any good for them to tell me to not do something anyway. They said go by how I feel, which I am doing. I think if you're diligent about your strength training and listen to your body, that you can do pretty much whatever you want on the new knee. I'm not going to be taking a lot of air and hard landings, I don't know that I'll go back to running, which I had to give up because of my previous very bad knee, and I'm pretty sure I won't go back to water ski jumping, which is how I f'd it up in the first place, but I will snow ski like I have always skied, which I would characterize as relatively aggressive. (if you ever ski at Squaw, we can connect, if you'd like)
Regarding rehab, Dr. Howell is super anti-therapy during the first 4 weeks. His belief is that therapists will push the patient too hard too soon and set them back. All he had me do in the first 4 weeks is: ice, ice, ice, elevate, elevate, elevate, short walks around the house or outside every hour, and self-directed flexion and extension. I followed his instructions to a "T" except that I tried longer outdoor walks during week 2 and around week 3 or so i got on a bike on a trainer and worked on flexion by pedaling and progressively lowering the seat. After my week 4 visit, his PA said "go ahead and go to therapy if you want, but take it easy". I have been injured several times and been through a s---ton of therapy, so I knew what to do. I went to all of one therapy session and after I told the therapist what I was doing on my own, she said "You've got it. Come back if you want, but you're doing all the right things." I wouldn't hesitate to hit therapy hard, though, if it was my first rehab or I just needed more pushing.
Good luck! I highly recommend it. First couple of weeks are a struggle, but it gets better quickly after that.
I'm pushing 70 and i started to use a electro stimulation machine.
It doesn't stress the joints at all and produces muscle contractions that you won't believe.
I don't use weights for legs anymore and I'm stronger than when i pushed 700 pounds.
Quick update.
A metal knee is not a real one but it plays that part in my movie.
Most of the time I completely forget I have one.
So far, all is well with no apparent wear on the joint.
Bring on the snow....
A metal knee is not a real one but it plays that part in my movie.
Most of the time I completely forget I have one.
So far, all is well with no apparent wear on the joint.
Bring on the snow....
My sawbones cautioned me that after a knee replacement a wreck that shatters the parts of the bone the artificial knee attaches to can be crippling. But--my bad knee is not yet bad enough to replace...I'm working on it. He suggested dialing back the skiing level after the replacement.
A fellow I ski with broke his femur in several places but spared his artificial knee attachment parts. It's hard to call the damage lucky that was bad enough that he needed a long metal strap with screws into each part of the broken femur, but I guess he kind'a is lucky.
I asked the sawbones about a partial replacement. I have kneecap bone on femur bone. He said that the end of the femur would need to be carved away to fit the partial, then when I needed a full replacement that would be a problem.
Binding release settings are reduced for us old geezers for bone weakening due to age. https://medlineplus.gov/ency/article/004015.htm
I know it's one number less after age 50, that seems kind of simple minded, what about the septuagenarians and octogenarians I ski with? (No, those aren't 7 or 8 legged critters.)
A friend has fragile knees due to soft tissue issues. He has had good results so far with the newest version of the KneeBinding. No inadvertent releases, and no strains from releases that didn't let go when they should have. (KneeBinding is made in Vermont. It has the usual lateral toe release and vertical heel release plus a lateral heel release.)
A fellow I ski with broke his femur in several places but spared his artificial knee attachment parts. It's hard to call the damage lucky that was bad enough that he needed a long metal strap with screws into each part of the broken femur, but I guess he kind'a is lucky.
I asked the sawbones about a partial replacement. I have kneecap bone on femur bone. He said that the end of the femur would need to be carved away to fit the partial, then when I needed a full replacement that would be a problem.
Binding release settings are reduced for us old geezers for bone weakening due to age. https://medlineplus.gov/ency/article/004015.htm
I know it's one number less after age 50, that seems kind of simple minded, what about the septuagenarians and octogenarians I ski with? (No, those aren't 7 or 8 legged critters.)
A friend has fragile knees due to soft tissue issues. He has had good results so far with the newest version of the KneeBinding. No inadvertent releases, and no strains from releases that didn't let go when they should have. (KneeBinding is made in Vermont. It has the usual lateral toe release and vertical heel release plus a lateral heel release.)
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