A Cyclists Survival Guide to a Total Knee Replacement – The Drugs (P-6)
I had a knee replacement and was prescribed oxy and tram. I was on it for 8 weeks before deciding I could manage the pain without. Attempting to discontinue usage was impossible. I don’t use that word lightly. It was impossible. The pain and the depression that came crashing down was unbearable. No doctors warned me of this. No program to aid with the discontinuation. I had to learn via the internet.
What a great thing to do, right?
Amidst uncontrollable and unbearable agony, I discovered that my lower dose was not enough to discontinue without severe withdrawals. I had to go back to full dosage to quit properly. I read that I needed to taper off at 10% per day, a 15 day process. I took my pills and cut them all into fourths. Every 2 days I’d lower my dosage by 1/4 of a pill (4 pills a day to start – 2 days later. 3 and 3/4 pills and so on) Even this minute change in dosage effected my mood and my body. Sleepless nights, sweats, agitation, unease, unsettling, leg and foot pain, hot foot, compiled with the normal knee pain.
After I took my last 1/4 pill, I was off. But, it took several weeks after that to start feeling normal again. I am not alone. It took a tremendous amount of will for me to move off the drugs. I didn’t want to. I’d pop a pill and my pain would be gone and I’d feel normal. My anxieties dissolved. I’d feel balanced. It wasn’t like the pill made me feel different, or high, simply, it made me feel normal. I was shocked to hear that oxy is routinely prescribed for depression, or for veterans suffering from ptsd. It’s asinine to think that a doctor can prescribe this and then discontinue the Rx without any program for withdrawal in place. It is not surprising that people turn to heroin. If I didn’t have enough of my prescription left to stop slowly, I don’t know what I would have done.
PS – this was only after 8 weeks. The withdrawal process takes much longer given longer periods of acclimation .16 weeks requires double the time. You have to stay on the script to ween off it. Longer periods of acclimation require even more time and there is a point when withdrawal might not even be possible by the simple weening process. Other drugs need to be introduced to take someone off one drug and hook them to another in order to attempt weening off the other. Now were in months of withdrawal, months of sleepless nights and sweats and pain and discomfort. Only a rare few can endure this. This is the dilemma.
Thanks for this great write up and I am really appreciative of the details … Good and Bad. Surgeons often play down the reality of surgery and the rehab afterwards. I’m an ex-runner turned cyclist (surprise-surprise 😛 ) and I am experiencing symptoms of knee function degeneration. I am pretty sure I will end with a TKR at some point. it’s just a matter of time. Your article was written in 2015. How are you doing right now. What level of activity have you returned since?
Had TKR on 3/28/18. Working the exercises 4-5 times per day. Scary about the narcotics. I’m on Norco, had plenty of Oxycodone in recovery. It’s important to drink plent of water, I would suggest having a urinal bedside. Makes my life a lot easier.
Thanks for this great write up and I am really appreciative of the details … Good and Bad. Surgeons often play down the reality of surgery and the rehab afterwards. I’m an ex-runner turned cyclist (surprise-surprise 😛 ) and I am experiencing symptoms of knee function degeneration. I am pretty sure I will end with a TKR at some point. it’s just a matter of time. Your article was written in 2015. How are you doing right now. What level of activity have you returned since?
Had TKR on 3/28/18. Working the exercises 4-5 times per day. Scary about the narcotics. I’m on Norco, had plenty of Oxycodone in recovery. It’s important to drink plent of water, I would suggest having a urinal bedside. Makes my life a lot easier.
Yes, I’d be interested in your cycling now… Thanks for the article. My experience seems to be following yours. I had an ACL / knee reconstruction two years ago. I cycle about 10,000 kms a year. I left the ACL surgery two decades too late. Not much cartilage left. But I find it impossible to run and have pain and awkwardness walking. But I can cycle without much problem. Doc said a knee replacement is in my future. But I want to last as long as I can without it…and yet not leave it to when I’m too old (48 now). Thanks for the articles.
Yes, I’d be interested in your cycling now… Thanks for the article. My experience seems to be following yours. I had an ACL / knee reconstruction two years ago. I cycle about 10,000 kms a year. I left the ACL surgery two decades too late. Not much cartilage left. But I find it impossible to run and have pain and awkwardness walking. But I can cycle without much problem. Doc said a knee replacement is in my future. But I want to last as long as I can without it…and yet not leave it to when I’m too old (48 now). Thanks for the articles.
I’m 2.5 years post surgery and the knee is fine. It’s still limited and leg size is smaller than the other, but, I’m functional and am riding. My last ride was about 60 miles. However, post ride pain is an issue, there’s lots of soreness. I was wrong about going into hyper-extension. Doctor said, “0 degrees is max” so, I do not have the same extension on my surgical as on my non surgical leg. Similarly, I cannot sit on my heel of the surgical knee, there’s too much pain. While I am functional, I’m not 100%. Am I better off than before? Yeah, I suppose, the knee doesn’t pop during sex (that’s a plus) and my stability on slopes and stairs is much better.
I’m 2.5 years post surgery and the knee is fine. It’s still limited and leg size is smaller than the other, but, I’m functional and am riding. My last ride was about 60 miles. However, post ride pain is an issue, there’s lots of soreness. I was wrong about going into hyper-extension. Doctor said, “0 degrees is max” so, I do not have the same extension on my surgical as on my non surgical leg. Similarly, I cannot sit on my heel of the surgical knee, there’s too much pain. While I am functional, I’m not 100%. Am I better off than before? Yeah, I suppose, the knee doesn’t pop during sex (that’s a plus) and my stability on slopes and stairs is much better.
Very enlightening article and a shocker in many ways. I too am bicyclist and just had arthroscopic surgery on one knee but the other one needs it too. doctor told me 3 to 5 years before I need a replacement depending on my level of activity. I love touring so am thinking ahead to the ultimate solution of going bionic. I think the drug withdrawal was the scariest part of the article. This will be my guide when I go in under the knife. May the wind always be at your back.
Very enlightening article and a shocker in many ways. I too am bicyclist and just had arthroscopic surgery on one knee but the other one needs it too. doctor told me 3 to 5 years before I need a replacement depending on my level of activity. I love touring so am thinking ahead to the ultimate solution of going bionic. I think the drug withdrawal was the scariest part of the article. This will be my guide when I go in under the knife. May the wind always be at your back.
Hi – thanks for sharing all of this info. I’m due for TKR in Feb. I love bike packing/touring. I worry that the replacement might make days in the saddle and camping difficult. Any opinion (s) on that? Thanks again.
My husband had a TKR in Dec 2015. The spring/summer of 2016 we did short overnight bike tours. The summer of 2017 we rode the C&O/GAP trail. The TKR did what it was supposed to do, it improved his stability and balance. His cycling was never affected and he is back to long distances. Ride on!
I forgot to mention…9 months after my husband’s TKR we rode Bike Maine, a 400+ Mile week long bike tour in HILLY coastal Maine. It was a Camping Tour but someone carried your stuff from campsite to campsite. No problems with the knee!
I’m glad your husband’s experience was a little more positive. I was back on the bike in about 30 days as well, but, the pain leading up to that was high mostly because I pushed my range of motion so my pain was in the red. I would really like to hear your husband’s perspective directly from him. Please have him write his experiences.
Had a TKR about 2 months ago. No real problems with the drugs, but getting increased flexibility is a HUGE issue. Progress is glacial. 90 degrees after 4 weeks, up to 120 now. Can go all day on a stationary bike but the “real” road bike with clipless pedals – the flexibility is not completely there yet. At what point (degrees) will this happen? Your description of the daily grind, with seemingly little to no progress, is spot-on! Groundhog day every day! As for the PT: the most difficult part is being solely responsible for administering your own pain…especially for us with low pain thresholds. Definitely a different kind of pain!
thank you, Mary Ann. I was excited and started planning to cycle the North Coast 500 in Scotland for next year, but the knee that’s been haunting me for 16 years just went useless. The news of your husband’s and your 400 + hilly ride gave me a glimmer of hope. thank you
Hi – thanks for sharing all of this info. I’m due for TKR in Feb. I love bike packing/touring. I worry that the replacement might make days in the saddle and camping difficult. Any opinion (s) on that? Thanks again.
My husband had a TKR in Dec 2015. The spring/summer of 2016 we did short overnight bike tours. The summer of 2017 we rode the C&O/GAP trail. The TKR did what it was supposed to do, it improved his stability and balance. His cycling was never affected and he is back to long distances. Ride on!
I forgot to mention…9 months after my husband’s TKR we rode Bike Maine, a 400+ Mile week long bike tour in HILLY coastal Maine. It was a Camping Tour but someone carried your stuff from campsite to campsite. No problems with the knee!
I’m glad your husband’s experience was a little more positive. I was back on the bike in about 30 days as well, but, the pain leading up to that was high mostly because I pushed my range of motion so my pain was in the red. I would really like to hear your husband’s perspective directly from him. Please have him write his experiences.
Had a TKR about 2 months ago. No real problems with the drugs, but getting increased flexibility is a HUGE issue. Progress is glacial. 90 degrees after 4 weeks, up to 120 now. Can go all day on a stationary bike but the “real” road bike with clipless pedals – the flexibility is not completely there yet. At what point (degrees) will this happen? Your description of the daily grind, with seemingly little to no progress, is spot-on! Groundhog day every day! As for the PT: the most difficult part is being solely responsible for administering your own pain…especially for us with low pain thresholds. Definitely a different kind of pain!
thank you, Mary Ann. I was excited and started planning to cycle the North Coast 500 in Scotland for next year, but the knee that’s been haunting me for 16 years just went useless. The news of your husband’s and your 400 + hilly ride gave me a glimmer of hope. thank you
Hi, I am also a cyclist and trekker – Double knee replacement in March 2016. Not fun. Took me a long time to walk without an aid, about 9 months. Have been training all of 2017 just to get back to some normality. It’s just hard to work it at the gym. Started spin classes a few weeks ago, that was good. Tried it 6 months ago but right leg just could not cope. Very exciting went for my first ride yesterday on my bike, was nervous but i did it, only 5ks ha ha! Hardest part ,not counting the pain, coz that is as you have said something you just have to live with through this process, was the mental attitude, getting up, pushing, achieving those little goals ( bending leg to achieve 120 deg, or trying to straighten it, going to the toilet without crutches etc) … nearly 2 years on, the hardest part is the continual pushing, motivating myself to keep trying, walk a little more, ride a little more each day. Sometimes I can do it, other times I sit on the couch and enjoy a good coffee, then head off to work. I have come far. Knee replacements are a journey…and I am doing ok. Good luck with yours, I hope all goes well for you. Janie
Oh to note….I trekked around NZ in Feb 2017…. it went well, just needed poles to help with stability. Next holiday is Central America April 2018 we are climbing some volcanoes!
Hi, I am also a cyclist and trekker – Double knee replacement in March 2016. Not fun. Took me a long time to walk without an aid, about 9 months. Have been training all of 2017 just to get back to some normality. It’s just hard to work it at the gym. Started spin classes a few weeks ago, that was good. Tried it 6 months ago but right leg just could not cope. Very exciting went for my first ride yesterday on my bike, was nervous but i did it, only 5ks ha ha! Hardest part ,not counting the pain, coz that is as you have said something you just have to live with through this process, was the mental attitude, getting up, pushing, achieving those little goals ( bending leg to achieve 120 deg, or trying to straighten it, going to the toilet without crutches etc) … nearly 2 years on, the hardest part is the continual pushing, motivating myself to keep trying, walk a little more, ride a little more each day. Sometimes I can do it, other times I sit on the couch and enjoy a good coffee, then head off to work. I have come far. Knee replacements are a journey…and I am doing ok. Good luck with yours, I hope all goes well for you. Janie
Oh to note….I trekked around NZ in Feb 2017…. it went well, just needed poles to help with stability. Next holiday is Central America April 2018 we are climbing some volcanoes!
My husband just had his second (left) knee replacement on November 9, 2017. His first TKR (right knee) was in Dec. 2015. He is a sub 2:50 marathoner turned long-distance cyclist. His experience could not have been more different that CV’s. He was back on the bike outside in 28 Days for the first TKR. The second one was slightly more painful and recovery was a bit slower due to previous hamstring surgery and he was back on the bike outdoor in 46 days. I believe the major differences are no anesthetic “block” was administered, so no numbness of the lower extremities and no catheter! Also, as CV stated, assistance at home is important. I was there 24 hours per day. Pain level was really low for the first knee (2 on a scale of 1-10) and a bit higher (4) on the second one. He also was prescribed oxycodone but took less than the prescribed amount. He had no problems ending the narcotics and replacing it with Tylenol. I realize that everybody has different responses to physical trauma but I did want readers to know that CV’s experience is just one. A TKR is, ultimately, an experiment of one.
My husband just had his second (left) knee replacement on November 9, 2017. His first TKR (right knee) was in Dec. 2015. He is a sub 2:50 marathoner turned long-distance cyclist. His experience could not have been more different that CV’s. He was back on the bike outside in 28 Days for the first TKR. The second one was slightly more painful and recovery was a bit slower due to previous hamstring surgery and he was back on the bike outdoor in 46 days. I believe the major differences are no anesthetic “block” was administered, so no numbness of the lower extremities and no catheter! Also, as CV stated, assistance at home is important. I was there 24 hours per day. Pain level was really low for the first knee (2 on a scale of 1-10) and a bit higher (4) on the second one. He also was prescribed oxycodone but took less than the prescribed amount. He had no problems ending the narcotics and replacing it with Tylenol. I realize that everybody has different responses to physical trauma but I did want readers to know that CV’s experience is just one. A TKR is, ultimately, an experiment of one.
Good good information. Very straight forward and accurate on every point.. One thing to know is there is another option for “some” knees called the MAKO partial knee replacement. If your whole joint is bad (both sides) then you need a whole knee replacement. But some people like me had only one bad side because of an injury years earlier.. In my case my outside edge was bad.. 3 scopes over the years. It put a stop to my activities including RAGBRAI.. I had a MAKO in Oct of 2015 when I was 61. MAKO takes a cat scan of you knee. Then on the day of surjury they open up the knee like they do with a TKR. A router is connected to a computer and that router shaves off some bone on the cartilage upper side, and some of the bone on the meniscus lower side. Then a metal alloy covers YOUR joint along with a plastic liner. Less rehab, less pain, more flexibility. And, later I can still have my first TKR.. NOTE, you MUST go to a MAKO surgeon to see if you are a canadate for a MAKO.. Face it, a surgeon will only suggest the brands and models that they are licensed to perform.. 9 months after MAKO I again rode RAGBRAI.. I am starting to have more problems with the inside edge.. I had a scope yesterday to clean it up. My doctor thinks that at my level of cicyling, p-90x, and yoga that I will have a TKR in 5 years.. That’s OK.. I delayed a TKR for 8 years..
I am an avid cyclist too. I visited with a orthopedic this week and a TKR. He does it a little different and uses the same procedure as a partial but you get a full new knee. He said he does not cut any muscles like the quad muscles. On his FB page there are lots of his patients that are walking within a day and they need little to no pain medication. They mostly take Tylenol. He said I would be cycling in 2 weeks. I think I need to tell him I am not a recreational cyclist and I ride long rides and lots of hills. Are there any questions anyone can think of for me to ask him? I probably will not schedule it till March. He is 2 months out and I have a ski rip planned and a long ride in March
thanks
Hey Susan – any more info on that orthopedic’s name or if the alternate procedure he is doing has a name? Sounds too good to be true, but have to ask. Thx
I am an avid cyclist too. I visited with a orthopedic this week and a TKR. He does it a little different and uses the same procedure as a partial but you get a full new knee. He said he does not cut any muscles like the quad muscles. On his FB page there are lots of his patients that are walking within a day and they need little to no pain medication. They mostly take Tylenol. He said I would be cycling in 2 weeks. I think I need to tell him I am not a recreational cyclist and I ride long rides and lots of hills. Are there any questions anyone can think of for me to ask him? I probably will not schedule it till March. He is 2 months out and I have a ski rip planned and a long ride in March
thanks
Hey Susan – any more info on that orthopedic’s name or if the alternate procedure he is doing has a name? Sounds too good to be true, but have to ask. Thx
I know I am a bit late to the party here. I am not yet an avid cyclist. I got my first big boy bike last week and it is winter in Iowa.
Back in October, I had my partial knee revised to a total knee. I’m 38 and have had two replacements (Thank You Army)!
I agree completely with everything you said! The recovery is total hell. Small goals are the key. It has been three months and my goals are getting bigger.
I ride my new bike on the trainer for about 30 or so minutes a day. I went back to work a month ago. I am a scrub tech, and it is really strange scrubbing the same surgery you just had.
Thank you so much for writing this up. How is your knee now?
Matt
I know I am a bit late to the party here. I am not yet an avid cyclist. I got my first big boy bike last week and it is winter in Iowa.
Back in October, I had my partial knee revised to a total knee. I’m 38 and have had two replacements (Thank You Army)!
I agree completely with everything you said! The recovery is total hell. Small goals are the key. It has been three months and my goals are getting bigger.
I ride my new bike on the trainer for about 30 or so minutes a day. I went back to work a month ago. I am a scrub tech, and it is really strange scrubbing the same surgery you just had.
Thank you so much for writing this up. How is your knee now?
Matt
Hey Matt, thanks. 2 knees? Ugh! I think my knee is as good as it’s gonna get. It’s better than before, but, not up to par with a healthy knee. There’s still soreness and stiffness, swelling and atrophy. It is what it takes s I suppose
Hey Matt, thanks. 2 knees? Ugh! I think my knee is as good as it’s gonna get. It’s better than before, but, not up to par with a healthy knee. There’s still soreness and stiffness, swelling and atrophy. It is what it takes s I suppose
Good blog and comments. At age 65, had both knees done in Nov, 2011. Not fun! Pretty intense pain for a couple of months but subsided quickly over the next month. Got back on bike (painful!) at around 2 months and progressed quickly. Rode RAGBRAI (425 miles) 8 months after surgery with no problems. Rode across US (Savannah to Oregon coast, 3800 miles) unsupported in 2014. Did 1,000 mile tour in 2016. Although I feel like most surgeries are a crap shoot and I was very lucky, getting and staying active ASAP helps a lot. Equally important are diet and managing weight. I guess I sound like I’m bragging but I’m just joyful. These knees gave me a new life. Not just a new bicycling life but a better family and social life. I feel very lucky. But, like I said, surgery can be a crap shoot. 🙂
Good blog and comments. At age 65, had both knees done in Nov, 2011. Not fun! Pretty intense pain for a couple of months but subsided quickly over the next month. Got back on bike (painful!) at around 2 months and progressed quickly. Rode RAGBRAI (425 miles) 8 months after surgery with no problems. Rode across US (Savannah to Oregon coast, 3800 miles) unsupported in 2014. Did 1,000 mile tour in 2016. Although I feel like most surgeries are a crap shoot and I was very lucky, getting and staying active ASAP helps a lot. Equally important are diet and managing weight. I guess I sound like I’m bragging but I’m just joyful. These knees gave me a new life. Not just a new bicycling life but a better family and social life. I feel very lucky. But, like I said, surgery can be a crap shoot. 🙂
Hi all, I’m a very keen cyclist and had bilateral knee replacement 31/4/19. Erghhhh, I thought I was tough but soon realised I am not that tough. Been 7 weeks now , improving daily but hell nights and after rehab. Initially In hospital 4 days, rehab hospital 2 weeks ( Australia we stay longer in rehab ) and then home. It’s a challenge and I underestimated the impact. On spin bike at home 2 x 10mins 5 days a week. Really improving , my research found out you can go too hard on trying to push it and end up going backwards . Right knee behind left in recovery. Range 3degrees and 107 degrees pushing pain barrier. We’re /your not alone finding this recovery a nightmare trip. It’s a mental test but remember there are plenty in the same boat so hang in there, remember the pain prior to commuting to the knee replacement.
I committed to a European 18 day bike ride prior to op and leaving in 12 weeks, hope I get back to at least ride every second day .
Hang in there team , your not alone .
Brett from Sydney
Hi all, I’m a very keen cyclist and had bilateral knee replacement 31/4/19. Erghhhh, I thought I was tough but soon realised I am not that tough. Been 7 weeks now , improving daily but hell nights and after rehab. Initially In hospital 4 days, rehab hospital 2 weeks ( Australia we stay longer in rehab ) and then home. It’s a challenge and I underestimated the impact. On spin bike at home 2 x 10mins 5 days a week. Really improving , my research found out you can go too hard on trying to push it and end up going backwards . Right knee behind left in recovery. Range 3degrees and 107 degrees pushing pain barrier. We’re /your not alone finding this recovery a nightmare trip. It’s a mental test but remember there are plenty in the same boat so hang in there, remember the pain prior to commuting to the knee replacement.
I committed to a European 18 day bike ride prior to op and leaving in 12 weeks, hope I get back to at least ride every second day .
Hang in there team , your not alone .
Brett from Sydney