Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is recorded in conjunction with WGVU in Grand Rapids MI. I examine the world of health. Whether it’s research that makes the news, another miracle diet, or a new food fad, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website drchet.com and sign up for my free emails.
Spending some time with a few thousand of my closest friends just before the 4th of July, one of the questions that I was repeatedly asked “How about an update on your knee?” If you're a relatively new listener, you may not be aware that I had a complete knee replacement in December of 2021. My knee was bad because of the 20 degree sideways deviation of my lower leg. The lateral side had deteriorated and there was no other way of addressing the issue. On top of that, i just could not get an effective workout whether on a bike, an elliptical trainer, or recumbent bike. I just could not get my heart rate high enough to regain the fitness I was losing. While I knew I would be giving up my running career such as it was, at least I would gain back a fully functional knee.
One of the things in my favor was working hard on prehabilitation. I wanted to stretch the muscles as much as possible as well as strengthen them to the degree I could before the surgery. That part worked very well for me as I exceeded the expected progress for flexion and extension within a couple of weeks. I won't talk about the pain because some pain relievers just did not work for me. So it took a long time for me to recover from the pain.
I think the thing that surprised me the most was the length of time it took to gain the confidence in the knee to return to full mobility. I had reached the range of motion within a few weeks as I said. Strength I’m still working on but I regained the five inches in thigh circumference that I had lost over the years. It was the fine muscle control necessary for side to side movements, turning, posture, and especially balance that dollartook at least a year. That doesn’t mean I was inhibited from walking, climbing steps, and doing yard work. But walking downstairs, moving quickly side to side, and even turning sharply is still not there yet. I feel like I'm at about 95% right now.
I'm also terribly frustrated as I indicated earlier.. I've been using the recumbent bike, elliptical trainer, and upright bike to exercise. I've also been walking outside when the weather permits in the winter and most days of the week now that it's summer. But there is nothing like running to me. Could I go back to it, even if in some limited capacity? The one thing you're told, as I said, is that you can't run after a knee replacement but is that accurate?
To say that I've had a little agony over not running would be an understatement. I certainly don't want to do anything that's going to impact the prosthetics in my knee. On the other hand, my frustration continued to grow over the inability to exercise as hard as I would like to exercise. I did what I always do: I looked at the research. Here's what I found.
Total Knee Replacement and Revision Rates. I decided to look at the most recent research on revision rates in people who ran or starting running after total knee replacement. Revision is the word used to describe replacing the original knee replacement because it loosened or has gotten worn. I wanted the most recent research because the quality of the prosthetics have evolved over the years as have surgical techniques. There were two research papers that included large enough sample sizes to help me make a decision. The references are both open access so you can find them in the show notes.
The first study was a meta-analysis of research done on the difference between low physical activity and high physical activity in people who had total knee replacements. While the focus was not on running alone, there were no differences in revision rates in over 4000 subjects who participated in high physical activity versus low physical activity over a follow-up period of 12 years.
The second study was a cross-sectional study of over 4000 people who had total knee replacement or total hip replacement. The researchers used online questionnaires to determine self-reported activity modes and intensities, postoperative characteristics, revision surgeries, and the Commitment to Exercise Scale and Brief Resilience Scale. The patient-reported follow-up reached 5 years.
549 subjects described themselves as runners before knee replacement and 65 subjects either returned to running or started running after the surgery. After the follow up, 6.2% of those who took up running again required revision surgery while 4.8% of those who did not run required revision surgery. The results were not significantly different. The prevailing recommendation from physicians was and still is to stay active but don't run.
My decision? The hint lies in the written introduction for this podcast as it refers to Willie Nelson’s song On The Road Again. I made the decision to start running again on July 1st, 2023. The research that I found was sufficient to give me the confidence to know that if done properly, a return to running can be safe.
What does that mean? Start slowly. While I'm using the word running, I’m actually talking about a very slow jog. One of the reasons that I decided to return to running was because my fitness level had reached rock bottom in my opinion. I also know it’s going to take some time to get to a level of fitness that I want to achieve.
The first day, I began with 20 seconds of jogging about every 5 minutes. I did not have to venture outdoors as I was in a hotel mega complex. For the most part, I had two days on thick carpeted surfaces with some occasional breaks on marble floor and concrete. I've progressed from there. On the day that I recorded this, I did 30 seconds of jogging within every 4 minutes. And that's about the way I'm going to progress: slowly. I'm not interested in running continuously anymore. I got used to walking and running before the replacement and before my knee got so bad I couldn't run. I enjoyed that.
Quick story. Back in my running heyday, when i did half and full marathons, I ran the Around the Bay 18.6 mile race in Canada. It was one of the hilliest courses at some points with a killer hill about a mile from the finish line. But I ran every step that year. The next year, I decided that I would run for seven minutes 30 seconds and walk for 30 seconds, starting at the beginning of the race all the way through to the end. I ran the entire race about 6 minutes faster than I did the prior year by running every step. And it was a whole lot more enjoyable.
I'm glad that my irritation level got high enough to check the research on revision rates post knee replacement. Perhaps it was really more about gaining confidence that, after a year and a half of recovery, the bone to prosthetic healing was at a point that could support running as I've described it.
Listen carefully. I'm not suggesting that anyone else should do it without checking with their physician--And expect to hear no. This is my decision and my decision alone. I'm basing it on the best information available today. No matter what health, weight loss, exercise, or nutrition goal you set, basing it on the most current scientific information is the best that you can do. I'll keep you posted on my progress. Until next time this is Dr. Chet Zelasko saying health is a choice people. Choose wisely today and every day.
Reference:
1. The Knee 2022; 39: 168–184
2. JAAOS Glob Res Rev 2023;7: e23.00019
