Riding with end-stage knee osteoarthritis

[anon38350891]

I had two bad ice slip-and-falls this winter, and the second one was nearly incapacitating, which made me so desperate I sought medical attention…

Voila! I have no cartilege in my left knee - ‘bone-on-bone’ end-stage osteoarthritis. This is my step-in-the-stirrup to mount knee.

The ortho doc said “Your meniscus got the sads and went bye-bye”. The tendons/ligaments are OK, just traumatized. He also said “Your knee is basically shot, so you can’t damage it any more. Just go do your thing!” But I didn’t ask about riding. A cortisone shot brought great relief. I’ve been experiencing knee soreness and stiffness in that left leg from longer trail rides, and have gotten more careful about dismounting - I hang on to the saddle as I go down, and try to place less weight on left leg than right.

Any others have experience and tips to share? I’m scheduled for PT in first week of April and hope to get some exercises to work on at home.

[McGurk]

I rode with bone on bone OA in my both knees for years. Cortisone shots do help, as do daily NSAIDs.

I always mount from a tall block, and my horses are trained to line up at the block for me to dismount. Dismounting onto a block is a huge help.

I experimented with various kinds of stirrups - the ones that work for me are the Sprenger jointed and the MDC ultimates that have the stirrup hang at a 90 degree angle to the leather and the horse. YMMV, try different ones to see what helps before spending the money.

Some people love the extra wide stirrup leathers, they didn’t appear to make a difference for me, but again, YMMV.

https://www.ridingwarehouse.com/Ovation_Wide_Comfort_Stirrup_Leathers/descpage-OVWC.html

It also may help to ride with a slightly longer stirrup, depending on what your doing. I ride with a flat work length stirrup unless I know I’ll be galloping and jumping. My preference would be to ride with the galloping length all the time, but my knees say otherwise.

Finally, someone taught me this lovely technique for dismounting when a block isn’t available - bring your offside stirrup across the saddle as you swing your right leg over, then hold on to the offside leather or stirrup and use it to lower yourself to the ground.

For reference, my left knee started to go in my forties. I managed with cortisone injections an having the knee scoped and cleaned until I was 50 and they would approve the knee replacement. Had the right knee replaced at 56. Happily riding at 64.

At some point there is nothing else to do but have joint replacement. I highly recommend it. I wished they would have let me do the left knee earlier.

[anon38350891]

Thank you so much for this extremely helpful info. The stirrup over saddle for dismount is something I will try immediately. I’m so glad your knee replacement went well. I need good thoughts about that, which my ortho doc described as the “only permanent solution”.

[McGurk]

That dismount is a gift I discovered WAY too late; I share it with every over 40 rider I know!

I wish I had known about it sooner, from the years before knee replacement, I always anticipate dismounting to be painful and am always somewhat surprised when it’s not.

There are age considerations with knee replacement (they assume you’ll need it replaced again in 10 - 15 years, and there’s a limit to how often it can be done), and it is, in fact, major surgery. So if you have other health considerations, that will factor into your decision about when to have the surgery done.

As I said, I wish they would have let me have the first one sooner. I was in a lot of pain, I gained a lot of weight and lost a lot of fitness during that time. I hobbled into the OR on a cane.

If I had it to do over again, I would have the replacement as soon as conservative treatments stopped giving relief; that is, the cortisone shots, the arthroscopic surgery and the NSAIDs and gotten my riding life back sooner.

Best of luck to you on this journey!

[Bluey]

Glad you posed this question, as I slipped on ice, fell on my knees and they were not working right.
Dr took x-rays and sent me to orthopedic surgeon, they said same, both bone on bone, need replacing, any time you decide to.

I have been thinking about it, not sure I want to go thru that at mid seventies.
That is serious surgery and months of rehab, for few more years of use …

Younger friend just had both replaced at the same time, ugh.
She is back on her horses and competing and said it was worth it.

OP, thanks for this thread, I hope you get more responses, I am sure not the only one reading and wondering.

[2DogsFarm]

@McGurk

conservative treatments stopped giving relief; that is, the cortisone shots, the arthroscopic surgery and the NSAIDs

Hijack!
@McGurk Pls tell me how arthroscopic surgery helped bone-on-bone OA. Or did I read that wrong?
I’ll be 72 in May (how the F that happened is a mystery ) & my right knee is same as OP. Left is better, but not by much.
I have friends who have had TKR, but of 4 only 1 has had a good outcome < meaning relief from pain.
Of the other 3, 2 are large - so deduct points. Last has other issues including RA.
So far Driving my mini (done oftener than I ride lately ) is not causing pain & when I do ride, it’s in a dressage saddle & longer stirrup. So far the bad knee isn’t hurting when I ride.

I’ve had 3 rounds of steroids & am now headed for HA injection #3. The last has helped, but not enough so I realize surgery is in my future. But arthro would be preferable

[KBC]

The two years that my right knee was ‘terminal’ as I went through the whole exploring all the options before replacement, and a 6 month deferral, because wasn’t getting a new knee at the start of show season!, were grim, and got grimmer over the time.

One thing that really helped me were my Back on Track knee braces, I had three, good old fashioned one to wear, one in the wash, one ready to go I couldn’t operate without one on, but my jury is out if any of that was a placebo effect, but I don’t think so.

OTC pain pills daily, prescription drugs for shows, heavy training days, clinics etc.

I also used a large mounting block, both for getting on and off, if I HAD to dismount without a block, I did the hold and slide, land on good leg and balance.

Now 3 1/2 years on, I still use the big block, just because. My new right knee is good, sometimes get a little pain in it, but nothing o concern me. I did take a while to use that leg effectively, still have ti be conscious of it. The recovery from the op is bloody horrible, but doing the exercises and resting, in correct balance, is key to lasting success. The physiotherapist in the hospital said that horse people usually get good results, because they have good leg strength, and have determination to get back in the saddle

Now I am feeling lefty muttering, started waking me up at night, but doesn’t do to bad in the day…

[McGurk]

@2DogsFarm,

The arthroscopic surgery cleaned up the joint; it’s the same surgery they do for a torn meniscus. The bone on bone portion was on the lateral surface of the joint, the central and medial sections still had some bits and pieces of cartilage that the surgery smoothed out. I believe the surgery also cleaned up some debris in the joint space?

I also had something called a lateral release, which cuts through a tight group of tendons in the kneecap and allows the kneecap to track in the patellar groove better.

Neither procedure made a whole lot of difference in my pain or function, I think we were just checking off the conservative options on the bingo card so the insurance company would approve the eventual TKR.

I was larger at the time of both surgeries. I lost some weight and was hitting the gym pretty regularly before the first one but had regained the weight by the time of the second surgery.

I did not find the PT and recovery to be horrible. After the first TKR, I was discharged from home PT early because the therapist would arrive and find me doing farm chores; in one case, I was driving the tractor when she arrived. I was riding again 4 weeks post op from both surgeries, albeit, on the guest horse, a dead broke QH with a tiny trot. After the second one, I was discharged from the hospital after one night because I had already hit all the post op goals. I was planning on sleeping downstairs in the recliner when I got home, but I was able to manage the stairs and sleep in my own bed instead.

I do understand that my results are not typical. But I would have the TKR again in a hot minute. I wished I had had them both done sooner. (The second one I waited a year because I had just started a new job and their Short Term Disability plan had a one year waiting period.)

[2DogsFarm]

Thanks so much for your info!
I will bring up the arthro surgery when I go for my HA injections… After I check to see if the procedure is covered by Medicare.
Still, encouraging to hear your experiences with TKR

[starsandsun]

Bluey, you’re young even at mid-seventies. I know a few people who have done both knee replacements and the quality of life after has been so worth it. They were both consistent/persistent with rehab and had great oucomes. You deserve it!!!

[Bluey]

@starsandsun

Bluey, you’re young even at mid-seventies. I know a few people who have done both knee replacements and the quality of life after has been so worth it. They were both consistent/persistent with rehab and had great oucomes. You deserve it!!!

Thanks, that helps.
A friend at 88 had a knee replaced, did so well, at 89 had the other replaced and said, now I can dance again!
Then she died at 92. Wondering if it was worth the long, grueling surgery and rehab.
We will never know, each one will have to take our chances.

A local fellow had first knee fixed, was very happy, had other fixed, said it is still not quite right and painful, they are considering if to go in there and see if they can fix it, again.
Hearing both kinds of stories, some even same person different knees, gives pause.
Since I had other surgeries that did great, maybe I am a good candidate to do right with this also, my luck holding and our excellent surgeons and their teams being a plus.

I hope we are not scaring the OP.
Best listen to the Dr, they really are the ones that know what is best for every one of us.

[McGurk]

The biggest difference between the first (2010) and second (2016) surgeries for me was that the second was done under twilight sedation and a local nerve block placed with ultrasound guidance.

Twilight sedation (I think it was proprofol) means no anesthesia hangover. The nerve block lasts 24 hours after the surgery and REALLY eases the post op pain. Any post op pain meds were oral. With the nerve block they had me out of bed, walking and going up and down steps the afternoon of the surgery. Did the same PT morning following the surgery and then they discharged me.

First surgery I had general anesthesia, was in the hospital 3 nights, and had much more trouble with the post op pain.

Techniques are getting better all the time.

[signmypapyrus]

My ankylosing spondylitis started in my right knee when I was incredibly young-- I was around eight-years old when I started treatment for the pain. I generally didn’t ride with stirrups, although I did just buy MDC stirrups because I haven’t ridden in years so I’m unstable. I find riding without stirrups eases up the pain a lot.

I also had surgery to clean up the knee and the ortho surgeon removed the bursa. He also shaved the area where my knee is fusing to the femur-- typical AS. I can post pictures if anyone wants to see it. I had NO issues post-op; in fact, I was walking the day of my surgery. I took my Rx NSAIDs after surgery instead of the pain medication the surgeon prescribed.

PT also has so many alternatives too, like ultrasound therapy, dry needling, different pain patches, etc. I also learned how to tape my knee, which helps support the knee.

[betsyk]

Bluey, my mom had one knee replaced when she was close to 80, I think, but then didn’t take action on the second one until much later when they told her she was too old and not a good candidate for the surgery. She lived with a lot of pain and the inability to move around easily had a huge impact on her quality of life. I wish she had replaced the second one so she could enjoy her last years.

[Bluey]

@betsyk

Bluey, my mom had one knee replaced when she was close to 80, I think, but then didn’t take action on the second one until much later when they told her she was too old and not a good candidate for the surgery. She lived with a lot of pain and the inability to move around easily had a huge impact on her quality of life. I wish she had replaced the second one so she could enjoy her last years.

I hear you, thanks for the prod.

[McGurk]

For me, and again, this is highly individual and YMMV, but it’s a choice between quality of life and quantity.

Did I want to be able to ride without pain NOW, in my 60s, and possibly run out of options in my 80s or did I want to wait until riding was no longer really on the table to have the surgery? I always assumed that with my medical history my life and activity in my late 70s and 80s will be restricted, so I opted for the surgery as soon as insurance would approve it.

I am a “carpe diem” sort of girl, so the idea of accepting limitations in my fifties in the hopes of a better life in my eighties seemed like a bad deal to me. We always have joked about “getting hit by a crosstown bus” or “runover by a beer truck” as worse case scenarios, but for me, NOT having the TKRs AND getting hit by the crosstown bus is truly the worst case scenario. I’ll have my fun RIGHT NOW, thank you very much, because none of us is promised tomorrow.

[timmy]

For those who have had TKR & have horses at home, how long post surgery before you were able to take care of them? That’s the main thing holding me back. I’ve been told 6-8 weeks.

[Bluey]

@timmy

For those who have had TKR & have horses at home, how long post surgery before you were able to take care of them? That’s the main thing holding me back. I’ve been told 6-8 weeks.

A friend had both knees replaced at the same time.
She said she needed 24/7 help, her daughter provided it, for two weeks and after that she was on her own in another week, taking care of her 5 horses.
It was a good 6 months before she was riding and training and competing again and said she is almost like new now.

I too also am holding back as long as I can, even one knee at the time.
It is very disruptive for however long it takes.
Don’t want to chance needing a repair if overdoing rehab causes problems.

[timmy]

Thanks Bluey, that’s encouraging. I think I could handle having someone else do horse care for 2-3 weeks. I just have 2 horses but they’re old & 1 has multiple issues.

[McGurk]

@timmy, it depends on what your horse care routine is. I could go out and top up the water trough and feed within days after surgery. Mucking and turning in and turning out? That would take longer. (I don’t do either thing as part of my day to day routine. My horses have run ins with mats, not bedded stalls.)