Osteoarthritis does not mean an OUT for road cycling - cycling with a knee prosthesis

Question from Detlef Sch.: In December 2015, I (60 years old, cycling 6,000 to 9,000 kilometres a year to date) had a total knee replacement. With regard to resuming road cycling, the general statements are usually: "depending on the healing process" or "a slow return to cycling is possible around six months after the operation". Are there any more detailed findings from practice? Is it still feasible or sensible for me to get back into cycling, especially with marathons and Alpine rides? Do I need to readjust my clipless pedals or my riding position? Are there any distances, riding situations or routes that I should avoid? What should I bear in mind?

Answer from Dr Peter Knöll: Osteoarthritis, i.e. the wear and tear of joint cartilage, is a very common disease. In Germany, around a third of men and around half of women aged 60 are affected - usually in the hip or knee joint. Unfortunately, it is not yet possible to repair worn joint cartilage. However, the function and durability of artificial joints are very good, especially in the knees and hips. After receiving a knee prosthesis, recovery usually takes three to six months. A cemented surface replacement prosthesis is standard for the knee joint. The joint can then be fully loaded immediately after the operation. A non-cemented knee joint prosthesis must first grow into the bone and can only be fully loaded after around three to six months.

Whether your racing bike needs to be refitted depends largely on how far you can bend your operated knee: If this is possible up to about 110 degrees (0 degrees would be the extended leg), you probably don't need an adjustment. If you can only bend the knee up to 90 degrees, you have two options: You can fit (or have fitted) a shorter crank arm on the operated side. Or you can obtain intermediate joints from an orthopaedic specialist dealer (available online under Rehab accessories/pedal pendulum/crank shorteners), which are screwed onto the crank arm on the operated side and thus change the position of the pedals.

Patients with knee prostheses can often start exercising again after six months. Cycling is generally considered to be easy on the joints. Even with an artificial knee joint, you should do exactly what you can do without pain. You should not expect any particular strain when pedalling in the saddle, cycling uphill or over long distances. Even travelling over cobblestones should not be a problem. Today's artificial knee joints have rotational mobility so that even clipless pedals with zero degrees of freedom can be ridden. However, to relieve the prosthesis, I would recommend clipless pedals with at least a small degree of freedom (4°) and adjusting the cleats so that you stand on the pedal with your foot turned slightly outwards.