Five weeks ago, a journey that you could say started over 25 years ago, ended with a
second knee replacement in my left leg (first, right, was done 5 weeks before that).
About 25 years ago I had my first injections of Hydraulic Acid to help lubricate my
knees. At the time if you had told me I would/could do 30 IronMan races I would have
said you are nuts. I have leaned a lot about this affliction and hope this short story will
help if you think you are heading in the same direction.

First up and I think important, Arthritis is not caused by excessive use of the joints.
There is an underlying condition. It could be genetic, an accident, of something
abnormal about your joint. In my case it was genetic helped along by a very painful
skiing accident at 14, with non release bindings, and 6 years playing rugby.
I am convinced that the best thing I did to prolong my knees was keeping a low body
weight and running. Every winter for the past 25 years I would gain 5-10 lbs, a good
thing, but my knees would hurt more. On the few occasions when I could not run for
over two weeks done to an accident it was painful getting back to my usual routine. I
asked one of my orthopedists 10 years ago what would have been worse for me, all the
running I had done or walking around with an extra 20lbs, without hesitation she said
weight gain.
Hydraulic Acid injections and Acupuncture kept me going through over 200 triathlons.
The last two years I added PRP (Platelet Rich Plasma) Injections and HA. The
Acupuncture was not your typical session. It was a technique developed by Whitfield
Reeves, who used to have a practice in Boulder and was taken over by Lindsay Long.
Whit has trained acupuncturists all over the world. His method stimulates the knee joint
with e-stim attached to the needles, it works especially well after HA injections.

I knew a time would come when I would need knee replacement. I got notification that
that time had come at the 2021 IM World Championship in St George. I was walking up
the last hill late at night on a quiet trail when I heard an odd noise, it had a rhythm to it. I
stopped, it stopped, I started walking again and the grinding noise restarted matched to
my foot steps. Amazingly it was not painful, but I got the message and when I got home
started researching my options.

I had already had knee x-rays several years earlier. I knew that I might be a candidate
for partial knee replacement, a better choice for a runner if you are a good candidate (at
the end unfortunately I was not). My litmus test for a surgeon was one who showed on

their web site that they did both total and partial replacement. Many do not. I also
wanted a doctor who felt that you can run on artificial knees. Again many, indeed most,
do not. That required more digging.

The problem with running is not that you can not do so but but there is a worry that
longevity of the joint will be impaired. There is no research on the longevity of the knees
with a runner. Very few people want to do this, they tend to be old, like me, but not all.
Most are happy to be able to do other sports pain free. With such a small population of
people who continue to run I could find no studies of the longevity of those knees. It
logically makes some sense that running would/should increase the wear rate you
would think. But one doctor I met argues that running strengthens the bones making for
a stronger bond between the prosthetic and bone reducing the chance of it getting
loose. Wear of the plastic insert still could be a problem.

There is also one important key to running on knees that are reaching the point where
replacement is being considered or are replaced. That is good running form, something
I have focused on in my training for many years. If foot lands mid to forefoot you have
the added cushion for your knees. I got this from ChatGPT.
When running on the forefoot, the primary cushioning comes from the
metatarsal heads (the ball of the foot) and the fat pads located beneath them.
The arch of the foot, specifically the medial longitudinal arch, also helps to
absorb shock and distribute the forces during forefoot running. Additionally, the
muscles, tendons, and ligaments in the foot contribute to shock absorption,
helping to reduce the impact forces on the joints.
I do think that if you have been an active runner, have good muscular strength around
the joints and are lean you can continue to run.
Here are my suggestions if you start to have joint pain in any part of your body.
 Get a through evaluation as soon as you have decided it is more than just a
niggle. Don’t wait until you can’t run.
 Get a second opinion if trouble is brewing and do this with a doctor who does
believe you could run again after treatment.
 Follow up periodically as you would with overall health.
 Don’t start masking the pain with NSAID pain med. If it hurts that bad that you
need this stuff you need more than pain relief. If you do always mask it, you will

not know when you have waited too long. I only used NSAID’s once, it was to get
me thru a race. The internal consequences were not pleasant.
 Try HA treatments to start, this is covered by some insurance plans.
 Treatment these days does not have be limited to knee replacement.
Advancements in treatments such as PRP and rebuilding the meniscus with
grafting are getting better and better. Unfortunately, these treatments are covered
by insurance yet. When I first considered PRP 10 years ago the success rate
was not worth the high cost. Now you can get both knees done for around $1,000
with improved success rates, it worked for me for 4 treatments.
 Search long and well in advance for the best possible surgeon you can afford.
Some of the best do not take insurance of any kind some are not in the US.
 Be sure to have some good support around you for a couple of months after
surgery
 I would be happy to chat and help anyone facing the problems I have had to deal
with.
I hope to prove with this study of one, me, you can get back to running and finish the IM
World Championship in Nice next September. The marathon will be a run/walk affair, but
it has been so for most of my career in IM. See you out there on a racecourse.

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