Recently a BOSI patient reached out to our practice to thank us “for my years of care and recent total knee replacement (May 1st, 2024). You helped me successfully complete the Ironman World Championship race yesterday and it was a HUGE Success!”
On October 26th, 2024—less than six months after his total knee replacement—the patient, Richard, competed in The Ironman World Championship in Kona, Hawaii (his 10th full Ironman), where he was able to “swim 2.4 miles, bike 112 miles, and run 26.2 miles consecutively.” In fact, he did all of that in under 14 hours and his knee was “ROCK SOLID!!!!”
We recently caught up with Richard to learn about his journey through surgery, rehab, training, overcoming hurdles, and achieving his goals. Here’s a bit from our conversation:
How did you injure your knee?
My first major injury was a complete tear of my ACL back in 1988 playing football. Since then, I’ve had multiple ACL, PCL, and MCL tears and meniscus issues over the years from football, hockey, and even wakeboarding. This meant multiple surgeries, ligament replacements, and meniscus repairs. I’ve had cadaver grafts, man made ligaments, my own muscle tissue, ligaments from other areas of my body, bolts, screws, and my own bone plugs—none of which lasted very long. But luckily, my body adapted to not having main knee ligaments and I was able to get by and still be fairly active.
Had you ever done an Ironman before?
Growing up, I was never a runner—in fact, I felt like running was a punishment. An orthopedic doctor I had before being treated at BOSI told me post-surgery I would never be able to run or jump again, which is what got me into running. Tell me I can’t do something and I’ll do everything in my power to prove you wrong. Furthermore, being a bigger guy, I was never great at running, but I loved the challenge and fitness it provided and it served as a great balance to my weight training routine.
After running multiple races, mud runs, Spartan Races, and Tough Mudders, I started into half marathons and eventually did several full marathons. My next progression was to try local sprint and Olympic distance triathlons, then half Ironmans (I’ve now done over 40), and in 2012 I did my first full Ironman race; I barely made it under the 17 hour cut off, but I made it. One race in 2017 I did the swim and bike portions, but I couldn’t do the run.
After some other health issues and significant knee issues, I was able to qualify for the 2019 Ironman World Championships. But unfortunately, as the 2019 race approached, my other health issues and knee didn’t allow me to race. Thankfully, because of my relationship with the Ironman brand and significant charity work I do with the Challenged Athletes Foundation (CAF), an Ironman Partner charity, I was able to “roll over” my participation to 2020—but then all races were canceled for 2020 and 2021 due to COVID. I was invited to race in 2022, and although my other health issues had been worked out, as I trained for the 2022 race my knee got worse and worse instead of better and I was unable to race again. But again, because of my contributions to Ironman and CAF, I was blessed to be allowed to participate in 2024, and was told that this was the last roll over I would get.
What was it like preparing for the 2024 Ironman competition?
Knowing this was my last chance, I worked diligently with Dr. Woodson and his team to get my body and knee into shape. But in April 2024, I realized my knee was too far gone and there was no hope of “band-aiding” it to get through the race. I approached Dr. Woodson with a written list and asked him to help me get through the race; he stated the only way was to get a full knee replacement, but if I were to go that route, it wasn’t recommended to run this type of distance, especially someone of my size. We also discussed the timing, which was too tight, but we proceeded to work toward the total knee replacement anyways. The plan was for me to swim and bike, but walk the marathon. Again, tell me I can’t do something, and I will strive to prove you wrong. I was honest with Dr. Woodson and once he realized I was going to do it with or without his support, he gave me his full support, albeit with several disclaimers.
How did BOSI support you pre- and post-surgery?
I was anxious to get the surgery done so I could start recovering and getting my strength back. I wanted it done as fast as possible but was concerned it would even work—I’d been promised a lot in the past with ACL, PCL, and MCL surgeries and they never really panned out. Pre-op, I had many drainings, Zilretta treatments (for osteoarthritis knee pain), gel treatments, and flexibility sessions to keep the knee working enough to train for the race. The BOSI team was AMAZING, accommodating, flexible, and very receptive to try new things—and we tried them ALL. They also worked very hard to get me the fastest surgery date possible once we agreed to do the total knee replacement. They adjusted schedules to get me in and even met my requests for moving surgery up.
Both pre- and post-surgery, Dr. Woodson was very helpful; he knew I didn’t want to sit still after surgery and wanted to recover and train ASAP, so he had a recumbent bike delivered to my home pre-surgery for immediate use post-surgery and during my recovery. He also made sure I got connected with a Physical Therapist that was familiar with someone as active and aggressive as I am, and worked with me knowing I wouldn’t be willing to take pain meds for more than three days post surgery. Additionally, he made it VERY, VERY clear what I could and couldn’t do post-op—and at what pace, telling me his biggest fear was for me to do too much too soon, jeopardizing the surgery. He worked with me in great detail and customized my recovery process to meet my personality and resources. The night of my surgery I was able to walk laps in my kitchen and ride the recumbent bike Dr. Woodson prescribed for me, and I started Physical Therapy the very next day.
How did the knee feel in the lead up to and during the competition?
The knee joint itself was stronger than it had been in 15+ years within five days of the surgery; the chore was getting the leg and muscles back up to full strength. All in all, I believe I raced with the leg about 90% full strength, and amazingly, the knee was not a factor in the race AT ALL! Zero pain, zero swelling, and zero problems. The leg muscles were sore, but 140.6 miles will do that to anyone! I have to say this again: I literally had ZERO swelling and no knee-specific pain AT ALL after the race. Honestly, sitting still on the plane ride to Hawaii was more uncomfortable on the knee than swimming 2.4 miles, biking 112 miles, and running 26.2 miles!
Any last words of advice for our readers who may be considering a total knee replacement?
My only regret is that I didn’t do this sooner, as Dr. Woodson recommended it many years ago. I was blessed that by following the process EXACTLY as planned, it worked perfectly. Clint, my Physical Therapist was also AMAZING and a HUGE part of this success. I wish the people I know that had knee replacement surgery and recommended against it had done the PT and recovery exactly as they should have, as I feel they too would have been successful in their own way. In talking to several Physical Therapists and others who have had procedures similar to this, their actions or lack thereof are the true cause of their failure to recover.
I hope at least one person benefits from this story, and that many more realize the word CAN’T is worse for your health than any injury. Like most things in life, don’t take shortcuts, don’t be lazy, and don’t give excuses; do what you’re supposed to do and things will work out. The body is an amazingly adaptive machine—treat it right and it will do incredible things!
Thank you, Richard!
As Richard said, “AGAIN, I can’t say it enough…THANK YOU!! This was very important to me and I could not have done it without you!!!! Your staff is always accommodating, kind, empathetic and a pleasure to work with.”
Richard, we’re absolutely thrilled to hear that you not only completed the Ironman World Championship, but did so after undergoing a total knee replacement! Your dedication, strength, and perseverance are beyond inspiring, and we couldn’t be prouder to have been a part of your journey. Your experience is a beacon of hope for others who are facing similar challenges. Love and congratulations from Dr. Woodson and the entire BOSI team!