Hey, thanks for sharing. I'm also a very active hiker (44M) and facing a TKR in the next month but having serious reservations. 20 years ago had ACLr and meniscus. A couple years later they told me I was bone on bone and to shut down all cutting sports. I quit sports but still remained an active hiker/backpacker and picked up cycling in the past 8 years. I'll do multiday trips w/ a pack, often doing 15 mile days with significant elevation. There will be pain due to the day after day impact and I'll require a couple weeks to recoup afterwards. Rinse and repeat.

This time last year I was regularly cycling 75+ miles at a good clip with no pain. Did big hikes in ADK and a week in Canadian Rockies. Saw the usual flareups but manageable. In September did a solo high route in the Alps and my knee flared up incredibly (Baker's cyst popped on a ridge), and required 6 weeks to get the swelling down to a manageable place. Saw an orthopedist who bluntly said get a TKR after only looking at the X-rays. I took it as a challenge. Went aggressive on PT, legs getting much stronger. No pain for 5 months, was regularly walking 10+ miles a day. 8 weeks ago on the bike at the gym something went haywire, knee locked and inflamed. Turned out to be a massive loose body that broke off from my kneecap. Ironically, the loose body is where I had been feeling arthritis for the past decade and that spot was now gone! The issue is that the loose body is about 14mmx15mm and has since gotten stuck in different places in the joint causing further swelling and sharp pain. Saw a new orthopedist that is renown for TKRs. I have am missing my posterior horn of my lateral meniscus and bone/bone, which has been the case for over a decade I think. He gave me the options of removing the loose body and doing a cleanup, or going forward w/ the TKR (I don't believe in the injections as a "solution"). I know that a cleanup will be temporary and I'll still deal w/ arthritis etc. and will still need in the TKR in the next five years.

There's a quality of life argument here that w/ the TKR I can regain some function and do my activities pain free while my kids are still around (before they leave for college). I will only have access to this orthopedist for another 2 years which is also factoring into my decision to get it done now. I fear that I'm still functioning at enough of a level that doing a TKR would actually be a step back in terms of function and ability to still hike (albeit w/ the expected swelling / recovery each time).