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One of my hips turns out a bit more than it ‘ought’ to. It doesn't affect my walking, but on a bicycle it means that my knee on that side must transmit force at an unnatural angle. It was less of a concern when I was younger and lighter, but even so it's probably why I had considerable intermittent knee pain in my teens. Now I don't ride at all.

Do bicycles exist that I could ride without pain?

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    You might want to consider riding a recumbent. – Daniel R Hicks May 11 '16 at 20:48
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    (And a recumbent trike might be ideal.) – Daniel R Hicks May 11 '16 at 21:47
  • @DanielRHicks unless the change in pelvis tilt associate with a recumbent rider position substantially alters his knee tracking, the current problem the OP faces will still persist. – Rider_X May 12 '16 at 4:36
  • @rider_x "It doesn't affect my walking" so its totally possible that riding the recumbent will have a different range/type of motion to a conventional bike. Certainly worth investigating. – Criggie May 12 '16 at 5:43
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Similar to the other answers it would be worthwhile getting a professional to assess your current bike fit (and potential modifications that may be required). If possible I would suggest a sports physiotherapist that specializes in bike fitting. They exist, I have used one before. A physio will be best qualified for assessing how changes in position can affect your hip and knee functioning. While many bike fitters have some training (and often good intuition), dealing with severe dysfunctions may be out of their area of expertise. Alternatively, you may need to facilitate a relationship between your physio and bike fitter if you cannot find a single person who can wear both hats.

To give you hope that it is possible to tweak a standard bicycle here are some things that could help (with the right guidance):

  1. leather hammock saddles (e.g. Brooks) break into a custom form fit for each rider. During the break-in phase you are physically tearing the taut leather until the pressure is equalized across the saddle. This results in custom form fitting that can accommodate different pelvic tilts and orientations. Be warned however, the break-in period can be long (although water break-ins can speed this up considerably at the cost of leather longevity).
  2. Shoe shims exist to help angle the foot differently to optimize knee alignment. Also foot orientation on the pedal can be used to help modify knee tracking.
  3. Shoe shims can also be used to accommodate for structural leg length differences.
  4. You may consider flat pedals over clip-less so that you can continually modify your positioning to reduce the likelihood of repetitive stress injuries.
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    I would add changes to crank length and Q-Factor, even asymmetric Q Factor come to mind as other options. In the extreme things like Pivoting and ratchet cranks allow you to ride with reduced range of motion. Electric bikes offer choices that may not have worked well well previously (e.g. pivoting cranks) Starting point for this kind of query is the only thing that will stop you getting onto a bike is how much will it cost, some equipment options are not cheap. – mattnz Feb 8 at 1:25
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First thing I would do is consult a LBS (local bike shop) that does quality bike fittings. There are a variety of things that can be done at minimal cost. My local shop does work on hand cycles and adaptable cycles. They have done things like install crank arms of different lengths for riders with legs of different lengths, install pedal extenders to move the pedal farther from the crank arm. This sometimes requires thinking outside the box. If you have difficulty finding a shop that is willing to listen and work with you, contact the local disability advocate and see if they have suggestions of some shops they may have dealt with.

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Sounds like you'd benefit from a proper bike fit session. Its possible this might be correctable with special cleats and packers to hold the cleat on a suitable angle. You may need oversized shoes with custom-shaped innersoles too, depending on the degree of angle required.

Are your legs different length? A longer+shorter crank may be required to bring it back to line.

Depending on budget, you may wish to explore recumbent bikes over traditional-shaped diamond frames. Or to an extreme level, a handcycle would remove the leg completely from the equation.

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