Knee replacement

LadyW55

My GP has told me I need a knee replacement. Severe OA.
Have been having steroid injections and lately (December) had 3 hyaluronic gel injections which helped greatly up until now and the pain is back again.
Doc says I can only have these twice a year.
Of course I need to lose weight which I’m sure would help, but I’m wondering how long I can put off this operation. I really don’t want to go for it at all, the very thought of it terrifies me.
Is there anything else I can do in the meantime?
Getting really sore now. Won’t take Naproxen. Painkillers/rubs don’t seem to help either.
Sorry for moaning, thanks for listening.

stickywicket

You are not 'moaning' just asking questions and giving us a bit of relevant information to go by.

Where do I start? Right. Injections. Steroid injections are limited because too many will do more harm than good. I don't know much about hyaluronic acid ones or the reason why you can't have them more frequently but I'd guess that (a)if needed more often they can't be working too well and (b)cost. I believe a course of three costs well over £1,000.

With arthritis, whatever we take the pain returns. Actually, I find it never goes but then I'm a glutton for punishment as I have RA in most joints which has led to OA in....yup, you guessed it My best joints are my replaced knees and hips.

Frankly, not a lot helps. Why won't you take naproxen? NSAIDS (Non-steroidal Anti-Inflammatories) are the standard treatment for OA. Not ideal but then what is? NSAIDS can be teamed up with painkillers (a misnomer if ever there was one :roll: ) but we do have to guard against toleration of the latter and therefore taking higher and higher doses. Sometimes, of course, it just has to be done, hopefully temporarily.

I don't know why you don't fancy a TKR (new knee). It's a big operation but a very safe, routine one. I've had nothing but success with mine.

However, with or without these things, the best treatment is what we can do for ourselves. A healthy diet and weight coupled with the right kind of exercise(s) really do reduce the strain on the joints and keep muscles strong and supportive which helps to reduce pain and slow deterioration. Have a look here https://www.arthritiscare.org.uk/living-with-arthritis . Good luck

LadyW55

Thanks for replying stickywicket. Will have a look at the link.
The Naproxen didn’t agree with me at all, had pains in my chest, so I stopped it very soon afterwards.
I’ve read some GPs prescribe amytriptyline too for arthritis although my GP didn’t mention it. Maybe I’ll mention it to him.
Thanks again.

dreamdaisy

There are alternatives to naproxen which, like all drugs, may help to give short-term relief. Nap did nothing for me in terms of either controlling inflammation or giving pain relief but did give me superb oral thrush. If long term relief is the desired goal then replacement is the way to go: imagine life with hugely reduced pain, greatly improved mobility and the opportunity it offers to take far less medication . . . . . I used to but now I don't because, having been refused the operation seven years ago due to my weight and being only fifty-two, things have become so much worse in far more joints that the thought of being virtually pain-free in a couple of areas is terrifying. DD

LadyW55

Are you having the operation Dreamdaisy?

stickywicket

From reading on here, my impression is that amitrip is prescribed mainly to be taken at night (It seems to make people very drowsy) and mostly for OA spinal pain but by all means ask your GP.

Here are some former threads on it https://tinyurl.com/yd45eqbq

dreamdaisy

I very much doubt it. As my other leg joints are affected by both kinds of arthritis I don't have the required post-op mobility to make the best of the new knee/s - what a waste of NHS money that would be and I know it's too late for the new knees to slow the progress in the other joints. I am, however, working steadily on maintaining the mobility I have by exercising regularly and suitably. Losing weight is helpful to slow the progress of the disease but it won't reduce pain levels, once the damage is done it remains done.

Surgery doesn't scare me, I am a veteran of seven operations, the majority of which were successful in solving the problem causing the need. The three that weren't were auto-immune arthritis related so no wonder they didn't 'work' DD

LadyW55

Thanks for the link stickywicket. Very interesting. Sounds good as I am not sleeping very well. Will definitely mention it to my GP.

Yes DD excercise is good but I found out to my cost to go careful as I went to the pool and did about 16 lengths resulting in my knee caving in again so haven’t been back since unfortunately.

stickywicket

It's essential to start gently with exercise and build up slowly. This can be frustrating if we've invested time and money into doing it but it will pay off in the long run. Try again but next time stop when you feel you can do much more. Little and often is the key.

LadyW55

Yes, you’re right SW.
I did too much. Saw a couple of ladies who were a lot older than me zooming up and down, they’d done a lot more than I had and of course I thought if they can do it, so can I. Wrong!

stickywicket

I'm the competitive type too. You'd think all my years of arthritis would have knocked some sense into me but, no. However, if harnessed well, it can work to our advantage. we have to learn to compete with ourselves and our former targets. Patience, which doesn't come easily to me, is essential.

dreamdaisy

When I am in the gym I am fully aware that those around me are often much younger and fitter and those who are not are probably years ahead of me in going-to-the-gym terms than I am so no way am I going to match them in ability or speed. I care not. They can laugh all they like at my two minutes on that bit of kit, a sit-down and five minutes on another: one minute of living with what I have would finish them - it often finishes me. I set my targets nice and low so that I can meet them, often exceed them and thus always feel good about myself after.

Swimming is good because it is non-weight-bearing as long as it's done sensibly: breast stroke is not recommended for those with knee troubles (or is it hip? Or both?) so I hope your front crawl is up to scratch. I'm OK when in the pool but as soon as gravity hits I'm done for, in the old days before my PsA was properly controlled my knees would swell to gigantic proportions stranding me on the sofa for 48 hours, a complete waste of time. Cycling is also good, it enables one to go further, see more and is generally more interesting than ploughing up and down in a chemically treated soup of human detritus.

I prefer not to swim, cannot cycle as the bend in both knees is not sufficient so stick to walking, I have been re-learning how to walk without the emotional comfort and physical support of my aids and that is challenging muscles that haven't been used properly for years; after a few months there is a noticeable improvement in my overall physical stamina which is what I'm after. A couple of weeks ago I spent three hours in a local market town, shopping, eating and drinking, without using any aids. If I'd used the aids I could have stretched that to five but hey, never mind! DD

LadyW55

I didn’t think for one minute that the swimming would have aggravated my knee, but it just shows you not to do too much.
No, don’t do the crawl, always breast stroke.
Going on holiday shortly, so hopefully that’ll take my mind off things. Will definitely do some swimming - not too much!
We got rid of our moutain bikes a couple of years ago (never liked them anyway - seats to small and hard LOL).
I did like the fitness cycle at physio though.
Is that alcohol-drinking you’re talking about DD?

dreamdaisy

We are lay people when it comes to things medical / physiological, we are used to our bodies working in a certain way and, if they always have, expect them to always do so; neither do we comprehend or consider the general stresses and strains which we cheerily place on our joints as we run, swim etc. because why think about something that doesn't hurt when we're doing it?

The simple ball-and-socket arrangement of the hip joint allows for lateral movement, the hinge of the knee not, the frog-leg style of the breast stroke demands a certain amount of lateral movement hence the effect on the knee joint. I've never seen anyone stretch or warm up before they hit the pool so tight tendons etc. are suddenly being made to do things they may not be ready for. My husband prepares for his thrice weekly swim by walking to the pool which takes around thirty minutes then walking back to cool down. He doesn't have OA, well, not yet, I fully expect his turn will come thanks to far too much football when younger.

I started using aids back in 2002 after my first synovectomy (things were so bad he took pics and my left knee is now in medical text books) so this was, on reflection, a big deal. Sadly no alcohol was involved during my adventures, just camomile tea. Dull, dull, dull. DD

LadyW55

Update: Asked my GP if I could try amitryptyline and he said of course, he would give me a month’s supply to see how I would get on with them.
Have tried one and woke up feeling very groggy the next day. They definitely do make you sleep, I’ll say that about them! Don’t know if I’ll continue with them.
He is also going to do the ‘gel’ injections again for me so I’m really pleased about that as the last time I had them I felt brilliant - no pain.

stickywicket

That all sounds positive and that's a very good thing. I hope the injections do their stuff.

LadyW55

Thanks SW. Don’t think I’ll continue with the Ami. Feel exhausted with them. They do knock you out. Even taking a half!

dreamdaisy

Amytryp is best taken around three hours before bedtime so you sleep better, earlier in the night. If you retire around 10pm then take it at 7pm. If you take it when you go to bed it takes a while to kick in hence the groggy feeling the next morning. DD

Helenbothknees

Getting two knee replacements six years ago was the best thing I ever did; I only wish I'd had them earlier.