It happened overnight!

BoeingBoy

Hello to everyone. This is my first post here so I’d better set out my stall.

65 years old, a retired Airline Pilot who enjoyed excellent health and mobility until a year ago when in September I went out to mow the lawn. After overdoing it with a petrol hover mower on wet grass I came in with a pain in my left knee. Thinking that I’d ‘just pulled something’ I ignored it and carried on walking my two dogs up to two miles a day over open farmland. The pain didn’t subside, it got worse, a lot worse, until by Christmas I was in agony and not able to function normally anymore.

Consulting my GP brought up the subject of Arthritis. He felt that it might be worth X-raying the joint and sure enough a week or so later some very graphic evidence showed that I had no cartilage left on the inside of my knee. Referral to a physiotherapist saw me waste an hour answering questions on a computer about my quality of life and level of depression. After not even examining the knee I was handed a leaflet and told to do some exercises (as if walking two miles with Labradors wasn’t enough!) so not a lot of help there sadly.

Referral to a Private Consultant working for the NHS confirmed that I had severe Osteoarthritis and that little if anything can be done for me other than a total knee replacement. Not what I was expecting to hear after simply mowing the lawn! However the conclusion was that a motorcycle accident in 1971 that resulted in a fractured tibia had not been accurately reset. That left me with a legacy of extra wear on that part of my knee and it was payback time.

Since I was not convinced that a total knee replacement was the only option I took a second opinion and the new consultant confirmed that as the outer portion of the knee is in good condition I am an ideal candidate for a partial replacement. A cortisone injection was given at that meeting but didn’t offer relief beyond a couple of days, which in fairness is what I was told to expect. So now I am wondering whether to go for the operation or hang on as long as possible.

My present state is that when resting or sleeping I have zero pain or discomfort. I manage most days without any medication but resort to NSAID’s if needed. I use a support bandage/sock over the knee to walk the dogs, and using a walking pole for support I can still manage a mile or so. In the house I use a stick for comfort rather than dependency, and when out and about using orthotic insoles and sock can manage to walk unaided, and with very little interference to my gait (limping). I do use the walking stick for comfort though.

Those that know me who’ve had knee replacements say that I am nowhere near ready for surgery and to hang on a lot longer before considering it. That said, living with the pain of walking each day, and the effect that is having on my spirit, which at times can be very low knowing that I’ve gone from fine to bad overnight makes looking at all options worthwhile.

Not helping is that I’ve also had to go through treatment for Prostate Cancer (Hormone/Radio Route) this summer and I even managed a dose of Shingles recently, so keeping my chin up and trying to stay cheerful has been hard to say the least, but I know that in comparison to many I am still very lucky and in many ways nowhere near as bad as I may think.

Looking to the future it would be easy to rush into surgery but I’m aware that it carries risks and might leave me worse off. I am particularly interested in waiting to see what new treatments might emerge before I’m forced into a choice and in particular stem cell technology might offer hope, but perhaps I’m too far gone for that to work.

So, if you’re still with me here (and thanks for being so) I would value your opinions on what surgery might offer and what treatments might be coming in the next ten years that might be worth waiting for.

Thanks for reading this, and thanks for your help.
David.

[Deleted User]

Hi BoeingBoy and welcome to the Versus Arthritis forums.

That's a very clear introduction to your Osteoarthritis and as you say, it didn't come about overnight as a consequence of simply mowing the lawn or walking the dog

The website has a great section on knee surgery: https://www.versusarthritis.org/about-arthritis/treatments/surgery/knee-replacement-surgery/

The operation is now pretty common and many forum members have had this done, including some of our moderators. The decision on having the operation is yours and you are right to ask others for their experiences, with the caveat that none of us are medical experts.

If you need to talk to someone in confidence then our free Helplines are also available: https://www.versusarthritis.org/get-help/

All best wishes
Brynmor

dreamdaisy

Hello, it's nice to meet you and I am sorry you have had to find us. I cannot help as my experience of arthritis is so different but I know I would change places with you in a heartbeat.

I have seen many people who, once they have done the hard yards in recovery and recuperation lead lives which are pain-free and very similar to how they used to be. What they all shared was OA in only one joint, a replaceable joint too, which makes things so straightforward. I began aged 37 and am now 59. I was refused knees aged 52 due to youth. I am not going to bother now because so much else is so much worse.

My dinner is served, I have to go. I wish you well, good luck with whatever you decide to do. DD

stickywicket

Hello David and welcome from me too.

This must all have come as a bit of a shock. Particularly as you've also had the Prostate Cancer and shingles to cope with. What a difficult time for you!

My husband is in a similar situation to you re the arthritis. He has a dodgy hip but he's been very slow to accept that because, at 75, he still sees himself as a keen sportsman :roll: Indeed, he does still play golf and walks quite a bit and that's probably why his hip is doing so well despite a nasty-looking x-ray. I, on the other hand, have had rheumatoid arthritis since I was 15 and, shall we just say, it shows

It's true that we sometimes pay years later for the recklessness of our youth. But it's quite common for osteoarthritis to set in following an earlier injury so, whether yours was set well or badly, the outcome might have been just the same.

Whether to have a total knee replacement (TKR) or just a partial one or to soldier on. Only you can make that choice. Personally I don't think I'd consider a partial one. My gut instinct is that you'll still need a full one a few years down the line. I've had both knees replaced (and both hips – I'm just a surgery junkie ) and they've all been great though the last hip is now coming adrift after only 10 years or so, so I'm waiting to see if it can be replaced. There's no guarantee.

From what you've written, I doubt you'd get a TKR on the NHS. Your friends are right. But, if you want one and can afford it, there's always the private route. Again, if you want one the key is to do the exercises conscientiously, before and after and not to rush anything else. When you say “Referral to a physiotherapist saw me waste an hour answering questions on a computer about my quality of life and level of depression. After not even examining the knee I was handed a leaflet and told to do some exercises (as if walking two miles with Labradors wasn’t enough!) so not a lot of help there sadly.” I would have to disagree with you. Walking doesn't exercise all the muscles, only some. The exercises are designed to keep all the muscles strong as strong muscles support joints. Hence less pain and slower deterioration. I'm never quite sure what people expect of physios as they often say' '(s)he just gave me some exercises to do.' Exercises are what have ensured my replaced joints have done so well and sorted out a bout of sciatica once. They really do make a difference.

Anyway, all this is just one person's opinion. Whatever you do or don't do I hope you'll feel satisfied with the outcome.

BoeingBoy

I see that I posted this thread in Nov. 18 so to bring you up to date I am now a month down the road from a total knee replacement. It's taken two years of pain to get here (not the fault of the NHS who actually only took three months once the decision was made to go ahead) but hopefully better times are ahead. I start driving again this week and my aviation doctor has told me to come back in another month to be re certified fit to fly as a private pilot. By day the knee is sore but responding to exercise and I'm out with my dogs for a mile a day along with walking without a stick or a limp when on level ground. Stairs are still work in progress as mine are open plan with no hand rail but already I can manage both up and down with alternate steps. My hip and lower back are now pain free and it's notable that I'm walking taller and straighter.

Like so many on this forum though I seem to be suffering one thing that I didn't plan on and that's lack of sleep. I am only getting blocks from thirty to ninety minutes and usually struggling to find a good place to put the leg that isn't resulting in me waking with it seized up and painful a while later. The pain is mostly at the rear as the ligaments settle for the night I guess.

I am only using NSAID's by day but at night I'm resorting to two Ibuprofen and two Cocodomol to at least get off to sleep. They tend to make me wake in a hot sweat so coupled with the Lavender spray that I'm putting on the pillows (I'm that desperate I'll try anything) the bedroom smells like a cross between a Turkish Prison and my Granny's bedroom in the morning!

I've tried everything from a full sized pillow to towels in and under the knees but nothing really works, so my main request is to ask what others find useful and to also ask how long other people found this to be a problem.

Any help appreciated.....

stickywicket

Thanks for the update. I'm pleased you got a new knee but, frankly, I'm concerned that it sounds as if you're rushing your recovery and that could jeopardise the whole thing.

Driving is usually recommended 6-8 weeks post op but it's wise to check with your insurance cómpany.

I was always told never, EVER to put a pillow or anything else under my new TKR as that can prevent it from ever straightening properly. And, yes, that is excruciatingly painful at times but absolutely necessary.

I'd guess your night time problems are mainly due to your doing too much during the the day and when you write “I am only using NSAID's by day but at night I'm resorting to two Ibuprofen and two Cocodomol to at least get off to sleep “ I'm now hoping that you're not taking ibuprofen on top of other NSAIDS as that would be very dangerous.

You mention walking but the essential things still are the exercises given by your physio as walking will only strengthen some muscles not all. Is your physio happy with how things are going?

You say your aviation doc is happy for you to fly again in a couple of months but please do check this with your orthopaedic surgeon. It must be very tempting to get back to 'normality' but, if you go for too much too soon, it might never return.

Have a look here for timescales https://www.nhs.uk/conditions/knee-replacement/recovery/
and I do wish you good luck and a full, happy recovery.

dreamdaisy

It can take years for joints to get to the right stage of damage to be considered for replacement but recovery is not a rapid affair either. It must be very tempting to think that because it's all new in there it's all better, but the deep healing takes much longer than what we can see on the surface. Muscles have been pushed around and bruised, bones sawn, tendons and ligaments moved out of position and getting everything settled again is a long process. Exercise for the benefit of the muscles must be done despite any pain, the joint must be exericsed to enable it to work properly despite any pain, nerves have to regrow which is an odd sensation in itself (I was advised that when my scar (ten inches of an open synovectomy operation) tingled to lightly drum my fingers along it to stimulate the nerves to help them regrow.

Trying to do too much too quickly is very common and the quickest way to undo any good that has been done so far and that could be achieved. I have read that a full recovery can take between twelve to eighteen months, the older the patient the longer it takes as the body naturally slows with age. Post-operative pain is the norm and for some reason seems to come as a surprise to those who are not familiar with the act of surgery which in itself is a bloody and violent business. The knee is a complex joint, time and patience are the key to getting your new one to work as it should. DD

BoeingBoy

Thank you for your replies. Of course I appreciate your warnings about overdoing things but I'm going within my pain boundaries and not setting any goals. I am working my way through the recommended routines and resting the leg with elevation and ice packs in between. Luckily I left hospital on day three with full leg extension and 95 degrees of bend. Two weeks later the extension is painless and I was up to 105 degrees. My second physio is tomorrow and I'm almost equal to my good leg so hopefully might see a higher figure.

I guess we are all different as the thing that floored me was lifting the leg straight up. The hospital expected me to be able to do it post op but I couldn't move the leg off the bed for anything. It's no longer a problem and I can lift both from the hip and the knee. The area I'm working on most is putting full weight through the bent knee which is what the physio tasked me with last time. Also losing the limp by walking backwards a lot (which our Labradors think is great fun).

Driving seems to be a topic that has no easy answer. My hospital states four weeks self certified on evaluation of an emergency stop, others six to eight weeks. The Royal College of Surgeons web site recommends six, but less if your car is an automatic. Having broken a toe earlier in the year no doctor was willing to state fitness to drive as they would not accept the legal liability so it seems it's down to you and your insurers. Mine makes no stipulation and as the condition is not notifiable to the DVLA it comes down to obeying your policy document and being sensible.

Interestingly for aviation it's not down to the surgeon. He/She supplies a factual report to the AME who makes the call based on specific Civil Aviation Authority protocols. That applies to most medical issues. For musculature conditions they simply state that if you can get in and out, assist passengers out in an emergency and operate the controls to full deflection whilst weight bearing on them you are good to go! Obviously though taking Codeine based opiates is a blocker.

I have my second physio tomorrow (mine is a military trained guy who I would not want to get on the wrong side of). I'll ask him what progress I should be making and if I'm doing too much. I know that last time he didn't offer any warnings of that only that I should stick to the regime and the particular exercises that benefit me personally.

Just wish nights weren't such a challenge to sleep through though.

stickywicket

If your physio and surgeon are both happy then all is going very well indeed and I'm pleased for you. Keep them happy and you won't go far wrong We do like success stories.

daffy2

Just a thought. The medics are happy with what you are doing but I wonder if the problems at night are your body saying 'actually I'd like you to ease up a bit'? The pros are dealing with the theory and the textbook, you are dealing with the practice and your body may not have read that textbook or might beg leave to disagree on certain points.