Denied a knee replacement because of Atrial Fibrillation

Bathonian

Hello, I’m at my witt’s end! I’ve been waiting for a knee replacement for nearly two years. Each time the pre op assessment nurse has turned me down because of my (unstable) AF. My cardiologist insists it’s safe to have the procedure and has written to say so.

My life is slipping by and every day is a struggle. Has anyone out there ever had these problems and can come up with a solution?

tThanks

HelenS

Hi @Bathonian

Welcome to the online community, and thank you for posting.

Dealing with a long-term condition can be extremely difficult, pain can also be made worse though periods of emotional stress which can have such an impact on our condition including arthritis. There is help available for people with arthritis possibly a referral to a pain clinic might be useful.

You may need to ask your cardiologist to liaise with your surgery team to discuss your options. Have you thought about looking into the different types of anaesthetic used for surgery, especially a spinal block, or epidural? I have included some links below which may be useful

https://www.versusarthritis.org/about-arthritis/treatments/surgery/types-of-anaesthetic/

https://www.nhs.uk/conditions/local-anaesthesia/

You may also want to post on our Living with arthritis discussion where other members may be able to add some advice.

Please do keep in touch

Take care

Helen, Admin

Bathonian

Thanks for your response.

My Cardiologist has written to the Orthopaedic surgeon but no joy. I have agreed to an epidural.

It seems a stalemate has been reached. Moving is extremely limited so my world/life has shrunk.

Thanks for your reply.

stickywicket

Your post rang a bell. This is a fairly recent one from @MikeM . I don't know if he ever got his op. Perhaps it might be up to the anaesthetist whether or not they're willing to do it. Perhaps a large teaching hospital might be better able to offer the right facilities. You could try PMing @MikeM

Byron

I’m in the same boat, I have left ventricular low ejection fraction heart failure and am waiting for a partial nephrectomy due to kidney cancer, plus hopefully ankle replacement or ankle fusion surgery, the anaesthetist doesn’t want to give me a general due to possible complications even though my cardiologist has given me the ok after an angiogram showing no coronary artery disease, ok the ankle surgery should be able to be done with an epidural but there’s a further complication in that I have OA in my lower spine too (at least that would stop the crippling pain from that for a few hours) I’m still waiting as well

Bathonian

I’m so sorry to hear of the many complications and health issues that you have. I guess it’s true that there is always someone worse of than yourself which I keep reminding myself on a daily basis.

I’m beginning to think that there is age discrimination in the NHS and the priority is being given to younger potentially fitter people than us retired patients with complications.

I’m going to try yet again to push for my knee replacement. Good luck with all your health issues.

stickywicket

'I’m beginning to think that there is age discrimination in the NHS and the priority is being given to younger potentially fitter people than us retired patients with complications.'

On the contrary, @Bathonian , I think, if you read a lot of other people's posts on here, it seems to be quite the opposite. Many PCTs won't consider anyone under 60 however bad things are. Younger patients are more likely to subsequently need revision surgery which demands twice the theatre time, more nursing and can have more complications. Plus not all consultants can perform it. I've been very lucky with mine.

I think much the same applies to people with AF (see here https://pubmed.ncbi.nlm.nih.gov/24005202/) and, in this 'covid lull' the plan might be to get the lists down as quickly as possible. So, maybe not age but fitness - apart from the dodgy joint, of course!

I hope you can get your surgery. I'd certainly be asking why not. They might simply not have the theatres or staff to deal with longer care. It seems all wrong but then so much is all wrong right now.

Bathonian

Hi stickywicket. When I was talking about discrimination towards older people within the NHS I wasn’t specifically meaning joint replacement. I fully understand the medical reasons for not offering joint replacement to younger people. I was talking about the general way people of a certain age are treated and could give you a multitude of examples but I wont’t bore you. My local hospital does have the theatres and staff and the refusal for me by the nurse in charge of the pre-op assessment unit is down (in her eyes) to my heart problems. In the meantime life is passing me by with pain and depression ever constant.

stickywicket

I'm so sorry life is so rough for you.

Here's where I'd be looking.

1. I'm not sure a nurse has the authority to turn you down. I think that must be down to the operating surgeon so....

2. I'd contact my local PALS to see if they could help.

3. Perhaps if you could sign something absolving the surgeon and anaesthetist from any blame should there be problems resulting from your AF.