Orthopaedic Consultation

Whiskey26

My GP has referred me for an appointment with an Orthopaedic Surgeon, re: OA in both hips. When diagnosed in 2020, I was told my right side was the most severe, however since Christmas, my left side has been really bad, probably because it's had enough of compensating for my right side. I am also waiting for a left knee x-ray, to confirm whether or not, the OA has spread there, or whether, like my right knee, it's just referred pain. My question is.....can anyone give me an idea of what will happen at the Orthopaedic appointment with the surgeon? I am 58 years old and ashamed to say that I am so frightened. Never had a hospital stay, other than when I had my two daughters, the youngest of whom is 27. My anxiety is bad at the best of times and I suppose it's fear of the unknown. I'm just not looking forward to it, or the op to be honest, even though I know the end result will mean getting a bit of normal life back.

jonr

Hi Whiskey26,

That 1st appointment is the most daunting one because you don't know what the process is, what the XRay or MRI will show up and what the consultant is going to say but please let me reassure you.

Before you go you'll get a form to complete which will basically set out your medical history and ask you to list any prescribed drugs you are taking.

At the consultation itself, the surgeon will have your Xrays to hand and will tell you the exact nature of your condition at the time they were taken and what the options are for treatment. If the XRays are not recent and/or you've not had an MRI they will most likely refer you for an upto data set of results so they can have an accurate picture of the state of the affected joints. He or she will probably perform a few tests to assess your range of movement and ask questions, you'll no doubt have many to ask yourself but in my case I was in and out in less than 30 minutes.

Once the results of the MRI are in you'll be invited back to discuss what the options are for treatment, if that is to be surgery then it will probably mean an overnight stay (well that's what my consultant told me), then you'll be discharged with pankillers, physio to do at home, crutches/wheelchair as required and a series of follow-up checks.

At that meeting they will describe what the surgery is to do, how long any artificial joint will last for and what it will mean to your lifestyle once you've recovered.

I have been through the consultation process very recently and now on the waiting list for a double knee replacement, so I doubt whether the scenario would differ much from what I've written above.

Hope it helps - it's the fear of the unknown, but these are pragmatic steps to take before understanding the exact nature of your condition and what it will mean to you moving forward.

Now you're in the system you should pass through smoothly - good luck and I hope this helps!

Jon

Whiskey26

Thank you so much @jonr for your reply, it's very reassuring to hear. My first and only x-ray was back in October 2020, when I was first diagnosed, so I'm sure an up to date one will be necessary. You spoke of having a few tests done, to assess your range of movement - what do these involve? I'm in such a lot of pain, especiallly if I have to be made to move in a certain way and dread the pain being made worse.

jonr

Ah, ok Whiskey26 - I don't know what the consultant will do regarding your hips but with my knees my one asked me to lie down and then he gently pulled on each leg in turn after inspecting them and asked me to bend them to see how far they could go before the pain kicked in. He then asked me to walk across the room a couple of times.

To be honest it was far less painful than what I was asked to perform for the Physio when I went to be assessed for exercises to perform at home so I reckon you'll be fine.

My guess is ( and it is only a guess) is you'll be asked to go for an MRI scan because it's far more revealing than a XRay. I hadn't had one of these before, it's a pretty big tunnel-like machine you go inside. How far in depends on where they'll be assessing. As it's your hips it won't be all the way in thanks God but you are in there for the best part of an hour for both to be done. You'll get some headphones and a choice of music to blot out the racket the machine makes, nothing to be afraid of and it doesn't hurt in the slightest. That will be done separately, not at your initial consultation.

On a different but connected note, you say you're in a lot of pain - what meds are you on and do you take any supplements or use any devices to help manage it?

Whiskey26

Hi again @jonr firstly, apologies for all the questions! The only people who can answer, are people who have been through or are going through a similar thing and I think sometimes forewarned is forearmed! In terms of my medication, what haven't I taken!!!! I think I've exhausted the pharmacy of everything. Back in 2020, I was on just Paracetamol and Ibuprofen, but because of my asthma and the risks associated with Ibuprofen, I was given an alternative, which I think might have been dihydrocodeine? It didn't work, so I then had Cocodamol 15mg, then 30mg. The 30mg was ok but took a while to kick in, so my GP tried me on Tramadol. That took effect quicker, but the pain relief didn't last, so he then tried me on slow release Tramadol, which as the name suggests, releases gradually into your system. Taken once in a morning and once at night. It made me very drowsy and feel quite sick and I didn't find the pain relief any better than the normal Tramadol. Now, I'm back on Cocodamol 30mg, up to 4 times a day, if needed. I find this the best option because if I take it at 8am, it usually takes a couple of hours to kick in, but then if it wears off, I can take more at 12pm if I need to. I also have Lansoprazole and Naproxen, for when things are really bad. I have Ibuprofen 10% gel to rub on four times a day and my GP also prescribed some Capsaicin cream, which was quite effective, but there have been manufacturing issues and it's not available until September now! I also have a TENS machine and I take calcium/vit D. There was talk of me going on morphine, but I'm not keen. How do you cope with your pain? What works for you?

jonr

No need to apologise Whiskey26, that's what the Community's for, a forum for support and a knowledge base.

I do sympathise, if you're on Co-Codemol 4 times a day then it must be pretty bad. My GP is less sympathetic than yours - I'm on Naproxen and Omeprazole but he refuses to prescribe anything else so I buy Co-Codemol from the local pharmacy and take that on demand.

I've tried lots of supplements in recent months, some work for me, some don't seem to have any effect and some (like Glucosamine and Type 2 Collagen) made my symptoms worse.

In terms of natural anti-inflammatories I take Bromelain capsules (derived from Pineapples), Black Walnut Husk Capsules (which are very high in Omega 3), and Turmeric and Black Pepper capsules.

For pain management, twice a day I smoothe on FlexiSeq gel (which helps to lubricate and reduce the crunching and grinding), followed by Voltorol 12 hour gel, followed by 5KIND Active Hemp Gel. I have a TENS machine too and 6 weeks ago embarked on a course of Acupuncture. The difference that has made is I have far less flare-ups than I used to and when I do they're less painful. That means I have more days when I don't have to wake up wondering if I'll be able to make it downstairs or not. I've been going once a week but will probably scale that back to once a fortnight, then monthly as it's quite expensive. I also take CBD capsules (derived from Cannabis but without the hullucagens). By all accounts they also help with sleep and CBD has other side-benefits too such as warding off Dementia (so it is cliamed).

I have an over-extended left leg and that can cause problems with locking and tendon strain, particularly the hamstring and for that I use a deep tissue massaging gun, lots available from Amazon at prices to suit most budgets. I take that on its highest setting and usually use it first thing when I'm stiffest to smooth the back of my knee and run up and down the tendons.

With luck I should be able to keep on top of my Arthritis until I have the 1st op, I'm able to do the physio and be pretty active so fingers crossed.

If there's anything you want to ask or just chew the fat over, don't hold back.

Jon

Whiskey26

Hi @jonr I'm sorry to hear you have an unsympathetic GP. Is changing surgery an option for you? Sometimes, a fresh pair of ears is all it takes. I forgot to mention, that I also take Omega 3 (vegan, made from algae, as I'm pescatarian). I do have some turmeric/black pepper but I've not tried them as yet. With taking the Calcium and the Omega 3, I thought that if I take too many together, I won't know which have worked and which haven't? I've not heard of Flexiseq gel, but I will be mentioning it to my GP when I speak to him next week. Even though the OA is in my hips, my knee cracks constantly every time I stand up or sit down and I get snapping sensations that travel up (or down) from my knee, up through my groin to my hip. The crunching noises are quite scary sometimes, they're embarrassingly loud too. I will also look up the active Hemp gel too. Anything is worth a try and with creams and gels, at least they bypass your stomach, causing less damage. The massaging gun may be a good idea for me, as my knee locks a lot, particularly first thing in a morning and last thing at night. Acupuncture doesn't interest me, I hate needles! 😂

jonr

Hey Whiskey26,

My surgery is pretty good TBH, my previous GP referred me to the ConnectHealth team which got me fast-tracked for the consultant - from initial conversation to MRI to recommendation for surgery in less than 3 weeks! Problem is they gave me a new GP so I'm going to look into seeing someone else.

FlexiSeq isn't available on the NHS and at £19 for a 50G tube it's well pricey but I found an online Pharmacy that sell it for around £12 a tube called iPharm. There is an article on the VA website about it, speaking as a user I can testify to the reduction in crunching and grinding so I'm a convert: https://www.versusarthritis.org/about-arthritis/complementary-and-alternative-treatments/types-of-complementary-treatments/flexiseq/

The Algae supplement sounds interesting, not come across that before - what's it called? Honestly speaking, I don't know which are doing more good than not out of the supplements I am taking but taken as a combo they do seem to be doing the trick so I'm not going to mess!

I buy the 5KIND Hemp gel directly from them online, though Amazon sell it but they charge more when you factor in their postage cost (unless you're a Prime member of course).

If your knees get stiff and they lock then the gun I think will definitely help. They usually come with a variety of different attachments, I like the one which is like a hard rubber Squash ball myself but as with all these things, it's personal choice.

After I apply the various potions to my knees I don elasticated supports which help with rigidity (so I am able to do physio and exercise more easily without fear of either of them giving way) and they help my knees to absorb the gels and prevent my trousers from getting mucky.

I don't like needles either so I close my eyes when she's putting them in though I can barely feel them, they're so small and fine, weird feeling though!

Whiskey26

Thanks for the info on Flexiseq, I'll have a read of the article and try some when I'm next paid. The Omega 3 Algae supplement I buy, is from a company called Together Health. I pay a subscription of £12.59 a month (free postage over £11) for 30 tablets. It says take one or two a day. I take one, so the pack lasts a month rather than just two weeks, as I think it's quite pricey. Apparently, Omega 3 isn't found in fish, but in the algae they eat, this means there is no need to eat fish to obtain this, so they extract it from algae instead. It also cuts out the fishy aftertaste that you can get with the fish oil. I have recently bought some bamboo knee compression socks, which I find help give me a bit more movement in my knee if it locks. I sometimes sleep in them too, although I do find they start to dig in and hurt a bit, if worn for too long.