Abuse of Oxford Knee Score to keep patients off waiting lists?

Bryony

Wondering if others are experiencing this?

Background - knee pain began in earnest in both knees in late 2019. Due to Covid pandemic I couldn't get access to face to face NHS physiotherapy until late 2021, and eventually got my first knee x-rays done in early 2022, which showed bone on bone in both. I saw a private osteopath meanwhile. Having been through all the GP check-boxes - PT, pain killers I got referred in early 2023 for a NHS knee surgery consultation. Both knees have a lot of pain, the left a lot of instability.

After many cancellations I finally got the hospital consultation 51 weeks later, with a registrar. He almost forgot to watch how I walked as I entered the room. Before doing anything else he said that I would be unsuitable for knee replacement surgery as I would get no benefit. He then proceeded to ask me a few questions:

1) Do you have people helping you around the home? I said no. (I live by myself, have no family in the UK and if I can't do something it now does not get done, hence garden and house unkempt).

2) Can you put on your socks by yourself? I can.

3) Can you wash and dry yourself? I can.

4) How far can you walk on the flat? I paused to think ... did he mean with pain, or without pain, or if my life depended on it, or after I'd stood a while doing the washing up? He moved on, before I could answer. No further questions.

He then did some physical tests, and at one point both he and I jumped when he pushed my knee and the joint jumped a long way.

He then said he'd look at their new X-rays but didn't expect to see anything on them. Then discovered both were bone on bone.

Sent me off to get fitted with braces and said I'd be seen in 6 months time, and would be given appointments with the hospital PT.

I discovered just recently his follow up letter to my GP stated I could walk on the flat all day long. I haven't been able to since early 2019!

These questions seem to have been cherry-picked from the Oxford Knee Score as the ones most likely to give the impression that not much is wrong. The Oxford Score has 5 categories - no difficulty up to impossible, but I was not given those options to consider. If I do the actual full test I get a score of 15-16.

It seemed that he'd decided before he'd even seen me that I was to be rejected for knee surgery, It very conveniently meant my referral to treatment time which was already on 51 weeks was now conveniently reset to zero.

Anyone else experiencing this sort of consultation? They couldn't rule me out for obesity - my BMI is normal, and I don't smoke. Seemed they were determined to create an excuse to delay.

jamieA

Hi @Bryony

I think if I were you I'd speak to your GP, stress the issues you have and ask for an urgent referral to another consultant. My health board works on routine and urgent referrals and the timescale differences are significant. In my case I was seen at a different hospital as an urgent referral than the one I'd been assigned to when my previous GP had originally put me in for a routine referral. I was seen within 3 months as opposed to the 58 week wait for a routine referral.

To be honest it's not made that much difference as when I was added to the list for a replacement knee I was told it's a 107 week waiting list.

frogmorton

Well that is a lesson learnt. I have never read this before though.

The answers you give next time will be very different won't they @Bryony

I wish I could think of something to help and would definitely try @jamieA 's suggestion.

I hope the braces are helping a little in the short term and that you see someone different in 6 months time.

Toni x

Bryony

Thank you both.

@jamieA - 58 weeks and then a 107 week if you hadn't been put on an urgent referral would have been 3 years. Yikes! Where are you now on the waiting list? How many years to go?

The 6 months is almost up, and the hospital PT told me to really argue my case very strongly with whoever I see. He's made copious notes but said that he doubted that they read his physiotherapy reports. He's been good - was what I needed 4 years ago though. 4 years ago I asked my GP about braces but they can't prescribe - have to wait until we see the orthopaedic consultant, and we can only see them when our knees are so bad that replacement is already pretty much necessary. So like much with the NHS, too little too late.

Yes @frogmorton Toni, my answers will be very different! I'll also take with me a completed Oxford Knee Score and MSK-HQ.

I only wear the left leg brace, which helps a little with the instability but nothing with the pain. For some reason the right one makes that leg swell. Also, wearing both isn't very clever as the velcro on each catches the other, so the legs get stuck together!

jamieA

https://community.versusarthritis.org/discussion/comment/725007#Comment_725007

Hi @Bryony

If the 107 weeks is accurate I've another 18 months to go. Going back to your original post walking on the flat isn't really a test of whether your knee needs replaced surely. I'm lucky I live near a canal and a river so the walkways are relatively flat. I walk my dog 50-60kms a week - albeit with a limp. I carry a collapsible walking stick but rarely use it. I have trouble with inclines, declines and the camber of the pavements in the 100 year old estate I live in as well as stairs. Two rheumatologists told me my knee needed replaced and the orthopaedics consultant didn't even examine me that closely but made the decision on the basis of the x-rays that were done in July 2021 - but yet I've been walking these sort of distances on the flat probably since early 2022 when my PsA was brought under control.

I'd suggest it might be worthwhile to put all your details in writing to your GP - I was told if you put your concerns and request in writing it is added to your patient record and so they have to be shown to do something in response.

Hope you find a better consultant.