Knee Replacement?

brian35
brian35 Member Posts: 58
edited 29. Apr 2009, 11:15 in Living with Arthritis archive
I was diagnosed with both osteo and rheumatoid arthritis, mainly in my knees, 8 years ago. For the past 6 or 7 years the osteo has not been too bad and the rheumatoid seems to have been controlled reasonably well with Methotrexate to the extent that I was seeing only the Nurse Practitioner at the Rheumatology Clinic once a year.

During the past year the pain in my knees has become worse and I have found it difficult to walk or garden as I once did. Before this year's visit to the Clinic I saw my GP and said that I wanted to know if the problem had worsened because of the osteo or rheumatoid and he booked me for repeat X-rays of my hands, knees and feet. The resulting letter to my GP said that my 'knees show advanced OA visible at both knee joints with complete cartilage thinning medially on each side and significant new bone formation' and recommended that I be referred to the Orthopaedic department.

I have since had one very informative and helpful consultation with the Senior Registrar to one of the top orthopaedic surgeons at our local hospital. At this consultation I was offered replacement knee surgery and a follow-up appointment, which is next week.

I am 73 and am otherwise in reasonable health but feel that unless I have something done my condition is likely to worsen and my quality of life deteriorate. However, I have never had an operation or general anaesthetic so, while wanting something to be done, have a certain amount of concern about the procedure.

I would therefore appreciate the views of anyone who has had replacement knee surgery and any points that I should raise at my next consultation.

Comments

  • greyheron
    greyheron Member Posts: 167
    edited 30. Nov -1, 00:00
    brian35 wrote:
    I was diagnosed with both osteo and rheumatoid arthritis, mainly in my knees, 8 years ago. For the past 6 or 7 years the osteo has not been too bad and the rheumatoid seems to have been controlled reasonably well with Methotrexate to the extent that I was seeing only the Nurse Practitioner at the Rheumatology Clinic once a year.

    During the past year the pain in my knees has become worse and I have found it difficult to walk or garden as I once did. Before this year's visit to the Clinic I saw my GP and said that I wanted to know if the problem had worsened because of the osteo or rheumatoid and he booked me for repeat X-rays of my hands, knees and feet. The resulting letter to my GP said that my 'knees show advanced OA visible at both knee joints with complete cartilage thinning medially on each side and significant new bone formation' and recommended that I be referred to the Orthopaedic department.

    I have since had one very informative and helpful consultation with the Senior Registrar to one of the top orthopaedic surgeons at our local hospital. At this consultation I was offered replacement knee surgery and a follow-up appointment, which is next week.

    I am 73 and am otherwise in reasonable health but feel that unless I have something done my condition is likely to worsen and my quality of life deteriorate. However, I have never had an operation or general anaesthetic so, while wanting something to be done, have a certain amount of concern about the procedure.

    I would therefore appreciate the views of anyone who has had replacement knee surgery and any points that I should raise at my next consultation.


    Hi Brian!

    Just making a quick visit to the forum, don't have time to reply at any length now but will try and post more over the weekend.

    I had a knee replacement 8 weeks ago for OA, have had my 'ups and downs' but basically absolutely no regrets.

    Main thing to ask about is physio input after the op / before discharge - I had great input which helped me get mobile quickly and safely, but I've heard of others who haven't been so lucky.

    Will be in touch again.

    Wendy
  • brian35
    brian35 Member Posts: 58
    edited 30. Nov -1, 00:00
    greyheron wrote:

    Hi Brian!

    Just making a quick visit to the forum, don't have time to reply at any length now but will try and post more over the weekend.

    I had a knee replacement 8 weeks ago for OA, have had my 'ups and downs' but basically absolutely no regrets.

    Main thing to ask about is physio input after the op / before discharge - I had great input which helped me get mobile quickly and safely, but I've heard of others who haven't been so lucky.

    Will be in touch again.

    Wendy

    Wendy, thanks your comments will be very helpful I'm sure.

    I think I will have to have both knees done but will go for one at a time. The loss of cartilage is mainly on the inside of the joints - my wife says I always walked bow legged so don't know if that contributed but presumably the RA did - perhaps I needed something different to MTX. Our son also walks bow legged so it may be a genetic thing. I don't think many hospitals do PKR.

    I'm afraid I am a bit of a negative thinker - at present something on the lines 'if I had to choose between dying as a result of the op. or putting up with my condition for another 10 years, I would choose the latter!'

    See what I mean!

    Brian
  • plmb48
    plmb48 Member Posts: 125
    edited 30. Nov -1, 00:00
    brian35 wrote:
    I was diagnosed with both osteo and rheumatoid arthritis, mainly in my knees, 8 years ago. For the past 6 or 7 years the osteo has not been too bad and the rheumatoid seems to have been controlled reasonably well with Methotrexate to the extent that I was seeing only the Nurse Practitioner at the Rheumatology Clinic once a year.

    During the past year the pain in my knees has become worse and I have found it difficult to walk or garden as I once did. Before this year's visit to the Clinic I saw my GP and said that I wanted to know if the problem had worsened because of the osteo or rheumatoid and he booked me for repeat X-rays of my hands, knees and feet. The resulting letter to my GP said that my 'knees show advanced OA visible at both knee joints with complete cartilage thinning medially on each side and significant new bone formation' and recommended that I be referred to the Orthopaedic department.

    I have since had one very informative and helpful consultation with the Senior Registrar to one of the top orthopaedic surgeons at our local hospital. At this consultation I was offered replacement knee surgery and a follow-up appointment, which is next week.

    I am 73 and am otherwise in reasonable health but feel that unless I have something done my condition is likely to worsen and my quality of life deteriorate. However, I have never had an operation or general anaesthetic so, while wanting something to be done, have a certain amount of concern about the procedure.

    I would therefore appreciate the views of anyone who has had replacement knee surgery and any points that I should raise at my next consultation.

    hi brian 35
    knee replacements are well worth having you will hear of some going wrong but few and far between .as for anaesthetic most are done with a spinal injection and you can stay awake or if you are like me i have a seditive dont feel a thing ha ha ha :P :P :P :P
  • colinone
    colinone Member Posts: 1,406
    edited 30. Nov -1, 00:00
    brian35 wrote:
    I was diagnosed with both osteo and rheumatoid arthritis, mainly in my knees, 8 years ago. For the past 6 or 7 years the osteo has not been too bad and the rheumatoid seems to have been controlled reasonably well with Methotrexate to the extent that I was seeing only the Nurse Practitioner at the Rheumatology Clinic once a year.

    During the past year the pain in my knees has become worse and I have found it difficult to walk or garden as I once did. Before this year's visit to the Clinic I saw my GP and said that I wanted to know if the problem had worsened because of the osteo or rheumatoid and he booked me for repeat X-rays of my hands, knees and feet. The resulting letter to my GP said that my 'knees show advanced OA visible at both knee joints with complete cartilage thinning medially on each side and significant new bone formation' and recommended that I be referred to the Orthopaedic department.

    I have since had one very informative and helpful consultation with the Senior Registrar to one of the top orthopaedic surgeons at our local hospital. At this consultation I was offered replacement knee surgery and a follow-up appointment, which is next week.

    I am 73 and am otherwise in reasonable health but feel that unless I have something done my condition is likely to worsen and my quality of life deteriorate. However, I have never had an operation or general anaesthetic so, while wanting something to be done, have a certain amount of concern about the procedure.

    I would therefore appreciate the views of anyone who has had replacement knee surgery and any points that I should raise at my next consultation.

    Hi Brian I am 62 years old suffering with RA and PA and whilst I have not had joint surgery I did have to major operations last year the first in my life. My main problem was fear, it was sheer panic lol. What you have to remember is these people are experts. Today they want you in and out of hospital as soon as possible with as little fuss to them and you as possible it make the job easy for them and your stay in hospital that much better for want of a better word. My Dads in his 80s and had both knees done he was awake for both ops and out of hospital in under a week. Its natural to be scared but the theatre staff are great they keep talking to you to keep your mind off things the next thing you know your back in bed on the ward. Take care Brian and let us know how you get on.

    Colin
  • greyheron
    greyheron Member Posts: 167
    edited 30. Nov -1, 00:00
    Hi Brian

    As promised, back again to share some TKR experiences!

    I injured my knee as a teenager, there were complications which led to a bone graft operation and I was told then that I would definitely develop OA in the knee and would need a replacement 'sooner or later' so I think I've done quite well to get to 63 before having it done!

    (Now you know I'm not really a youngster but I'm 'young at heart'.)

    An arthroscopy about 18 months ago bought me some time, but eventually the pain and stiffness got so bad that it was preventing me 'living my life' so I went back to the surgeon who'd done the arthroscopy and he agreed that it was time for the replacement.

    (I've got private health insurance - I've been self-employed for the past 6 years but had health insurance from the company I used to work for so kept it going as I knew the TKR was coming up.)

    One thing that I wasn't advised to do but I've seen other people mention on this forum is doing exercises in preparation for the operation - I really wish I'd done that. There's another new 'knee replacement thread' running at the moment and someone mentions pre-op exercises on there - maybe you could check that out?

    I did get very nervous in the week leading up to the op, was on the point of cancelling but got lots of support from people here. I think it's only natural to feel nervous, I think you just have to 'ride it'. I know what you mean about 'negative thinking', I've been there too but, although nothing in this life is certain, TKR is an op with a very good success rate these days ...

    I had a general anaesthetic though I gather it's getting quite common to do it under a local anaesthetic / spinal block. To be honest I wouldn't have fancied that but it seems to work OK for the people that have it. Do you have a choice?

    The main thing as I mentioned before was to get as much physio as possible in the post-op days. I actually took the decision not to have any visitors which might sound a bit odd but it meant that I divided my time between doing my exercises and relaxing with TV or a book - keeping in touch with friends and family by phone. It wouldn't work for everyone but it worked for me.

    Pain control was very good though unfortunately the intravenous morphine made me sick so they had to use intravenous paracetomol which worked well - I had that for the first 2-3 days, then Tramadol. It's really important to keep the pain down in order to make it possible to do the physio.

    The first time out of bed was fantastic - I put my leg to the ground and NO PAIN. I started mobilising on a zimmer (which was great - really gave me confidence), spent a little while on crutches (which I didn't like at all) then went on to sticks. By the time I left hospital I was using one stick and felt very secure. That was my goal and I was really pleased to avchieve it.

    I didn't have any physio in the 6 weeks between discharge and my follow-up visit to the surgeon. That was my choice as it would not have been easy for me to get to the hospital, so I was happy to go home with a leaflet of exercises and do them at home. On the whole that worked out well but the 6 weeks did seem to drag and I missed having someone to tell me that I was doing OK or to suggest variations on the exercises. With hindsight I think it would have been good to have a review physio appointment 3-4 weeks after discharge - I could have done if I'd asked but by the time I thought of this it was nearly time to see the consultant!

    I did have a few problems - mainly because I found walking so easy that my 'little walks' turned into longer walks and I 'overdid it' - my knee got very painful and hot, I phoned the physio and she advised me to 'ease off'. That knocked my confidence a bit, and I'm still struggling to find a balance between doing too little and too much. Again I think if I'd had one physio appointment during that period it would have helped. Will you have any choice in how much physio you have and when? Even if it's not much, I can't say strongly enough how important the phsyio exercises are, even though they can seem like a great bore at times!

    Another problems was that I had a 'pustule' (like a boil) come up on the scar which was very scarey, of course it happened at the weekend, the emergency GP sent me to my local A&E and they gave me antibiotics and I bathed it twice daily with warm salty water. When I saw the consultant he said it was one of the internal stitches, that I'd done the right thing and that it would settle down in time - it's nearly healed now, what a relief! But I would say that if you have any worries in that post-operative period, don't hesitate to contact someone to put your mind at rest because otherwise worries can get on top of you.

    Also, be prepared to have emotional 'ups and downs', I think it's part of the overall recovery process and you have to 'go with the flow'. I didn't sleep well for about 5 weeks after the op, kept waking up with my knee complaining, and as I usually sleep really well this made me feel quite rough at times - but that's improving.

    I live on my own so arranged for friends to stay over for the first 4-5 days after discharge and then had lots of visitors who were happy to help with shopping etc. I can also recommend Ocado (Waitrose) delivery service!

    It's now 8 weeks since my operation. My knee is still painful at times (especially if I sit for too long) and still feels odd because of the nerve block which means the left side of my leg is numb and / or tingly. My general mobility is fantastic - already better than before the op. I'm driving again (left knee, automatic car) and have made my first foray on the Underground. So life is getting back to normal.

    My two struggles are bending the knee - I got to nearly 90 degrees before I left hospital but am finding it hard to improve on that - and going downstairs (up is fine). When I saw the consultant at 6 weeks he was very pleased with my progress and has referred me to physio for 'finishing touches' - I have my first appointment tomorrow and already have a long list of questions for the physio.

    Although I've had my 'down times', basically I don't regret having the op, I can already feel the benefit and am very optimistic of even more improvement.

    Hope this has been helpful, do ask if there's anything else I can tell you about - and good luck!

    Wendy
  • brian35
    brian35 Member Posts: 58
    edited 30. Nov -1, 00:00
    Wendy,
    Thanks for your very helpful comments which I will print off and take with me to my consultation tomorrow. I will let you know how I get on. Have been at the funeral of our daughter-in-law's grandmother today. She was 100 last August, bless her.
    Brian
  • greyheron
    greyheron Member Posts: 167
    edited 30. Nov -1, 00:00
    brian35 wrote:
    Wendy,
    Thanks for your very helpful comments which I will print off and take with me to my consultation tomorrow. I will let you know how I get on. Have been at the funeral of our daughter-in-law's grandmother today. She was 100 last August, bless her.
    Brian

    Glad to have been of help, as I say, let me know if I can help any further - or indeed other people on this forum, there is a mine of information and support here!

    Good luck with the consultation and let us know how you get on.

    Wendy
  • brian35
    brian35 Member Posts: 58
    edited 30. Nov -1, 00:00
    First, thanks for your help Wendy. I have seen your post about knee bending and I'm sure you'll get there!

    I had a good consultation with the Senior Registrar that I saw in December. Unfortunately he is moving to another consultant at the end of the month to get experience on hip replacements. He told me that the hospital performed more knee replacements than any other in the UK and has a good success rate.

    I took a list of questions, most of which were answered satisfactorily. Apparently RA drugs, including methotrexate (which I take), reduce the ability to fight wound infections but the anti-TNFs are worse. Perhaps I can drop methotrexate in the lead-up? The infection rate is less than 0.5%. I was told that I am unsuitable for a partial replacement due to my bow-legs.

    I asked about cycling after the op. and was told that it might be difficult because the joint (which is a Genesis) only allows the knee to bend a bit more than 90 degrees. I thought that cycling would be OK - can anyone comment please?

    I decided there and then to put my name on the waiting list to have my left knee done, though I could have both knees done at the same time. The target time is 3 months maximum.

    Before going I answered the following questions that I found somewhere on the net:

    The answers that best applied to me are in bold.

    1. Medicines are controlling my symptoms. Yes No Unsure
    2. I have more bad days than good. Yes No Unsure
    3. My quality of life is poor with my current treatment. Yes No Unsure
    4. My general health is good. Yes No Unsure
    5. I have to severely limit my activities because of my knee(s). Yes No Unsure
    6. I am worried about needing another replacement surgery in 10 or 20 years. Yes No Unsure
    7. I am anxious to be able to resume hiking or other activities. Yes No Unsure
    8. I know complications sometimes occur with surgery, but getting relief from pain and regaining some use of my knee is worth the risk. Yes No Unsure
    9. I think my bad knee is going to continue to get worse. Yes No Unsure
    10. I am concerned that an artificial knee will not be stable. Yes No Unsure

    As a result, I decided that I am leaning towards knee replacement.

    I have had a few colly-wobbles about the decision I have made when I wake up around 4-5 a.m. Last year I attended an NHS Anxiety Management course. One thing the tutor was fairly keen on was the Bach remedies, which I was very sceptical about. At the end we were all able to prepare a mixture of 5 or so remedies that we thought applied to our own individual feelings. For most of the time my mixture has sat in it's bottle but I decided, with little confidence, to give it a try each night before settling down. I have to say that it does seem to alter my anxiety and negative thoughts so I am quite pleased.
  • elnafinn
    elnafinn Member Posts: 8,043
    edited 30. Nov -1, 00:00
    Hi Brian

    Just seen your posting and your cycling question.

    I had a DePuy total knee replacement over a year ago now and was riding my bicycle at around 6 weeks. I did get a good knee bend though which surprised the consultant because I achieved a knee bend more than he said it would be. Hopefully the same will happen to you and you will be able to ride your bike afterwards too. If you can get an exercise bike to use at home that would be good as this was of the great help to me in getting mobile along with all the other physio exercises which I did religiously every day.

    I wish you the very best. I had a few hiccups after the op, not with mobility but with pain, but that is all by the by now and it is fantastic. No regrets at all.

    Elna
  • brian35
    brian35 Member Posts: 58
    edited 30. Nov -1, 00:00
    elnafinn wrote:
    Hi Brian

    Just seen your posting and your cycling question.

    I had a DePuy total knee replacement over a year ago now and was riding my bicycle at around 6 weeks.

    Thanks, I wonder if that is a better type, was it done on the NHS?
  • elnafinn
    elnafinn Member Posts: 8,043
    edited 30. Nov -1, 00:00
    brian35 wrote:
    elnafinn wrote:
    Hi Brian

    Just seen your posting and your cycling question.

    I had a DePuy total knee replacement over a year ago now and was riding my bicycle at around 6 weeks.

    Thanks, I wonder if that is a better type, was it done on the NHS?

    Hi Brian

    I don't know if mine is a "better" type or not and it was done privately. The consultant does private and nhs work and mentioned that he always uses DePuy. I asked my consultant how many TKR he performed per year and how long he had been doing this operation, as it is reassuring to hear that he does many and has had very few "not go quite to plan".

    Elna
  • brian35
    brian35 Member Posts: 58
    edited 30. Nov -1, 00:00
    I had my pre-ops last week and today the consultant's secretary phoned to offer me Monday 30 March which I accepted. I have to be at the hospital by 7.15am which is not difficult as we only live 2 miles away.
    Thanks to all on the forum who have helped me.
  • elnafinn
    elnafinn Member Posts: 8,043
    edited 30. Nov -1, 00:00
    Hi Brian

    Not long to wait then! Here's wishing you all the best with the op and your recovery.

    Please let us know how you get on when you have time.

    Do as you are told and you will be fine!

    Take care
    Elna
  • kikkajane
    kikkajane Member Posts: 4
    edited 30. Nov -1, 00:00
    Hi Brian

    I had RTKR 4 years ago, I was 46 - it has been very good. I was back riding, diving and sailing within a few months. I can remember the joy when I climbed my first hill after the op - I had thought it would never happen.javascript:emoticon(':D')

    Good luck with the surgery, I hope it all goes well for you

    KikkaJ
  • brian35
    brian35 Member Posts: 58
    edited 30. Nov -1, 00:00
    kikkajane wrote:
    Hi Brian

    I had RTKR 4 years ago, I was 46 - it has been very good.

    KikkaJ

    Thanks KikkaJ and the others. It was just what I wanted to hear! Sorry to read about your horse riding accident and hope all goes well.
  • mrsmopp
    mrsmopp Member Posts: 73
    edited 30. Nov -1, 00:00
    brian35 wrote:
    I had my pre-ops last week and today the consultant's secretary phoned to offer me Monday 30 March which I accepted. I have to be at the hospital by 7.15am which is not difficult as we only live 2 miles away.
    Thanks to all on the forum who have helped me.

    Hi Brian,
    Im new to this forum, just would like to wish u good luck for your op. I have had my left knee replaced 4 months ago. I was on crutches before i got op done. Im now walking about no bother. It was a bit painful for a while but with physio it didnt take long to improve. It has been totally worth it. Take Care
  • greyheron
    greyheron Member Posts: 167
    edited 30. Nov -1, 00:00
    brian35 wrote:
    I had my pre-ops last week and today the consultant's secretary phoned to offer me Monday 30 March which I accepted. I have to be at the hospital by 7.15am which is not difficult as we only live 2 miles away.
    Thanks to all on the forum who have helped me.

    Hi Brian

    Have been away from the forum for a while due to computer problems and work commitments. Very glad to see that you have your date, lots of luck and let us know how you get on. 30th March is the first day of the rest of your life!

    Wendy
  • brian35
    brian35 Member Posts: 58
    edited 30. Nov -1, 00:00
    Getting a bit frustrated and depressed at slow progress! The 'tight band' feeling around the knee and ankle pain stops me getting on with things that I want to do and I am an impatient person.

    Decided to have another look at the DVD I was given at my pre-op. This painted a rosy picture of a real life situation for John and his cousin who both had TKR but the consultant does say that swelling and pain in the knee and ankle can last up to 9 months so guess I just have to go with it aided by paracetamol and ibuprofen.

    A kind neighbour in his 80s has given me a set of pedals on a board that he used after his TKRs that you can work from a chair to improve knee flexion. 2 weeks to my follow-up, hopefully with the surgeon who did the op and who has just been promoted from Senior Registrar to Consultant at the hospital.
  • elnafinn
    elnafinn Member Posts: 8,043
    edited 30. Nov -1, 00:00
    Hi Brian

    Sorry to hear that you feel progress is a bit slow! I too thought that because although I could use the knee very well I had a lot of pain, both in the day and at night. This did eventually go but it took a long time.

    I found elevation of the leg when resting and lots of "icing" helped with the pain and also the swelling. Has all the bruising gone by now? Do you think you may be on your feet too much in the day perhaps?

    I wish you well with your appointment coming up soon.

    Best wishes,
    Elna x
  • greyheron
    greyheron Member Posts: 167
    edited 30. Nov -1, 00:00
    brian35 wrote:
    Getting a bit frustrated and depressed at slow progress! The 'tight band' feeling around the knee and ankle pain stops me getting on with things that I want to do and I am an impatient person.

    Decided to have another look at the DVD I was given at my pre-op. This painted a rosy picture of a real life situation for John and his cousin who both had TKR but the consultant does say that swelling and pain in the knee and ankle can last up to 9 months so guess I just have to go with it aided by paracetamol and ibuprofen.

    A kind neighbour in his 80s has given me a set of pedals on a board that he used after his TKRs that you can work from a chair to improve knee flexion. 2 weeks to my follow-up, hopefully with the surgeon who did the op and who has just been promoted from Senior Registrar to Consultant at the hospital.

    Hi Brian

    Hope you're doing OK and seeing improvement - sometimes it feels like 2 steps forward and 1 back but hopefully as time goes on you will look back and realise how far you have come.

    I'm nearly at my '6 months' anniversary. My general mobility continues to be fantastic and the bending is improving degree by degree. My only 'issues' are going down steep stairs which is still difficult, and occasional pain which makes me feel a bit grumpy - until I think back to how bad and continuous the pain was pre-op.

    I'm very fortunate to have access to 'group hydrotherapy' (up to 4 patients + physio) and I'm sure that's helping me maintain improvement.

    You're not so far down the road as me but do take advantage of any physio / hydro input that's offered.

    It's interesting that your DVD mentioned 9 months for full recovery, I've heard minimum of 6 months and potentially up to a year or more - so I guess all of us 'knee-ites' have to learn patience even in this wonderful world of replacements!

    Take care and keep posting!

    Wendy

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