Knee osteoarthritis

simon1945
simon1945 Member Posts: 1
edited 31. Mar 2025, 07:07 in Living with arthritis

Hello, I'm new to this forum.

I've had pain in one knee, gradually getting worse, for 14 years and had an arthroscopy 12 years ago. I've had 3 X-rays on the knee showing gradual degeneration over the years, the last a year ago. I've had 2 steroid injections since last June, the 2nd of which only gave pain relief for a few days.

I discussed the situation with my GP this week, and after asking me how far I could walk, then suggestions of pain killers, physio. I asked directly to be referred to a specialist, and this was agreed. I assumed this would lead to place on the knee replacement surgery list.

I now find I've got to attend the Trust's MSK Triage unit, and when I called them was told they would decide which "pathway" would be suitable for me. It seems only one of the 3 pathways leads to a knee operation, the others being physiotherapy and something else I didn't catch.

I'm concerned I might be fobbed off with a physio exercises (which presumably I'd have to do for ever) rather than a knee operation. I'm in my 80th year, and although not overweight and in reasonable health, quite frankly I don't want to spend my time doing exercises, which obviously can't repair my knee.

Can anyone comment, or have had a similar experience? Do I have any recourse if I'm not offered an operation?

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Comments

  • Poppyjane
    Poppyjane Moderator Posts: 897

    Hello @simon1945 welcome to the online community,

    You have had OA in your knee for years and had expected to be referred for a knee replacement surgery but now find that your journey to that goal is being deflected to a MSK Triage unit. There are a number of Health Trusts which have introduced an intermediary assessment to help support those patients with MSK issues and also provide physiotherapy , hydrotherapy and medication as treatments for pain relief. Your visit will guide you on that pathway as they describe it .

    Meanwhile I attach some links which I hope you will find useful. I include knee exercises which will help ease the pain and increase flexibility and mobility, although I appreciate your thoughts that it may be wasting your time and efforts.

    https://www.versusarthritis.org/about-arthritis/exercising-with-arthritis/exercises-for-healthy-joints/exercises-for-the-knees/

    https://www.versusarthritis.org/about-arthritis/treatments/surgery/knee-replacement-surgery/

    Whilst you are waiting for your appointment it may be worth considering investigating some complementary treatments like massage and acupuncture.

    There are lots of members of the community who have similar conditions with OA of the knees and I hope they will be able to share their tips and experiences with you.

    Do let us know how your appointment goes with the MSK unit.

    Best wishes

    Poppyjane

    If it would be helpful to talk to someone ring the Helpline 0800 5200 520

    Monday - Friday 9.00a.m. - 6.00p.m.

  • Bryony
    Bryony Member Posts: 76

    I'm in my 60s. I was fobbed off with physiotherapy, despite having already done physiotherapy exercises for my knees for over 3 years, and known to be bone on bone for for 2 years in both knees (when they finally did x-rays which were delayed because of the covid situation).

    In the second sentence they said to me, before they'd examined me, looked at my x-rays or taken a history was "you will not benefit from knee replacement surgery", with no explanation why this would be the case. So be prepared to ask 'why?' if you get a similar experience. Don't let them shut down the conversation about knee replacement surgery before it has started.

    I was so taken aback that I didn't counter it at the time. I'd waited nearly a year for that first consultation, due to them cancelling it numerous times, and I'm sure this was about waiting times statistics manipulation - any excuse to get me off the waiting times statistics, by 'treating' me with physiotherapy. If they had put me on the waiting list for replacement, then I'd be close to the 2 year mark before surgery - very bad for their statistics.

    Cynically I believe this is about rationing treatment, and reducing costs, by making people wait so long they feel they have no option but to go privately, even if it puts them into financial insecurity, or they develop a more urgent condition so knee surgery gets shelved whilst the newer condition takes priority, or worse still die during the waiting period - it all keeps the costs down if any of those 3 happen!

    I think the option you didn't hear was probably pain meds / steroid injections.

    What stage of arthritis did your most recent X-rays show? If stage 3 or 4 then that means you are potentially a knee replacement candidate.

    When you go for assessment, make sure you have your walking aids with you. Take with you what you use when you are at your worst. I'd also suggest you fill in an Oxford Knee Score sheet to take with you, and use it if they are dismissive.

    It is definitely worth doing some physiotherapy - to keep try to maintain range of motion, and to keep muscles and ligaments from weakening. It will all help in recovery from the operation, if that is offered. If the wait for the triage system is long, do try to start physiotherapy before then. You can then say you have already been doing exercises.

    Do take someone with you. You are more likely to be fobbed off if you go by yourself.

    Finally, if you do go and feel they are dismissive, and not put on the list for surgery, there is another option (or you could do this and not even bother with the MSK triage at this stage):

    Choose a surgeon (look up on the National Joint Registry for details of all the surgeons in your area, which hospitals they work at, their experience), then select a private hospital which also is contracted by the NHS to do knee replacements. Then book a private appointment there for a consultation with your chosen surgeon. The first consultation costs c £150-200. You've already had x-rays done, so get a copy of them to take with you. If you know your OA is restricted to the medial compartment of your knee, then maybe think about choosing a surgeon who has plenty of experience in both partial and total knee replacements. That information is on the National Joint Registry.

    If the consultant thinks that you are a suitable candidate for knee surgery, at that point say you want to be transferred to their NHS list. There will be a much longer wait for surgery than going private for that, but it is free from then onwards. If he thinks you are not suitable then that will be his honest opinion as it will have been based on your clinical presentation not on NHS rationing pressures. It might be that to make a decision he'll need to do new X-rays, if your current ones don't show advanced OA, and that would cost.

    This is what I had to do, having been messed around by an NHS hospital for 2 years, and still languishing near the bottom of the waiting list, with a consultant surgeon I didn't trust as far as I could throw. I'm now under an excellent surgeon, but still with a 6-9 month wait for surgery, paid by the NHS but at a private hospital. My x-rays showed very severe OA, so he didn't need to do new ones to make the decision, so I didn't have that extra cost. He will be doing new x-rays and MRI, but paid for by the NHS, before the surgery.

    Hope that helps.

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