Clive
Clive had been having problems with his left knee for a long time. Three years ago, he saw a surgeon who suggested he try steroid injections. The steroid injections didn’t help, and he went on to have total knee replacement surgery. Clive’s surgery went well, though his other health problems have impacted his quality of life and recovery.
Clive has two grown up children. He is a pet shop owner. His ethnicity is White British.
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Clive has osteoarthritis which affects his shoulder and left knee. He experienced pain under the kneecap “nearly all the time” and struggled with his knee giving way. Clive has had several falls, some of which have been quite bad. In order to keep his balance, he had to put more weight on his opposite side and this resulted in a bunion on his right foot. Clive had heart bypass surgery 15 years ago, and takes tablets to manage his high blood pressure and reduce the risk of angina attacks. Clive also has asthma and uses an inhaler regularly.
Clive had been in touch with his GP about knee problems for many years. Knee surgery was mentioned when he was first diagnosed with osteoarthritis 10 years ago, but he and his doctor decided to hold off. At the early appointments, Clive was considered too young for joint replacement surgery because the prosthetic joint would only last a few years and then need to be replaced again. He had an operation to clean out the knee joints instead. He has also had physiotherapy for his knee and shoulders.
Three years ago, Clive saw his GP who suggested it was now “bad enough” for replacement surgery. Clive went to an appointment with a surgeon, who said he could have joint replacement but seemed a little hesitant. When Clive asked for the surgeon’s opinion, it was suggested that he try steroid injections first. Clive appreciated the surgeon’s advice and was “quite prepared to try” the injections if this solved the problem. However, the onset of Covid-19 meant that Clive couldn’t get steroid injections for many months. After “pushing and pushing”, he eventually received the first steroid injection. He didn’t find much of a difference in his pain levels, and had flu-like symptoms afterwards which he worried might be related. At the appointment for his next steroid injection, Clive asked the GP to contact the hospital again about surgery, which they did “virtually straightaway”.
In his day-to-day life, Clive struggled with pain and mobility issues because of his knee and shoulders. To manage his knee pain, Clive took paracetamol on a daily basis, occasionally used ibuprofen gel, and wore athletic elastic bandages around the joint. He tried co-codamol for pain relief but found it caused constipation. Clive also had handrails installed in his home, used a walking stick, and switched to an automatic vehicle. He explained that “I just hate getting up” because getting showered and dressed can be a “nightmare”. His joints were also troublesome at work, where he needs to reach things on shelves for customers. Doing his food shop became Clive’s “nightmare of the week”, as he needed help with lifting things so he tried to stick to one local shop where he could find things easily.
Before having surgery, Clive thought that a knee replacement would be “the one thing that would keep me going more”, and prevent him being stuck at home in a chair in the coming years. He knew that the surgery involved some risks, but considered these to be worth taking a chance on. He had some worries about the anaesthetic, after a bad experience for his heart operation and his ex-wife’s experience of having a lump left on her back after an epidural. This left him “absolutely petrified” about being anaesthetised for knee surgery. Nonetheless, Clive considered knee surgery his top priority, as he would “much sooner give it a try rather than continue with the pain I’m in”. Clive had expected to wait another three or four months.
At his appointment, Clive’s surgeon took X-rays and discussed the possible outcomes of the operation with him. Clive felt confident in the surgery being worthwhile, as the other options to manage his pain hadn’t helped. After the pre-operative assessment, Clive was offered a cancellation date for the surgery. He chose to accept, even though it was a bit harder to get his “mind mentally round it all” on short notice.
Clive feels that his total knee replacement surgery went smoothly, and he found having anaesthetic in his back was less frightening than her had expected. After the surgery, Clive noticed improvement to his knee pain straight away. As the pain cleared up, he became more aware of some numbness, tingling, and shooting pains in his legs and feet though. These sensations have impacted his balance and made it difficult to do the physiotherapy exercises.
Concerns were also flagged up when Clive went in to have clips removed, as swelling in his knee indicated a potential blood clot. Clive was directed to A&E at a different hospital and was shocked by how disorganised and dirty it seemed. Tests ultimately showed that Clive did not have any clotting issues. His eight-week check-up went smoothly, and the surgeon seemed pleased that Clive no longer needed a walking stick. Clive’s issues with shooting pains and numbness in his legs were noted during physiotherapy, resulting in a referral to a vascular consultant. Based on his vascular appointment and some tests, Clive was re-directed to neurology. He is currently waiting on next steps.
In hindsight, Clive feels that it would have been helpful to receive more of a timeline of treatment options. He feels that surgery should have been emphasised as an option when he was younger, as he would have been “far happier” in the more active years of his 60s and 70s. He advises others to “try and get the operation as early in life as possible”.
Clive is still working, but has passed the business on to his son as being a shopkeeper involves long hours on his feet. He recently had a bad fall from his right knee giving way, which fortunately didn’t injure the replaced joint on his left knee. Clive feels that his “other [health] problems are causing me chaos” at the moment, and he continues to need daily painkillers. Clive is now trying to keep healthy by eating well, drinking alcohol less, and keeping up his physiotherapy exercises as best as he can.
Clive had a new difficulty with walking not related to his knees. Getting a diagnosis became more of a priority than his knee surgery recovery.
Clive had a new difficulty with walking not related to his knees. Getting a diagnosis became more of a priority than his knee surgery recovery.
I've still got a little bit of numbness down the leg a little bit. A little bit of tingling on the kneecap side, but no problem whatsoever, you know, even if I lie on the floor and bring my legs up to my body, it hurts more in my right leg than it does in the left leg that I had done.
So, no, a definite improvement.
And as your knee has got sort of better and better, has that had an impact on your overall life and what you can do now?
As far as the knee is concerned, yeah, although the other problems are causing me chaos.
I've been getting like electric shocks down my legs—
Oh, gosh.
— and which takes me off balance so-, and I can't put any pressure on-, or couldn't at the time, put any pressure on to try and do-, lift yourself up onto your toes because suddenly it would give way to try and walk one foot in front of the other, I was losing my balance, and well, just general movement has affected me quite a bit, and certainly not my leg, you know my leg itself the operation, then no problems.
Clive says it was the right decision to have knee replacement. He wishes it had been done ten years before so he could have had a better quality of life in his 60s.
Clive says it was the right decision to have knee replacement. He wishes it had been done ten years before so he could have had a better quality of life in his 60s.
And in terms of your overall health and the overall impact of the knee surgery, do you feel it was the right decision for you?
Yes, definitely.
My only one criticism is the fact all through my life, and there’s thousands upon thousands of people that are exactly the same as me, is that it should be done earlier because mine could have been done 10 years earlier, but their argument is they say, “Well, the knee doesn't-, you might have to have another replacement in 10 years’ time.”
Well, I look at it the fact that I'm nearly 80, I'd have been far happier having it from 60 to 70, comfortable life, when I'd got more to do and everything like that, than I am now.
Clive says it helps give patients encouragement when healthcare professionals explain a plan of care if treatments don’t work.
Clive says it helps give patients encouragement when healthcare professionals explain a plan of care if treatments don’t work.
Possibly, and they probably do in a lot of instances, but I would say, you know, rather than just saying, ‘right, I'll give you these painkillers and we'll see how you go with those,’ is to give a list of, ‘right, what we'll do, we'll try the painkillers first for three or four months, then if you've had no relief from that, I think possibly we ought to try the injection, the cortisone injection and then you have 12 months on that and then we'll look at it again,’ or something along those lines to give people that bit more of an encouragement instead of saying, ‘well, you're too young to have it.’