Dorothy
Dorothy had pain in her right knee, which caused knock-on problems for her leg, ankle, and toes. Dorothy had a positive experience with a previous total replacement on her left knee. After being told that she would need a total replacement for her right knee, Dorothy had the surgery. The improvements from the knee surgery have exceeded her expectations and resolved many of her co-existing health problems.
Dorothy is widowed and has four adult children. She is a retired legal secretary. Her ethnicity is White British.
More about me...
Before her surgery, Dorothy considered herself to have relatively few health problems asides from her right knee. She had pain, swelling, and mobility issues in her knee, and took paracetamol for pain relief. Dorothy’s knee pain was “always in the background”, with bouts of increased pain, and often affected her sleep. She was disappointed that she was unable to see her friends as much as before, and that activities like gardening or going to the theatre were affected. The pain was making her feel “quite depressed”. She used a walking stick for support and stability.
The problems with Dorothy’s knee also had knock-on effects for the rest of her body. She found that the pain from her knee radiated into her calf and thigh, which she thought might be to do with the sciatic nerve. She previously had operations for sciatic pain, as well as for cataracts. As a result of redistributing her weight to the opposite side, she also had issues with her toes and strained her Achilles tendon on her left leg. A private podiatrist told Dorothy that her toes would need surgery, but she hoped to avoid this and that the situation might be better if her knee improved. Dorothy also takes blood pressure medication and is affected by osteoarthritis in her hands and feet.
Dorothy had a total knee replacement on her left side seven years ago. Dorothy says her knee replacement outcome has been “amazing compared to the life I had”. Though she is pleased with the outcome, since developing problems with her right knee, her left knee ached sometimes from having extra weight on it. Dorothy’s recovery from her left knee surgery went well, though she did have some issues with a trapped nerve. The painkillers also caused constipation and this led to a haemorrhoid, which was later surgically mended. This was one reason why Dorothy was cautious about taking pain relief other than paracetamol, and also found that co-codamol and other opiate painkillers tend to affect her stomach. The issues with Dorothy’s right knee began about two years ago. Some of her friends pointed out to her that she had a limp, and she realised that her knee was quite swollen. Dorothy felt it was “just an inconvenience” at the time, and she was still able to walk without pain. However, since then, Dorothy’s knee became progressively worse. She spoke to her GP over the phone, who recommended a steroid injection. She found the first injection to be effective for a few months, but the next one was less effective. At Dorothy’s request, X-ray scans were taken. The scans showed that her knee was bone-on-bone, and she was referred onto the hospital. Dorothy was also encouraged to consider private physiotherapy services based on the long NHS waiting list.
Before going into her appointment to discuss options, Dorothy did not expect to be offered the surgery due to her age and media reports about lengthy waiting list times. Nevertheless, she planned to accept it if offered by the surgeon. Based on her previous knee replacement, she felt that the procedure “can change your life so much”. Dorothy worried about the increased risks based on her age, and the potential that delays in surgery could increase these. However, she felt that some risks like stroke become “part and parcel of life” as one gets older. Dorothy was also concerned that, without surgery, the pain would mean she eventually had to use a wheelchair. Overall, Dorothy felt that “the quality of life is better than the quantity”, making knee surgery worthwhile to her.
Dorothy was surprised and relieved to be offered the surgery and signed the consent form on the same day. After a pre-operative assessment showed no major concerns, Dorothy received a surgery date. Whereas she had attended an in-person “tutorial” before her first knee replacement, this time, Dorothy was given a large written booklet of information outlining the details and risks of the procedure. While Dorothy did not have many questions due to her previous replacement experience, she was apprehensive in the weeks before the surgery due to the potential risks. Her surgery date was delayed by two weeks, before Dorothy then had the surgery. The surgery went well, but she had to stay in hospital for seven days after the procedure because she developed a temperature. After returning home, she received three home visits from orthopaedic nurses to remove her stitches and check her progress.
Soon after the surgery, Dorothy caught Covid-19 and had to cancel her first physiotherapy appointments. Nevertheless, Dorothy managed to reschedule these appointments and was taught exercises to improve the bend and stretch of her knee. The physiotherapists were pleased with her recovery, as was Dorothy. Apart from an occasional twinge in the morning, Dorothy notes that her knee pain has steadily decreased since the surgery. Her leg sciatica and toe problems have both been resolved too. She has been able to return to gardening and social activities with friends, and emotionally feels much more optimistic. Dorothy’s says her physical activity is still limited, but she thinks this is more due to the weather and age-related lack of stamina, as well as her recent Covid-19 illness and an upper respiratory infection. Dorothy says she “just cannot believe the difference” the surgery has made to her life and would enthusiastically recommend knee replacement to others in her position.
Dorothy’s knee was swollen and ached when walking which progressively worsened and sometimes affected her sleep.
Dorothy’s knee was swollen and ached when walking which progressively worsened and sometimes affected her sleep.
It was actually - when I looked at my knee, yes it was swollen, it was larger than my other knee, let’s put it that way, but I didn’t consider it, you know, to be dreadful, it was just an inconvenience really. You know, I found I couldn't walk for as long without it starting to ache, but I mean that was initially, that was in the first year.
But through the pandemic obviously I wasn’t going out as much but it did get progressively worse to walk on, and I also found that- I don’t know what was happening, it was pinching at the back of my knee and so I was getting almost like a sciatic pain in my calf and my thigh which made it worse.
And which knee is it that you have problems with?
The right, now. I had my left knee replaced seven years ago.
And does it have an impact on sleep?
Yes, a bit. Not so much, I mean lying down it is actually better than standing up obviously, but it does sometimes- yes. If I’ve had a bad day with it, it’s still painful when I get into bed, you know, sometimes it isn’t every night though, it depends how much I’ve done during the day really—and the more I use my leg, and the more I walk on it, usually that affects my sleep more.
Dorothy could no longer easily go shopping with her friends. She stopped going to keep fit exercises and instead walked around her back garden and took lots of rests.
Dorothy could no longer easily go shopping with her friends. She stopped going to keep fit exercises and instead walked around her back garden and took lots of rests.
Yes, it’s affected my being able to get out and about and meet friends like I used to, you know, I used to go out every week and at least twice a week and even sometimes, you know, two or three hours, I mean, just shopping, having a coffee, etcetera, but that’s been affected, and also, yes, I used to like to do keep-fit exercises and I found those more difficult to do as well.
And as I say, I used to like to walk a lot further, but now I tend to do my exercise walking round and round the garden [laughs].
You know, that seems to be the only way to go for any length of time is when I’m walking round and round the garden—if I feel it’s getting too much, I can sit down and rest for a bit.
And it has affected my gardening as well because I like gardening—but I find now I have to do sort of a quarter of an hour limping round the garden and then sit down for 10 minutes, you know, if I want to do any more.
Dorothy went to the GP because pain had spread to the back of the knee. After being offered a steroid injection which didn’t work she went back and asked to be referred to a specialist.
Dorothy went to the GP because pain had spread to the back of the knee. After being offered a steroid injection which didn’t work she went back and asked to be referred to a specialist.
No, I said although it had started in the February, I’d kept on going because it was the height of the pandemic and, you know, you couldn't access doctors very easily. But by the time it got to November of that year I was in such pain, I mean it wasn’t just the knee, I’d got this pain starting at the back of my knee which was, you know, more like sciatica and, and so I was just desperate to try and get some kind of relief.
That’s why I contacted the doc - and I thought ‘well, if I had an X-ray and somebody can say to me, 'this is definitely something going wrong here," you know, perhaps something could be done about it? But that’s when they suggested I have the steroid injection.
So, I went for another steroid injection in my knee. Unfortunately, after about two to three weeks it gave no respite at all, it didn’t seem to give me any comfort whatsoever, so I just carried on with taking paracetamol at that time to try and cope with the pain.
And then, yes, the last one, I think it was the last November about, I think, I rang up again and they did suggest having another injection, but when I got to the doctor, I explained that the previous injection had no effect at all on my knee, and in the interim I had had an X-ray and the doctor said he agreed with me.
There wouldn't be much point as really, I was bone-on-bone now, there was nothing, just one bone rubbing against the other, so that’s when he suggested that he would put me forward for the [hospital] and he also recommended, maybe, I could take stronger opioids, but I’m not keen to do that.
Dorothy decided not to use prescribed opioid patches because of the side effects.
Dorothy decided not to use prescribed opioid patches because of the side effects.
He recommended- in fact he did prescribe pain patches but he said to me it was an opioid - I have had it delivered but I haven't taken it yet. Fortunately it’s got a long date on it, because after I read all of the leaflets and I went online and looked at side-effects, I decided I didn’t want to go down that route yet because it said things like making you drowsy, making you nauseous - and you can’t come off them without the doctor intervening, and I thought ‘I don’t want go down that route yet.’
Obviously if I get no surgery and the knee pain gets worse, I might well end up on stronger painkillers to cope.
Before knee replacement surgery, Dorothy had pain in her knee, leg, ankle and toes. A walking stick had been useful for stability when out and about and to lean on if she needed to stand for a while.
Before knee replacement surgery, Dorothy had pain in her knee, leg, ankle and toes. A walking stick had been useful for stability when out and about and to lean on if she needed to stand for a while.
I mean now if I go out for any length of time, just walking round the shops, maybe if I can do that, I use a stick now.
How long ago did you start using a stick?
Well, actually the doctor recommended it after I went to my last appointment, he said- you know, because I was worried about my knee giving way—it felt sometimes as though it was a bit unstable.
He said, “I’d use a stick to support yourself when you're out walking,” and really it does help because the worst part of it now is that it hurts more when I’m standing still for any length of time.
So, a stick’s useful to lean on so I can take the weight off my right foot.
Dorothy has tried various knee supports but none had given her enough support when walking.
Dorothy has tried various knee supports but none had given her enough support when walking.
No, well, I mean I have to say over the last year certainly, I have tried different knee supports you know, from just a band under my knee, to a much more comprehensive one, a bigger one, but the trouble with the bigger ones is you can’t wear them under your clothes very easily and I’ve not found that any of them give me any real relief from the pain you know, despite the claims being made about them.
I mean I would love it if somebody could say to me, ‘oh well, this particular apparatus would help,’ but I haven't found anything that gives me any support really when I’m walking.
Dorothy was advised by her GP to see a private physiotherapist as the NHS wait times in her area were 12 months. She decided to do the exercises her GP gave her at home instead.
Dorothy was advised by her GP to see a private physiotherapist as the NHS wait times in her area were 12 months. She decided to do the exercises her GP gave her at home instead.
No, well, I mean I mentioned it to the doctor saying, “Would physiotherapy help?” And he said to me, “It might do and I could refer you to the hospital but,” he said, “I’m telling you at the moment, even physiotherapy, the waiting list is 12 months so if you required physiotherapy, it would be best if you tried to go privately.”
But I haven't - well, I mean I’ve had people's recommendations but I haven't found one and so the doctor gave me some exercises to do every day to help, and so I’ve been doing those every day.
How’ve you found those? Is there any impact on your knee doing them?
Well, it- I don’t think it depends on my knee itself, I think the whole idea is to strengthen the muscles around my knee to try to support it. The pain in the knee itself is pretty constant, I manage to do them but I can’t say it’s not painful when I’m doing them.
Dorothy had a trapped nerve after knee replacement surgery. Her surgeon referred her to physiotherapy which fixed the pain.
Dorothy had a trapped nerve after knee replacement surgery. Her surgeon referred her to physiotherapy which fixed the pain.
Well, when I went back, obviously with my six week - after having had my left knee replaced, I told the consultant, that I was having great difficulty. Actually, I could walk very well but the pain I was getting was sitting, and in bed particularly at night, I couldn't move my leg without being in awful pain.
That’s when he recommended me for physiotherapy at the hospital and the physiotherapist, when I first went, tried to get me to move my knee and I couldn't move it when she bent it. The pain used to shoot down from my knee into my foot and she said, “You’ve got- you've got a, a nerve trapped there, and I’m not going to push it.”
So that’s when she suggested that she do acupuncture and so, as I said, I went for - I think - five weeks running and now I get 20 minutes, half an hour, and it did seem to alleviate it.
Then they suggested I should go to the gym. I, I think I went about four or five times, at the end of which I was referred back to the consultant and, you know, it was fine; all the pain had gone.
Dorothy had considered the risks of surgery and what the future might look like without having knee replacement and thought, “What have I got to lose?”
Dorothy had considered the risks of surgery and what the future might look like without having knee replacement and thought, “What have I got to lose?”
You know, if it was going to do any good, I’d go ahead and have the operation if it was offered even though there may be underlying risks. I think ‘well, what have I got to lose now?’ Because sometimes the pain is so bad you think ‘oh, what is this- is this how it’s going to be from now on?’
You know, if I don’t have anything done, these are my only means of carrying on, by having stronger and stronger painkillers you know, is that the only way to deal with it?
And I would hate to end up, as I say, sort of sitting around all day now, doing nothing. I think the quality of life is better than the quantity.
I mean I was in such pain with my knee, and I was walking with a stick and limping a lot, and I had been like that for some time, and really, I thought unless I had an operation, I could well end up in a wheelchair because I couldn’t walk very far before the pain kicked in, and it sort of limited what you could do. I mean even a simple thing like going out shopping, etcetera, you know, I didn't have to walk too far before it got worse.
And anyway, I thought anything was better than carrying on as I was, and I’d rather take the risk and go ahead, you know, and just sort of put the disadvantages, or things that could go wrong, at the back of my mind.
Although feeling “a bit apprehensive” Dorothy thinks once you’ve decided to have the operation “you’ve got to remain fairly positive about it.”
Although feeling “a bit apprehensive” Dorothy thinks once you’ve decided to have the operation “you’ve got to remain fairly positive about it.”
Well, a bit apprehensive obviously because of all the contraindications they say to you. You know you think, ‘Well, yeah, let’s hope nothing goes wrong.’
But on the whole, I mean once having made the decision to go ahead with the operation, really, you've got to remain fairly positive about it and think, you know, this is going to be fine, nothing’s going to happen.
Dorothy stopped taking strong painkillers when she came home from hospital because of the side effects. Her knee pain gradually got better but she still experienced pain at night.
Dorothy stopped taking strong painkillers when she came home from hospital because of the side effects. Her knee pain gradually got better but she still experienced pain at night.
Oh, I mean it-, well, I mean soon after the surgery, coming out of hospital obviously, the pain, you know, gradually decreased. Obviously in the first couple of weeks, you know, it’s all swollen and bruised, your knee, so that takes a while to go down.
And then I think the last sort of pain I had with it was usually during the night and I think it’s because sometimes in the night, you're lying in one position maybe for too long and so it wakes you up because it’s painful.
But I used bags of frozen peas on my knee to ease the pain. I didn't want to take - once coming out of hospital, personally - I didn't want to take any more painkillers because while I've been in hospital, obviously you are given a lot of medication, and I’d ended up very constipated, and I hate it, so when I came out, I got off painkillers as soon as I could.
After her knee replacement surgery, the physiotherapist measured the bend in Dorothy’s knee and gave her a bending and stretching exercise.
After her knee replacement surgery, the physiotherapist measured the bend in Dorothy’s knee and gave her a bending and stretching exercise.
Well, when I went to the physio, they're a big department, I mean I was already-, because I’d been delayed a fortnight, I was already walking without a stick, etcetera, so they were quite pleased about that.
Really all that happened was they got me up onto the bed, measured again the bend in my knee, which apparently was very good, but there was still a problem when my knee was very flat on the bed. I hadn't got it completely flat behind my knee, but my knee at that point was still very, very swollen, you know, so it was quite painful.
So, all they suggested was one exercise which was pushing my foot against the wall so that I was stretching the back of my leg, and also, I think bending and stretching.
I was only there about 20 minutes, and then I went home and the next appointment I had was the same really, they were just checking to see whether the bend or the stretch had improved.
And in between, yes, they just said, just keep on doing, you know, this particular exercise, and obviously keep moving, just to try and get that leg straighter at the back.
Dorothy felt depressed about the future before having knee replacement surgery. Now she feels much more optimistic.
Dorothy felt depressed about the future before having knee replacement surgery. Now she feels much more optimistic.
Oh, no, I feel much more positive.
Because before I went in, I was getting quite depressed because I thought, as I said, I don't like painkillers, and the pain was so bad I thought, you know, where’s this all going to lead? If I don't want to take painkillers and this pain is so bad and I'm moving less and less? I can't walk as far, I was getting quite down.
So now, no, no, I'm much more optimistic about the future, whatever future I've got. I mean you have to be realistic I suppose when you get to 85. But it’s made a real difference to my life,—
Good.
—and my mood I suppose.
Other pains in Dorothy’s leg, including pain in her foot, have resolved since her knee replacement.
Other pains in Dorothy’s leg, including pain in her foot, have resolved since her knee replacement.
And last time we spoke, Dorothy, I think you said that you had some problems with your toes that you thought might be related to your knee problem?
Yeah, and do you know, I think that was absolutely right: that’s all gone.
Oh really, so it’s completely resolved—?
Yes, I was getting trouble with my foot, I couldn’t get my shoe on properly. I couldn’t wear the shoes I normally wore. And my one toe was very bad, but, no, that’s all gone.
And so, and I was also, before the operation, getting sciatica in the back of my leg and touch wood that’s gone too.
That is yes, it’s marvellous how lucky it’s cured quite a lot of other things that were going on at the same time.
Do you know, and they all seem to be attributable to the fact that I just wasn’t walking properly. And so, yes, I mean the thing is like you're transferring your weight obviously to the other side of your body, and then that doesn't do your other leg much good either.
And your back as well can be affected, you know? I’d find my back just get more backache. And so, yes, it’s not just the knee itself, it’s other things that it can make worse, I think.
