Making decisions about knee replacement as an older person with multiple conditions
Key messages for other people with knee problems alongside other health conditions
Deciding to have knee surgery if it is offered is an individual decision. It will not be a suitable option for everyone, depending on the cause of their knee problems, their other health conditions and priorities, and their surgeon’s advice. In this section, we share key messages and advice from the people we spoke to.
How to manage and cope with knee problems, and when to seek more help
- It’s normal that knee problems can have an impact on mental health, but there is support available and talking to someone you trust can really help
- Try to stay active but find ways to help, for example how best to move around and to manage your pain
- Push for a referral to a consultant when other options aren’t working, as it might be the appropriate time to join a waiting list for knee replacement.
Well, I have given advice to other patients, or people I know who are waiting or they've got the same problem I've told them, “If you start getting a problem with your knee or your hip-” and this is what I did, I mean with this knee now, because I knew how painful the operation is for four to six weeks afterwards and it is painful, I've sort of been pretending to myself that I didn't need it on my right knee and I probably should have booked in two years ago, in all honesty. So, I've said to them "don't-," these are people who are obviously younger than me - I said to them, “As soon as you think you've got problems,” I said, “don't delay.” I said, “get booked in with your doctor and get it seen because, you know, especially with the waiting lists as it is now, for goodness sake, don't delay.”John says if you’ve got any knee problems at all, don’t delay, go to see your doctor.
John says if you’ve got any knee problems at all, don’t delay, go to see your doctor.
I think it's really important that therapists listen to their patients, listen to their needs and concerns, and there's a lot of focus on this at the moment - it's called shared decision making. And understanding what matters to the patient. So, you know, what difficulties are they having at home? And it's important to drill down into the detail of that. I think it's wrong to assume that all patients are the same and that all patients need the same exercises or whatever, although that does go on sometimes, but I'd be- I'd encourage people to challenge that, and to make sure that the treatment is tailored for them. And that really will dictate how often they're seen, what the treatment involves, to make sure that the outcome is a good one. I think just to just have an open and honest conversation with the therapist about what they're looking for. You know, what the patient is looking for. What their expectations are, what their goals are. And make sure that there's a mutual understanding between two people as to what really needs to be done. So, it needs to be guided by the patient, facilitated by the therapist, is probably the way I would put it. We always try and treat patients holistically, taking into account other problems, whether they're joint problems or general health problems. So there may be certain positions that a patient can't get into or, you know, a certain activity that they find particularly difficult. For instance, they may have shoulder problems, you know, therefore getting down to exercise on all fours might be something that they just can't do. So, I think while the physiotherapist should take these things into consideration, I think it's important for patients to flag it to the therapist. You know, if they have any particular concerns or difficulties. It really should be a two-way conversation. I mean, unfortunately during the pandemic, patients’ treatment assessment and treatment was paused often, wasn't it? Or we tried to manage people the best that we could remotely, based on not being able to bring them into hospitals. And I guess all we can do from here going forward is to offer people the best service that we can in a timely manner, and give them what they need. For people sitting on waiting lists, there is a focus in a lot of organisations at the moment, which is worth patients looking into, around what's called ‘waiting well’. So there are things that can be offered to patients – whether it's exercise, whether it's pain relief, whether it there are certain apps that are out there that people can use, to allow them to stay well and fit while they're waiting to see the clinician. While in the background services try and get the waiting times down to an acceptable level.A physiotherapist encourages patients to get the most out of their appointments and seek support on 'waiting well'.
A physiotherapist encourages patients to get the most out of their appointments and seek support on 'waiting well'.
Making a decision about knee replacement surgery
- For those who had a good outcome from knee replacement, the advice was to ‘go for it’, because it can improve your quality of life and give you a new lease of life.
- However, it’s important to be aware that knee replacement doesn’t always work as you expect and hope, especially when people have other health conditions (see - Making a decision about knee surgery in the context of other health conditions and personal life) and recovery can be complicated
- Don’t expect your experience to be the same as other people’s – everyone has different circumstances, health conditions and levels of fitness
- Those who had robotic-assisted surgery recommended it, if you are offered it (see - Having knee replacement surgery).
- Ask a healthcare professional if you have any concerns or anything is unclear – don’t let worries fester.
Waiting for surgery
- Get as fit as possible and try to do exercises to strengthen your knee muscles while waiting for surgery (see - Trying to keep well and stay active with other health conditions).
- Do research on different hospitals to find the best in your area; some hospitals may not be options if you need extra facilities, such as intensive care services as a precaution, and consider wait times as well as whether the travel involved is manageable
- If you can be available at short notice, ask to be put on the cancellation list as you might have your operation sooner
- At your referral appointment, be honest about the impact of knee problems on your life – don’t try to downplay the impact and ask questions if you have concerns
- Plan for someone to help you at home when you are recovering from surgery
- Get the level of information you need to feel prepared for the surgery (see - Finding out information and getting support for knee problems and knee surgery).
Recovery from knee replacement surgery
- Follow the guidance given by healthcare professionals; get moving but don’t overdo it immediately after surgery
- Take the recommended painkillers
- Do your post-surgery physiotherapy exercises – it may be painful after surgery but persevere with your exercises
- Expect recovery to take a while. The muscles around the knee and leg are affected during knee replacement surgery, and it can take several months for these to return to normal.
Listen to what they say to you about getting yourself ready for the op, you know. It’s important to get physically fit before the op if you can, you know what, so that the muscles are about as good as they can be. And above all listen to everything they say to you about what you do post-op. I think that is above everything else that’s important because they do it all the time. I mean they’re churning people out each and every day, and they know what happens when people don’t take the advice. And the results. A lot of people simply think, “Oh I feel absolutely fine, you know.” And as I said before these joints when they - if people don’t take notice and they manage to dislocate their hip or they mess up their knee or something like that, or not do the exercises for your knee, can’t be bothered, you know? Then they don’t get the result, or you know they get other problems. I know when people have said to me that knee ops, they ask me what it was like and I don’t tell them it’s easy. I tell them how it is, and I always say to them the first four weeks it’s blooming painful. But I said it - having seen how the knee feels since it’s - I said it’s worth doing it for four weeks of pain. When I talk- I’m talking 9 out of 10 stuff. After the four weeks you start getting better, and it’s paid off really, so those last six years have left me pretty good really.Toby says follow the guidance post-surgery. It will make a difference to your recovery.
Toby says follow the guidance post-surgery. It will make a difference to your recovery.
John says it was very painful after knee surgery but worth it.
John says it was very painful after knee surgery but worth it.
What to do if knee replacement is not an option or right for you
- Ask your healthcare professionals for advice on other treatments or things that could help such as walking aids. These may help you manage knee problems, and reduce your pain or the chances of a fall
- Consider asking for a second opinion if you feel unhappy with the decision or assessment made (see - Not having knee replacement surgery). If you feel your knee problems have got worse over time and that something may have changed, it may be worth asking to be assessed by a specialist again or rethinking your decision.
Copyright © 2024 University of Oxford. All rights reserved.