Lynda

Age at interview: 73

Brief Outline:

Lynda has osteoarthritis and high blood pressure. She has had both of her hips replaced, and recently had a total left knee replacement with the same surgeon who operated on her hips. Lynda feels the knee surgery went very well.

Background:

Lynda is married and has two children. She is a retired teacher. Her ethnicity is White British.

More about me...

Lynda has osteoarthritis, which led to having both of her hips replaced. Her osteoarthritis has continued to affect her knees and hands with “slightly knobbly fingers”. Lynda has had falls in the past, but she thinks these may have been related more to her eyesight as they stopped after she had cataract surgery. Lynda also has high blood pressure, though she and her doctor consider this to be well controlled by low doses of ramipril and bendroflumethiazide. Weight management is an ongoing concern for Lynda, and she finds her weight goes up and down like a “yo-yo”.

Lynda first had problems with one of her hips after having a sharp pain while giving birth at around age 30, and then her hip was “never right after that”. She has seen doctors for many years about the pain and issues with walking. For a long time, her doctors “wouldn’t even contemplate” a joint replacement based on her age being ‘too young’ and prosthetics typically lasting only 10-15 years. She thinks that the years spent with an awkward gait from arthritic hips may have contributed to issues in both of her knees. Lynda is also aware that she has “always tended to be a little knock-kneed” and has noticed this get worse over time. Lynda had one of her hips replaced when she was aged 59, and the other when she was 65.

At the time of having her second hip replaced, Lynda was told by the surgeon that she would probably need to have knee replacement in the future too. She felt a “little apprehensive” to hear this because she had heard that the recovery would be more difficult for knees than it had been for hip surgery. Lynda was experiencing pain and mobility issues in both knees, but her left was causing more discomfort than the right. To manage her knee pain on a day-to-day basis, Lynda took ibuprofen tablets. She also tried ibuprofen gel, but didn’t notice much of a difference. Lynda was told to ask her GP to contact the surgeon directly when she was ready to have knee surgery to avoid having to “jump through so many hoops”. She chose to wait a few years because “why put myself through if it’s not impacting my life?”

Eventually, Lynda’s knee problems began to cause her trouble with activities like climbing stairs or standing for a long time in a queue. She was using a walking stick when going out, but was able to manage without one around the house. At night, she frequently woke up feeling stiff and sometimes needed to have a walk around to stretch it before getting back to sleep. Lynda’s husband also has back problems, and so they both were thinking “very carefully” about the logistics of where they were going and how much walking they could manage. Lynda chose to stop driving as she was not confident that she could use the emergency brake. She felt that she had a “certain slight lack of independence” from not driving. Lynda was keeping active by swimming, and found that she still felt “perfectly free” in the water. When Lynda felt her knees were “not okay anymore”, she saw her GP who gave her an in-depth physical examination and put a referral through to the surgeon who had done Lynda’s hip surgeries.

At her consultation, the surgeon confirmed that Lynda needed a total joint replacement on her left knee. This was the decision Lynda had expected, as she had been told many years ago that knee replacement would be necessary so she had “never really considered anything else”. The surgeon outlined the benefits of surgery as well as risks, and expectations for recovery. Lynda was also given a booklet with information, including about exercises that she could do to prepare for the surgery. Because she was very happy with the results of her hip replacements and had heard good things from others about her surgeon, Lynda felt confident agreeing to have the knee surgery. She was also happy to go straight to a total knee replacement, because she had heard of others with partial knee replacements having to go back years later for more surgery. Her surgery was scheduled for 10 weeks after her consultation, and she was asked if she was willing to participate in a trial for robotic surgery. Lynda agreed to take part in the trial because she feels that contributing to medical research is important and because she hoped it would make it less likely that her surgery could be cancelled.

Lynda had her surgery as scheduled and, six months later, feels it went very well. She does not know yet whether she had traditional or robotic surgery. Before the procedure, Lynda was nervous because she was going to be kept awake during the surgery. She feels this was fine in the end. After surgery, Lynda spent one night in hospital before going home. In the first few weeks after surgery, she used two arm crutches and needed her husband to help her around the house. Because Lynda does not like taking strong painkillers, she quickly went down to paracetamol for her pain relief during her initial recovery. Lynda was consistent with her exercises and attended four in-person physiotherapy sessions. One month after surgery, Lynda was only using a walking stick when outside the house.

Lynda dislikes the appearance of a small bit of her surgery scar, but otherwise feels that her recovery went “exactly as he [surgeon] would have predicted.” At a six-week check-up, Lynda’s surgeon confirmed that everything had healed well and that she was able to resume swimming. Lynda was excited to hear this as originally she had been told she would not be able to swim for three months due to potential infection. At six months post-surgery, Lynda now doesn’t require any walking aides and is back to driving, which has allowed her to feel independent again. She feels she has around “95% of usage” of her left knee but thinks that it is unlikely to improve from there. Lynda hesitates going down stairs, but feels this is due to ongoing issues with her right knee rather than any concerns with her replaced knee. Despite this, Lynda does not yet feel ready to consider surgery for the right knee because “it’s fine at the moment for normal life.” Overall, Lynda is very pleased she went through with the knee surgery. For others considering a knee replacement, Lynda has the following advice: “listen to your surgeon, and go for it, and do all the exercises, do the physio both before and after. Even if it hurts, you’ve got to do it. You’re not going to get better if you don’t do it”.

Lynda had a sudden deterioration in her knee. She was less mobile and found the stairs difficult to manage.

Yes, I got up to go to the loo in the middle of the night about two o’clock and I put my foot down to the ground and I did almost fall over then. I couldn’t put it to the ground, I literally had to hop and to get to a place where I could sit down. That lasted probably for about eight or 10 days until whatever it was that had gone in the back of the knee settled down.

But it has left me less mobile than I was, certainly. As I say, it’s going up and down stairs that’s the worst thing.

Do you have any strategies for how to get up and down the stairs more easily or comfortably?

Not really, other than I go upstairs at night and come down once in the morning and that’s it. We have a downstairs bathroom and a downstairs loo and I don’t go up and down any more than I need to.

Lynda had stiffness and pain in her left knee which impacted sleeping, walking downhill and going up and down stairs.

I can neither fully straighten nor fully bend my left leg, it just won’t go, so I can’t particularly lie straight on my back in bed with the left leg—I either have to be on my side or twist it a little bit into an unnatural position.

I would say sometimes that I don’t-, I think it has slightly affected my balance in that very occasionally it just gives way.

I’m using the stick just for balance but only when I’m outside, not in the house.

And with the pain that you experience, what is that like for you? How often does it come on or what types of things make it come on?

If I move it suddenly. If I turn round suddenly. Going up and down stairs is severely impacted, I’m not at all happy going up or down stairs.

Other than that, on the flat, I’m perfectly fine; not terrifically fast, but perfectly fine.

And what about sleep, has that been affected?

I do wake up quite a bit, and I do feel stiff. Sometimes I get up, go to the loo, walk round, get back into bed, but I have no trouble going back to sleep; that relieves it—and then I go back to sleep.

I take one lot of ibuprofen each day which my doctor suggested as an anti-inflammatory.

As I say, the only- you know, the biggest test is coming up and down the stairs. I shall know if it's got better because I’d be able to go up and down the stairs properly. I don’t like walking downhill either.

Is that the pain and the unsteadiness or-?

It’s the- yeah, it’s the pain. It’s the fact that I don’t feel I can do it quickly or- you know, it’s like taking baby steps when you’re going downhill to make sure that you don’t overbalance.

Lynda, who has osteoarthritis and two hip replacements, could still go swimming regularly but walking around the city with her knee pain needed careful planning.

We think very carefully, say, if we want to go into the city or things like that; my husband has a bad back as well, so we think very carefully about how far we’re going to walk in the city and things like this.

I’m certainly not driving because I’m not convinced I can do an emergency stop—and they say don’t drive if you can’t do that.

So, I do feel a certain slight lack of independence by not being able to drive myself. I would think those are the two big things.

It certainly hasn’t stopped me swimming; I certainly feel perfectly free in the water. So as long as the access to a pool or the sea is easy enough that’s fine.

I can do the movements in the water, which I do, pretend you’re riding a bike in the water, you know? And a lot of water treading and things like that to keep them going and that does help.

I do notice a difference if for any reason we don’t swim, because we go normally every other day, so I do notice-, only for half an hour, you know? It’s not excessive, but it keeps us going.

A surgeon told Lynda that she would need knee surgery in the future. When she woke in the middle of the night and couldn’t walk, she contacted her GP about surgery plans.

I got up in the middle of the night one night and I couldn’t walk - something had gone in the back of the knee. That has since righted itself somewhat, but I mean the surgeon was telling me it was almost bone-on-bone back in 2000 and- well, I suppose, ’15 or ’16 when he finished my check-ups.

And was that the sort of trigger event that happened, and then you saw your GP wanting some more investigations?

Yes. Yeah, because the surgeon had always said to me- when I felt the knee needed doing, because he already has one X-ray on file already, although I will be having another one on Friday. He said, “Just get your GP to contact me directly, you don’t need to jump through so many hoops to get to me,” he said, “you will know.”

And I’m on, you know, I’m on the books, as it were [laughs].

Do you mind me asking a bit more about that appointment you had with the GP? What was that like, what sort of topics did you discuss?

Right, first of all I had a phone appointment—and then she said, “Oh, I think I need to see you.” So, I went down to the surgery and she did quite a thorough physical examination - poking and prodding and stretching, and seeing how far I could bend things.

From what I remember that’s when she prescribed me the ibuprofen gel.

She was - I thought she was good, she was only a young woman and I didn’t know her—but she did take her time, you know? She took time to do it—and I was quite glad to be seen quite honestly.

I asked her to refer me—explaining to her that this is what the prof had told me to say—that he sort of knew about it and knew it would need doing and just told them to refer as soon as I said.

Lynda describes what was discussed at her referral appointment with the orthopaedic surgeon.

On the 4^th of February, I think it was, I had a consultation with the professor and he agreed that it definitely needed doing, and he said he would do it as soon as possible. I asked him to define ‘as soon as possible,’ and he said within a couple of months, and it wasn’t much more than that at all.

He also asked me if I was willing to take part in a trial for robotic surgery, which I also agreed to, so I've been part of that trial as well.

It lasted I suppose about 25 minutes, something like that.

He’s a man I know quite well because he’s done both of my hips in the past, so he has all my records. He discussed obviously the pros and cons of having a knee replacement operation, the potential side effects and dangers, because it is more difficult than the hip surgery. He discussed the potential recovery period, what I might expect at the end of it.

Lynda had no concerns because she knew the surgeon and trusted him completely.

I trust him completely, and he has a very, very good reputation in the area, and I had very good treatment from him before. The hospital here-, he’s one of only, I think, they said two surgeons involved in this robotic surgery as well, in trialling it, and he’s doing it for hips as well.

No, I trust him completely, and I don't know anyone who’s ever had a bad word to say about him, so I definitely wanted the same man.

Lynda decided to go ahead with knee replacement because she thought the outcome couldn’t be any worse than how she currently was.

And you mentioned the pros and cons of surgery that you discussed with the surgeon; could you talk me through those please?

Well, he wanted to make sure that I knew that surgery was actually, it -, that other options would have included injections and things like that, but neither of us thought that was going to solve the problem, certainly permanently.

And because-, I think it was possibly slightly shorter because we have discussed some of this before - he told me some time ago that the knees needed doing, and then of course Covid intervened, and he said he would leave it up to me more or less to decide when it was really necessary.

He said, “I've got to warn you, that knee surgery is often not as successful as hip surgery,” and he knew, obviously that I’d had positive outcomes from the hip surgery, so he just wanted to make sure that expectations were not too great, but it was absolutely fine.

And was that outcomes in the sense of more pain initially or that the mobility might not be so good in your knee compared to—?

All of those things, and the length of recovery time. And he did warn that some people would say, even after the knee operation, that they were sorry they’d had it done, it had made no difference to them, but I can-, could never say anything like that at all.

How did you feel when you heard that information, that some people would be disappointed with their outcome?

Well, I thought to myself, ‘it can't be any worse than I am at the moment, even if I flatline here, it’s no worse.’

Lynda took part in a robotic surgery trial for her total knee replacement surgery.

Apparently, the robot makes much better, or more accurate, rather than better, more accurate decisions as to where to make the incision and whatnot.

I don't know how much more of a part it plays in the actual surgery.

Did you have any concerns about the robotic trial when you were offered it and you agreed to take part?

No, I was quite excited about it actually.

Do you mind me asking why?

Just because it’s an innovation and just I'm going to be part of history here.

Lynda didn’t like taking strong painkillers and quickly stopped taking them. Her pain started to improve after two to three weeks.

The pain was managed, I was given sort of strong painkillers, and I got off them as soon as I could, because I don't like particularly taking them, so I was down to paracetamol quite quickly.

I found sleeping a little bit strange: I’d moved into a bedroom on my own for a while, but that-, geographically in our house it meant I didn't have any steps between me and the bathroom, so that was all right. But sometimes I was just getting up and having a little walk round.

And did you find there was an improvement on a day-to-day basis? How did you sort of notice things were getting a bit easier with the pain and mobility?

The pain I think really started to subside after two to three weeks.

Mobility didn't really start to improve ‘til about four weeks, but that’s what everybody said it was going to be, and it did.

Lynda had physiotherapy exercises to do at home and went to four group physiotherapy sessions after her knee replacement surgery.

The physiotherapy-, well, there was a physiotherapist came to see you in the hospital and went through the exercises.

I had two pages of exercises, and then there were four face-to-face sessions. They were small group sessions, three or four people who were at the same stage as you were, and we had a circuit of exercises for an hour each time, we had a circuit of exercises that they designed for us, that we had to go round and do all of them, and they increased in difficulty.

And each week, very basic on week one, and then if they thought you had a problem, they would keep you on for more, but I think all of my little group was dismissed as being satisfactory.

Lynda says she can almost fully use her knee six months after her total knee replacement. She feels unsteady coming down stairs but she thinks that is because of problems with her other knee.

The first I would say week, week and a half, was two arm crutches, which then reduced to one [crutch] after about a week and a half, just moving around the house. If I went outside, I still took both.

I would say at about four weeks I could move around the house perfectly well without, and I went to a walking stick just outside then.

At six weeks, when I went for my six-weeks check-up, I gave the crutches back to the hospital and I used a walking stick probably till three months, just for balance, especially if I was outside the house, not inside the house, but outside.

I would say I've probably got 95% of usage, and I don't think it’s going to improve from that; I think this is it.

The only thing I don't like doing now is going down stairs. I don't mind going up, but I don't like coming down, but I do feel that might be as much the problem of the other knee being a bit dodgy and not necessarily the fault of the operated knee.