Making decisions about knee replacement as an older person with multiple conditions

Making changes to lifestyle and activities for knee and other health problems

For many of the people we talked to, having knee problems as well as other health problems impacted on their lifestyle and activity levels. This section covers people’s experiences of:

  • Changing types of exercise
  • Pacing
  • Supports and aids to help keep active
  • Weight management

Changing types of exercise

As knee problems got worse, people often had to make changes to their lifestyle and activities to help them to manage pain and other symptoms. Changes might be in response to knee problems only, due to other health problems, or a combination of both.

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.

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.

Age at interview: 73
Sex: Female
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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.

People had made changes to their daily routines to manage their knee pain and to continue the activities they wanted to do. For some, this meant changing the type of exercise they did, the length of time they spent on it, or doing it in a different way. Tina still continued with her daily walk but, because her knee was painful and had a “giving out sort of feeling”, she did a shorter walk and avoided hills.

George was used to having an active lifestyle. While waiting for knee surgery he began cutting other people’s grass as a way to exercise, but wondered about the impact on his knee.

George was used to having an active lifestyle. While waiting for knee surgery he began cutting other people’s grass as a way to exercise, but wondered about the impact on his knee.

Age at interview: 70
Sex: Male
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Since retirement what I’ve been doing is grass cutting, you know, and that’s been, like grass cutting round the village.

People kept saying, you know, 'would you, would you cut me grass?' And I’ve limped round, you know. That’s, just to try and keep some exercise going, just to go and cut a couple of little lawns and things, just to try and get some sort of exercise.

Cos you can cut a stretch, and then sit down on a seat or something. That, helps you know? Just rest it rather than just say, “Oh I’m gonna sit in a heap.”

I’ve tried to, to keep it going you know? And I keep thinking ‘am I just making it worse here?”

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.

Age at interview: 85
Sex: Female
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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.

Pacing

Pacing themselves was a common approach people described for managing knee pain. Lesley said if she put too much strain onto her knee, “by the end of the day it would be horrible.” But she wanted to “keep moving otherwise it will just seize up altogether.”

Mary could manage her vegetable garden and walk for about a mile without any knee problems but “the after effects of a long walk are that it will ache.”

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Mary could manage her vegetable garden and walk for about a mile without any knee problems but “the after effects of a long walk are that it will ache.”

Age at interview: 78
Sex: Female
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I have a large vegetable garden which I manage, look after.  And I can walk, I would walk almost every day except that the garden demands a lot of time.

So, when I’m doing the garden, I don’t get as much, many days go by without having a proper walk, but then I’m pottering around on the garden and going up and down the village. And I, so at the moment, I walk about - oh I don’t know - half a mile each way, and one way is a very steep hill and then I’ve got to come down.

So, I get a fair bit of exercise doing that. And I can do that without any problems.

But if I go for a longer walk then my knee will ache, that night it will ache. So I tend to, you know, think, ‘well that’s because of my walk, and that’s it’. But my knee is nowhere near as bad as my other knee was when I had it operated on first.

And that had got so painful that I could hardly-, well I was just walking as little as possible because it was very painful.

But this second knee, it’s not painful like that, not at all. It’s just that the after-effects of a long walk are that it will ache and also if it gets wet it will ache.

Some people said they knew how far they could walk before causing pain so they managed their time carefully when making trips into town. Karen could only “go a very short distance” with one place per trip and checking beforehand how far it is from where she can park.

Supports and aids to help keep active

Some people mentioned using support bandages to help with daily routines and exercise. Emily found it helped to use a support bandage when she went grocery shopping.

Marjorie took co-codamol prescribed by her GP before her Zumba exercise class so she could keep active. She hoped a support bandage might protect her knee during the class.

Marjorie took co-codamol prescribed by her GP before her Zumba exercise class so she could keep active. She hoped a support bandage might protect her knee during the class.

Age at interview: 73
Sex: Female
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I’ve got co-codamol from my GP. If I’m going on an outing or if - I went to - I go to a class for Golden Zumba, which is for old people [laughs] this morning and they do a normal impact, but I do a low impact.

I stand at the back of the class, and I just want to keep moving. And so that I know it’s gonna hurt a bit. So, I take two co-codamol from the doctors. And that helps. And but I did feel it a bit this morning.

And I did think that I would have to go and get something to like a brace for it, a sort of a soft elastic pull on, something to support it. A support bandage or something, you know?

But I don’t go mad. I just go, I sort of I just don’t want to stop moving. I don’t want to give in. But it’s, if I didn’t take the tablets, I don’t think I’d get, I wouldn’t be able to go.

Mobility aids helped some people to continue with their activities (see Using mobility aids). Buying an automatic car or mobility scooter could help people to still get around and maintain some independence. As knee problems worsened, reliance on aids sometimes increased. Jill had been able to use a walking stick when her knee problems started but started to need a four-wheeled walker to walk a short distance. It later became necessary for her to drive everywhere.

An automatic car and mobility scooter helped Ann to stay active.

An automatic car and mobility scooter helped Ann to stay active.

Age at interview: 72
Sex: Female
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And I’m a bit insecure so I walk around with a walking stick and if I go outside, I take the, what I call the trolley. So that I can walk and then sit down, walk and sit down. Well, the walking stick I bought myself, and the trolley I got from the physio department.

I’ve got an automatic car. And so, I don’t have to clutch, I just have to brake, and that’s my right leg, which is the partial knee.

And then I’ve got a mobility scooter. ‘Cos I can’t walk the distance. So that keeps me active, I can slip off into town. Drive into town, go to the car park and offload my, my scooter and I’ll go into town. I used to be able to go and, with my scooter. Sit on the scooter and watch the rings performing and stuff like that, but they’re restricting now, no visitors. Which is I find very, you know, I used to enjoy the weekends because I’d get out in the fresh air and watch, watch the dogs and watch my daughter judging if she’s judging, or, or if she’s competing, and, yeah.

Jan could still get out and about because her automatic car allowed her to drive despite her knee and shoulder pain.

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Jan could still get out and about because her automatic car allowed her to drive despite her knee and shoulder pain.

Age at interview: 71
Sex: Female
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I managed to get an automatic, so that helped my shoulders as well.

So, that was just my right knee that I have to use then, you see [laughs]. I didn't have to use the left. It affected the driving dreadfully. The clutch, couldn't do the clutch. It effected my driving terribly. So, but no, with the automatic it’s wonderful.

That’s good.

Helped my shoulders as well as my knee [laughs]. Very old car, but I mean it just, you know, it helps, yeah.

Jill is in “sheer agony” when walking with her four-wheel walker. She can only go places where she can drive to with a short distance to walk from the car.

Jill is in “sheer agony” when walking with her four-wheel walker. She can only go places where she can drive to with a short distance to walk from the car.

Age at interview: 72
Sex: Female
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But you see the problem now is the knees are so bad I’ve now got a four-wheel walker because I just can’t walk much more than the length of a car.

And they’re absolute agony depending on how far I’ve got to walk.

Gosh.

So, while they had meetings on Zoom, virtual during the pandemic, in a way that was easier for me.

But now they’re gonna go back to meeting, so the community college moved their meetings downstairs, which is good. Deaf academy is a modern, new modern building so that’s fine. But it’s the distance I’ve got to walk before I sit down. So, I’ve got a four-wheel walker because the problem is I fall over. And when I fall over, I can’t get up.

Making physical changes to their home and/or garden helped some people to manage their knee problems, maintain an independent lifestyle, and continue with hobbies. After falling on a step, Lesley had changed her garden to one level and raised the flower beds. In preparation for recovering from knee surgery, Emily had her bathroom refitted to make it easier to get into the shower on her own.

Being in pain restricted some people’s activities. Ruth was unable to leave the house much or go for long walks like she used to because of pain in both knees, her back and other health problems. She used a trolley mobility aid to walk around the house. For Michael X, increasing pain from his knee, his spine and ankles meant he struggled to walk very far and needed to use a walking stick.

It was common for people to say that periods of inactivity had affected their ability to continue with their activities. Dave Y had noticed that when he reduced his activity, during the Covid-19 pandemic for example, it made his pain worse. Tina had lost confidence going places after not going out during Covid, and now held onto her husband for stability.

For experiences after surgery, see Outcomes and satisfaction with knee replacement surgery.

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