Marjorie

Age at interview: 73

Brief Outline:

Marjorie had a partial knee replacement on her right knee 15 years ago, and began experiencing pain and instability in it 12 years later. She has now had a total knee replacement in her right knee. She had complications with blisters and nerve sensation, as well as an upsetting experience with the anaesthetics, but is overall “really pleased” with her new knee.

Background:

Marjorie is retired. She is married and has children. Her ethnicity is White British.

More about me...

Marjorie has osteoarthritis which affects her knees, shoulder and wrists. She had a partial knee replacement on her right knee 15 years ago, which began causing her pain as time went on. She also had a total knee replacement on her left knee four years ago. Marjorie has slightly high blood pressure and takes simvastatin, atorvastatin and ramapril. She had spinal stenosis (narrowing of the spinal canal which can cause compression of the spinal nerves) 12 years ago and needs to ensure her back is always well supported, for example when driving or sitting on the sofa. As a teenager, Marjorie had a very bad sprain on her ankle; she had surgery to repair the ligaments in her ankle about 6 years ago and, although it still sometimes swells up, it doesn’t ache anymore. Marjorie used to enjoy sports and dance but, “as my leg’s got worse, so my exercise has slowed up and I gained the weight in the last ten years”.

After having the partial replacement on her right knee, Marjorie was very pleased. However, she then needed a total replacement on her left knee four years ago and, about three years ago, her right knee started to “play up” again. She “kept putting it off and putting it off” about going to her doctor and then, “just as I was thinking about going to my doctor, COVID came”. Marjorie’s right knee was very painful: “if I sit wrong or if I sleep and I move, it wakes me up. Sometimes it makes me shout out if I move quickly and don’t think about my knee first”. The pain was concentrated at the back of her knee and down the side of her leg. Marjorie has had “a nasty fall” and “a couple of trips”, and the knee felt very unstable and weak. Marjorie takes co-codamol to “keep moving”; the thought of not being able to walk “frightens me a bit […] I really don’t want to get into that situation”.

Marjorie was “quite pleased” with how quickly her appointment with an orthopaedic surgeon came through, considering the impacts of COVID-19 on NHS services. Based on an x-ray of her knee a few months ago, she expected a total replacement would be recommended. Going into the assessment appointment, Marjorie hoped the surgeon would give her an indication of how long she might have to wait for the surgery: “you can start thinking about what you want to do with your life [whereas] your life’s on hold all the time at the moment”. She was aware of the extra risks associated with anaesthetic, which motived her to try to lose some weight by eating healthily, drinking more water and with light exercise when she can.

At Marjorie’s appointment, she was scheduled in for a total knee replacement. She found the surgeon to be “very nice”, and was impressed that the wait time for operation was only one month. In the consultation, Marjorie’s weight wasn’t mentioned. She did bring up being on blood pressure tablets, but her surgeon “seemed quite happy to go straight ahead with it”. Marjorie had further heart and blood tests before the surgery. Because she had already had a partial replacement on her right knee and a total replacement on her left knee, she felt she had a “pretty good general idea of what’s coming” in terms of assessments, preparing for surgery and the recovery.

A month later, Marjorie had her partial knee implant taken out and a new total joint inserted. There were problems with having the anaesthetic administered which was in the spine, despite Marjorie’s history of spinal stenosis. After several painful failed attempts, Marjorie heard alarmed voices from the nurses and anaesthetist but then passed out. She didn’t wake up until after the surgery, which was “really frightening”. Marjorie has some hearing problems, so she is unsure if her surgeon had mentioned a spinal injection at her consultation. In hindsight, she wishes she had been given a leaflet so she would have been more aware that the hospital was planning on a spinal injection.

Marjorie was told beforehand that this would be more painful and difficult to recover from than her previous knee operations, which she found to be the case. Shortly after surgery, she developed complications of nerve pain and blisters. Both of these were unexpected, but Marjorie was able to have her concerns addressed quickly by calling her GP. Her doctors assured her that while her symptoms were a “bit unusual”, they were not a cause for concern. Moving around on her new knee now feels “absolutely fine”, and Marjorie is “very grateful” to have undergone the surgery. She is now able to walk without pain, and feels she has a “really good strong knee”. She hopes to lose additional weight and stop taking blood pressure tablets now that she can be more active.

Marjorie wondered if doing lots of sports when she was younger had contributed to her knee problem. She thought the weight she has gained since exercising less has made it worse.

I used to do a lot of sport, dance, I was always active. And I think, I don’t really know what I did, or if I didn’t do anything to cause it, it’s just - again - it’s my right leg.

So you tend to move with your right leg I suppose. I don't know. And it was I think it was dancing, and I used to play squash, badminton. I used to run years ago.

It could be ‘cos I’m weighty now. I’ve put weight on. But I wasn’t weighty then. As my leg’s got worse, so my exercise has slowed up and I gained the weight in the last ten years, you know? So that’s, I think that could be a reason.

It’s got quite a lot of weight on it to start with, and you know, that’s what started it all.

Marjorie had increasing pain in the back of her knee which sometimes made her shout out if she moved quickly.

In the last couple of-, last week really. I’ve noticed I can’t walk very far at all. I usually used to go out with my husband with the dog, I can’t even go round our local village rec now without taking painkillers.

It’s affecting my hip and my back as well. Because my left leg's taking my weight, you know, it’s taking all the pressure of walking. And it’s very, if I sit wrong or if I sleep and I move, it wakes me up.

Sometimes it makes me shout out if I move quickly and don’t think about my knee first before I move. If I turn and twist or something. And the pain is actually all in the back of the knee.

And it’s the pain, it seems to be in coming through from the back, you know? I can’t really describe it. And down the side of my leg, down towards my ankle, and it really, really feels painful. I cant really say more than that, that’s it.

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.

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.

After seeing the X-ray the physiotherapist referred Marjorie straight for surgery.

With the second knee, my left knee - four years ago, I said - I went to her and when the referral went through, the hospital asked me to do a physiotherapy course of so many weeks, which didn’t help at all. And it was a -  it made it worse if anything.

And exercises, because there was exercises that you use your legs more. And it wasn’t any good for me. And I went back to her after I’d finished a course and she referred me straight back to this hospital. And I was taken in, you know, and had it done and that was it.

But the physiotherapy course before that was just a waste of time because it was bone, and it was all to do with muscles, and they could hear my bones cracking. The guy that was doing it said, “Is that you? Is that you, your knee?” I said, “Yes, it is.” He said, “Oh.”

And I thought ‘no, I shouldn’t,' you know? I didn’t think that was, I didn’t think that was a good idea for me. But I had to go through it so I could be re-referred again. You know?

So, like I was a bit a bit miffed to be honest, but it had to be, I had to do it because I was triaged to do it. So to be honest I thought it was a waste of time.

But I haven’t had it with this one because this leg, well so far, because when I spoke to the referral guy - physiotherapist actually - he saw my x-rays and I think he realised it would be a waste of time.

And [so] he referred me back to the surgeon.

Marjorie was told some initial results after her X-ray. She learnt more when she talked to the physiotherapist who referred her to the orthopaedic surgeon after looking at her X-ray.

Well, as I’ve said, it was three years ago [when] I realised there was something wrong.

And I kept going, you know, and thinking-, and then just as I was thinking ‘right, I’ll go to the doctor’, we were all shut down with Covid.

So, obviously, I kept going and didn’t bother the doctors because they were up to their eyes in it, which I, you know, could see.

But swelling. I had quite a bit of swelling. My, my knee is quite swollen. And pain, you know? I knew something was wrong. I’d run down the stairs, you know, easily, but now I have to come down one at a time because of the pain in the knee, which I’ve been doing for the last three years now. One step at a time if you see what I mean.

So, it all just got worse?

Yeah, it just got worse, yeah.

But I was referred, she said, “I’ll refer you to the hospital-,” “I’ll refer you for an x-ray.” That’s it. It was an x-ray.

And she sent me to a local hospital, had an x-ray. The person who took the x-ray showed me my x-ray and he said, “You’ve got no ligament down the side-, the right side of your leg at all.” And I said, “Right.” I said, and they showed me what it was like. They said, “I think you’re gonna need a full knee.” I said, “Yes, it looks like it. If I understand what I’m looking at”.

And then he reported it back to my GP, I suppose. Then I had a letter that she’d referred me to this certain hospital and people would be in touch.

That’s when the physiotherapist phoned me to say he’d seen my x-ray and we had a little chat about my weight and everything. And he said, “I’m gonna refer you back to the surgeon and you’ll get an appointment.” And this is the appointment I’ve got tomorrow.

When Marjorie spoke to the triage team at the hospital, she felt relieved that she would be sent straight to the surgeon rather than having physiotherapy.

My doctor referred me and it was quite a long time, and I think I got hold of her and she re-referred me, I went to see her, she re-referred me, and it all got moving then quite quickly.

But yeah - I can’t remember if I phoned the hospital or the hospital phoned me, and just cos I, I just didn’t want to have to go through all those exercises again because I knew, I knew it wasn’t muscular, I knew it was you know my knee.

And so when I spoke to this guy from the triage team he said, “No,” he said, “You won’t need to do physio before you go,” he said, “This is going straight to the surgeon.” So I said, “Oh thank you.”

This, or the surgical team, or something like that so.

At her referral appointment, Marjorie's surgeon told her she could have knee replacement surgery. She also had some preoperative tests.

I had to go and see the surgeon beforehand, and he took a lot of notes and asked me about my general health, and thought I was okay to go ahead.

I didn’t have to wait very long. I can’t remember really now - I think it was about a month if that I had to wait. And he was very nice.

Well basically he was just checking that I was okay to have the op, and he said the team, actually I’ve just kind of remembered that, he said that there was a team at the time when I was being interviewed, so he sent me for blood tests and heart and something, at that time.

After he’d finished speaking to me he passed me over to some nurses, and I had all the pre-op check out then. I’ve just remembered that and I didn’t see him again. So, that was it until they called me in for my op.

Marjorie had been worried that being overweight would increase her risk when having an anaesthetic but it was not mentioned as a concern at her referral appointment.

Well, I think my weight for surgery, that’s a little bit of an issue with me. I mean, I most probably will get told that tomorrow.

So, I am, as I said earlier on, I am really trying to get some weight down and get some weight off, because of the anaesthetic. Because the heavier you are, you know, it’s more anaesthetic they have to give you.

And I’m 73 now and I need to, if they told me, you know, tomorrow, they can’t operate until I lost say another two stone or something like that, I would lose the two stone to get it done. And that’d be it and, you know?

But I don’t know, I mean, I’ve seen people waiting with me when you go in and they’re bigger than I am. But it’s also perhaps they’re not there for a knee. Perhaps they’re there for a hip or something?

But I do know weight’s a problem definitely with surgery so, that’s something I should’ve addressed a long time ago, really. But there we go.

When we spoke in June we spoke a bit about weight gain, and you’d done an awful lot at that point actually to lose a bit of weight.  I wondered did that come up with the assessment appointment or when you were getting ready?

No, no it didn’t.

I don’t, I said to him that I struggle with my weight, I usually tell the doctors that - well I do.

And I did lose about 8 or 9 pounds, something like that just under about. So I’m very heavy anyway, but I did lose about - it was just over the half a stone I think.

My daughter told me to - she’s a nurse - and I did really try, but I, no, that really didn’t come up to it at all. Come into anything. Unless they were being polite. But I wasn’t, I know I’m overweight, but I don’t remember anything mentioned, being mentioned about my weight.

In the days before her surgery, Marjorie showered at home with the antimicrobial shower wash the hospital gave her.

You have to do certain things before you go in the hospital for the operation and what have you. And that’s all very clear.

You have to shampoo in something, I can’t remember now. Some special shampoo and well body wash actually, it’s all over. And that’s all in a letter printed out to you, black and white.

And you do that and it’s all done.

Marjorie was “thrilled that I could walk” when she took a few steps with a walking frame a few days after her total knee replacement operation.

Yeah, it was four or five days because I can remember getting up and the physio came to me, and they gave me a frame [and] I started to walk.

I took a few steps and I was so chuffed because I was laying in bed and my leg was really painful, and it was down the side of my leg, where they’d had to tourniquet my leg.

I think it had all, it was all the nerves mending down the side of my leg. It was like electric shocks going down - it wasn’t my knee that was playing up, it was just, apart from the blisters, the knee, from my hip to my knee I got, I was having like electric shocks going down my leg. But it was the nerves mending, cos they, they obviously had been damaged in the op, which it is absolutely fine now.

So, I took a few steps with the physio, that thrilled that I could walk, and so from there on I, I took myself to the toilet and back and I think I went out the next day.

I think I went out the next day which was about four or five days.

Four or five days I was in there.

Marjorie’s leg was very bruised and swollen after total knee replacement surgery. She was advised by the surgeon to keep her leg up for at least two weeks.

Well, normally they’d encourage you to get up and move around and walk, and after, I’d, on crutches.

And when I went back in the surgeon could see how swollen my leg was, he said I was to keep it up for at least two weeks, not to do anything, not, he said, “Don’t even put the kettle on.” You know, “Keep it up.”

So, I did and it was, it sorted it out, my, the swelling. It sort of slowly went down and I could move around you know better, after about two or three weeks. Three weeks I could move around quite easily.

But he just said a couple of weeks, just put your, keep the leg up.

Marjorie developed blisters on her knee "bigger than a walnut" after her total knee replacement surgery.

And when I was about to come home five days later, I kept getting water leaking from my knee, and they had to take the dressing off, and I’d got massive blisters all across the top of my knee.  They were not, not little blisters, they were big blisters, like a walnut, bigger than a walnut.

Oh gosh.

And I had about ten of them. And the doctor came to see me, another doctor, lady doctor, she said I was okay, this does happen but it is a bit unusual.

And the photographer from the hospital came in and took some photos, and asked me first, and said would it be okay, I said, “Yes, what’s this for?” She said, “For learning.” For you know for it to be to say, you know to take your photographs of your knee for training, training surgeons or something.

And I said, “Alright okay.”

So, I came home and these blisters were bursting and I was so worried that it was going into the cut of the knee, you know the, where they’d made the incision to do the knee.

Anyway, I rang my GP and I was sent back into the hospital, I think two days later and the younger surgeon was there and he was lovely. He looked, he had a good look and he, he said that I could stay in overnight just to keep an eye on, and how did I feel? 

I said, “Well I think I’m over the worst, it’s just the pain down the side of my leg, but if you think that’s, I just asked him if it was safe because of all the stuff from the pus, the pus coming from the blisters, and he said, “No that’s absolutely fine. They’re not going in.” Cleaned it all up, dressed it.

I didn’t stay over; I came home and I just recovered from that. I had to keep my leg up for about a fortnight. I wasn’t allowed to really do much. She told me you must rest it because it was so swollen and it was black and blue basically.

And I couldn’t get my foot in even my big slippers, I had to cut my slippers on one side on one leg to get my foot in at all, but it gradually after about ten days, perhaps eight to ten days, I started to move round a bit more easily with it, and after that it just, it’s absolutely fine now. It’s brilliant.

Marjorie had more pain from the “electric shocks” going down her leg than she did from her knee after her total knee replacement. She took strong painkillers for the nerve pain.

Apart from the, the nerves down the side, the knee wasn’t painful at all.

You know it seemed crazy really cos the knee was absolutely fine, apart from the blisters but they were just a bit of a nuisance in the end. But the side, it was the side of my leg, the like electric shock feeling going down my legs - and if I moved too quickly or turned over in bed, you know, asleep it would wake me up.

And it was just, it was really painful for the first I should say month after I’d come out of hospital, for a month I was in a lot of pain from just that. But not the knee, the knee was fine.

The surgeon who was, you know, that did it, the younger guy, he said, “Yes, it’s going to be more painful and it’s going to take longer to recover.” So, he was absolutely right, but it was just the fact that I didn’t expect the nerves, the nerve pain.

I suppose the thing is, thinking about it, if they’d taken the old knee out, I haven’t had that before, so they obviously they had to take the old knee out, and you know and then put the new knee in, it was going to take much longer so I suppose my leg was tied up or whatever they call it, and for much longer, and that’s perhaps where the nerves had broken, I presume they were broken, I don’t know.

And it was then mending. But that was really painful after, so if you are doing some research and that happens, with people, perhaps it might be a good idea to take note that the leg that’s being done, you know, for the nerves.

It was very, very uncomfortable, very uncomfortable for about a good four weeks and then it started to go. I was on strong painkillers as well, so, which helped.

Marjorie’s knee is still slightly swollen six months after her total knee replacement surgery but she is able to go for a walk most days and she feels she has “a really good strong knee.”

Yes, I did, yes, she gave me loads of exercises which I did, and it’s paid dividends now because I’m, it’s a really strong good knee, I’m totally okay with it, you know.

It doesn’t actually feel like I’ve had an operation on there at all. It’s just like well you know it’s really settled in very well.

I had crutches which I’ve still got here. I ought to take them back. Yeah again, I can’t really remember but four to six weeks and I was fine, you know. I felt fine so I didn’t need them after that.

I walk and yeah, I’m not actually doing the physio things to be honest, but I do quite a lot of walking. I’ve got a little dog - I take him out most days with my husband. You know so I don’t feel I’ve got a problem with it at all.

You know my leg’s the same size as my other leg, you know it’s - the knee is still slightly bigger than my other knee which I fully expected, you know, it’s only six months ago, and that will take another year I should think to get settled back down to the other, to the right size, but it’s fine. I’m very happy with it.

Marjorie had been dancing again and had lost some weight. She hopes this will help bring her blood pressure down.

Oh, absolutely. Once you get over, you know once that pain had gone from the side of my leg, I was absolutely fine. I mean you know we’ve been out and I’ve been up, believe it or not, and danced.

So, we went out with some friends a few weeks ago, and it was great, and I didn’t feel any stress on my knee or anything, and yeah, I’m fully functioning with it, you know?

And how has the rest of your health been over the last six or so months?

Oh good. Yeah, I’m getting there. I’m still trying to lose some weight, which is coming off slowly and yeah, good. I’m all, you know, I’m fine.

I am on, if you would like me to tell you, I’m, it doesn’t matter - I’m on atorvastatin. And ramipril, for blood pressure.

But I’ve lost some weight and I don’t, I’m hoping that I can in the next six months not take it after they say another six months, I hope I don’t have to take the ramipril. For blood pressure. I’m trying to bring it down and eat sensibly.

But yeah, no, I’m fine. I’m, you know I haven’t got a problem.

I have got a little bit of blood pressure but I think that’s quite, quite normal for people my age and I feel well in myself, so you know, so I’m very lucky really at my age to feel the way I do.

Marjorie would have preferred to have written information about the spinal injection so she could “read it and digest it” as she “never picked up” that she would have it when told verbally by the surgeon.

I do vaguely remember when I spoke to the surgeon a few weeks before my op he did say something about a spinal injection, but it was very sort of like - he didn’t make a big deal of it. It was very - I felt it was a bit up in the air. But so, I am a bit deaf so I just assumed you know, he was just passing it by me, and I didn’t really take any notice of it to be honest.

I never gave it another thought, you know?

A leaflet would have been, especially with the surgeon, the younger surgeon I spoke to - if he’d given me a leaflet on the spinal injection, or something I could have read it through and I would not have had it done. I would not have gone for it anyway. Because of my stenosis in my back.

And it being a long operation I would, I wouldn’t have wanted to, cos that’s to stop you going to sleep, isn’t it?

I wouldn’t have wanted to be awake for that length of time, while they were doing, taking one knee out and putting another one in. I would have refused it, and said, “No, just put me to sleep.” You know straightaway.

But a leaflet would have been good, after he’d finished talking to me - and he did ask me if I wanted to ask anything, but I didn’t want to ask because I felt I knew what I was going into, but it was going to be more painful, and take longer to recover from.

He did mention this needle in my back and but never said anything else, and I didn’t pick him up on it to be honest. But a leaflet, actually so you can read it, and digest it, would have been a good thing.

Marjorie has spinal stenosis. She experienced poor communication while having an epidural and thinks people should be given information to take home with them.

I’m trying to remember, but I mean normally - and I’m not going to say this didn’t happen, but I can’t remember the surgeon coming into me and saying they were going to do this.

I definitely, definitely didn’t say a spinal, or anything like that, but he might have come in and just said, “Oh, you know I’ll take you down.” But I don’t even remember him coming into me, to be honest, to say that he was gonna do. Cos they normally just come in and have a word with you, don’t they? Before you go down.

And I don’t remember him doing that, but they certainly didn’t tell me I was gonna have a spinal epidural or whatever they were gonna do.

But when I went to the operating theatre there was a team waiting for me outside two anaesthetists, I think one was his junior, and two or three nurses, and I was taken in. And instead of being laid down on the bed to have my pre-op things and get ready to go in, they asked me to sit on the side of the bed and lean forward.

And I thought, well I’ve not had this before. Cos as I’ve said, I’ve had this done before - this was the third op, time I’d had it done.

And I asked what was going on? And they said, "oh we’re going to inject you in your spine."  Oh, and I thought, well that was, they haven’t done that before.

And so I leant forward, I did as I was asked, and the anaesthetist was quite abrupt. And then he started to get annoyed because he couldn’t get the needle in the right place in my spine, and it really hurt.

And after about the fourth or fifth time he got cross because I kept telling him it was really hurting, and I said to the nurse that was stood in front of me, “They do realise I’ve had spinal stenosis?**  Do they?” And she looked across behind - cos she was stood looking at me - she looked behind at the anaesthetist and she said, “No, I don’t think they do.”

And anyway, I said to her, “I’m gonna pass out in a minute,” because he tried again, and got very cross. Then I heard the junior anaesthetist say something quite sharp to the one that was doing the injections, or trying to.

And he tried once more and I said to the nurse "I’m going to pass out,"  And I passed, I leant to the right, or went on my right side and, to be honest I heard a bit of shouting and because I was right on the edge of the bed, I thought I was going to fall off the bed. But I just passed out and that’s all I can remember.

And when I woke up, I was in recovery.

Yeah, I mean, like the interview I had before the surgeon, before the surgery, especially about the spinal injection, perhaps to give them a leaflet? 

Because that, I think, because some people - I mean I have got a hearing aid, but I never wear it. And, and it’s stupid of me really but if someone’s in there and they don’t catch what’s said, or they just get the end of something, especially people my age, and there’s -

You know it, it would be nice if the surgeons, if they said like, you could have this, and give you a leaflet on it, and you can read it and then you can make your mind up whether you want that or not. You know? I would have definitely have said no anyway.

** Spinal stenosis is a term used to describe a narrowing of the spinal canal.