Mary

Age at interview: 78

Brief Outline:

Mary had a total knee replacement on her left knee, after previously having had a total knee replacement on her right knee five years before. After being told about the NHS waiting list for the left knee surgery, Mary chose to have her surgery done privately. There was a postponement of the surgery because it was found she had a heart murmur. The surgery eventually went ahead and Mary is very pleased with her operation, even though a back injury has made her recovery more difficult.

Background:

Mary is a retired tea room assistant. She is widowed and has children. Her ethnicity is White British.

More about me...

Mary described herself as being in good health overall, except “all the problems with getting older”. Five years ago, she had a total knee replacement on her right knee. At the pre-operative assessment for this surgery, she was diagnosed with atrial fibrillation. The right knee replacement surgery went ahead and she later started on warfarin, which was then replaced with apixaban. Mary has also had a hysterectomy, some cysts removed, and a cataract operation which led to a complication that affected her vision. Mary also has a “sensitive bladder”. Mary also takes Alendronic acid, calcium supplements, and a statin.

Mary has been mostly happy with her right knee since the replacement; she no longer has pain but finds it doesn’t bend or kneel quite as well as her natural knee did. She thinks this is because the surgeon needed to use a slightly larger prosthetic to fit her bone shape. After her knee surgery, Mary realised that her knee was straighter and that she had been “bow legged” before. It also improved her posture: “I’m very slouched, very stooping, and I did notice that for a while with that new knee I was walking much more upright”.

At the time of her right knee replacement, the surgeon told Mary that she would probably need the left one doing eventually too. At that stage, Mary didn’t feel she needed it and declined an appointment to discuss surgery at the start of the Covid pandemic lockdown. However, in the last two or so years, her left knee became more pressing. Mary said that her left knee was “nowhere near as bad as my other knee was when I had it operated on”, but it was aching and could be painful. Going up and down stairs was difficult, and Mary needed to take them slowly and carefully. Mary’s garden was important to her and working on it was a regular source of exercise for her.

Before seeing the surgeon, Mary had “a slight worry” that she might be told “you’re too old to get it [surgery] done or it’s [the knee’s] got too bad to be done” or, conversely, that her knee was “not bad enough to be done yet”. She hoped that it would be “a clear-cut decision” about surgery. There was some to-ing and fro-ing about the appointment to discuss knee surgery, as Mary was contacted by two different hospitals in the same day. She accepted the first offer of an appointment but it was then cancelled and rescheduled for a later date.

At the appointment to discuss knee surgery, Mary was told that she was eligible for the surgery but the “very, very long waiting list” meant she would be waiting another two years before having the operation. This was “a bit disappointing” as she had already waited two years to reach the appointment to discuss a knee replacement. Based on the wait time and encouragement from her family, Mary looked into having the knee replacement privately. She asked the surgeon she had seen through the NHS to do the operation privately, and was told that surgery would be possible in six to eight weeks. Mary chose to pay extra to have robotic-assisted surgery and a custom fit prosthetic made based on CT images of her knee, which she hoped would give her a better range of motion with her new knee. Mary was given informational leaflets about the surgery and was able to ask the nursing staff questions about the procedure.

Mary went into hospital to have the surgery and “got as far as an arrow being drawn on my leg,” but the anaesthetist had a concern whilst listening to her heart. Mary was told that the surgery would need to be rescheduled so that she could have further tests. A few weeks later, she saw a cardiologist and was told that she has a heart murmur from a malfunctioning valve. Mary was told that she may need keyhole surgery in the future for her heart, and that she would need regular monitoring, but that it was likely her knee surgery could go ahead. When an ECG confirmed that the heart murmur was not serious enough to stop her having knee surgery, Mary was given a new surgery date.

Even though her original surgery was delayed, Mary felt “very pleased” that the consultant and anesthetist were cautious and that the heart murmur was picked up. Mary “knew immediately that they were acting in my best interest” and considered the delay to her knee surgery worthwhile.  Whilst waiting for a new surgery appointment, Mary focused on keeping active, eating well, and watching her blood pressure. In preparation for her surgery, Mary purchased female urinals to be used upstairs, as she anticipated she would have difficulty getting downstairs to use the bathroom in the night. In the lead up to her surgery, Mary hurt her back after lifting something too heavy. While she still had some back pain at the time of her knee procedure, Mary says they still went ahead with the surgery because “it wasn’t my back that was being operated on, it was my knee”.

Mary had a total knee replacement and was kept in hospital for five days due to a drop in her sodium levels. In the first few days after returning home, Mary’s daughter came to stay and got Mary a commode. Mary was given paracetamol and codeine to manage her pain. She feels her knee recovery was progressing nicely and Mary had been able to walk on her new knee to the end of her village with just one crutch. However, she then she started having “very, very great pain” in her back and soon found that she “couldn’t move without my back going into spasms”. This severe back pain left Mary bedridden and unable to do exercises for her knee. Mary was then sent into her local NHS hospital for low sodium levels again. Whilst in hospital, Mary had x-rays taken of her back which revealed that she had multiple wedge fractures in her spine as a result of osteoporosis.

Mary was discharged from hospital and told to limit her fluid intake in order to keep her sodium levels up. She was given morphine for her back pain, but eventually dropped back down to paracetamol and codeine for her pain relief because she was worried that she was becoming dependent on the morphine. She and her family also noticed that the morphine was causing her to become confused, even when doing simple tasks like using the remote control for the television. Mary is unsure if this was a direct side effect of the morphine or if it had something to do with her low sodium levels or general forgetfulness with getting older.

Whilst recovering from surgery and her back injury, Mary hired someone from her village to help with gardening and household tasks such as cleaning and emptying her commode. Mary also hired a neighbour to install grabrails and extra banisters throughout her house for walking support. Mary’s daughter also bought her a stool to help make showering easier, but Mary found it difficult to get in and out of the bath. Mary used a frozen meal delivery service, but noted that she became “very, very thin” because she was in too much pain with her back to think about eating.

Mary’s back pain has started to ease slightly and she has been able to focus on her new knee again. At her surgery follow-up appointment, the surgeon was “very pleased” with the outcome of her new joint. She has seen a physiotherapist who mainly provided her with exercises for her back. The physiotherapist has encouraged her to keep moving and doing things to push herself. Mary feels she is “getting stronger and walking again”, but she is not yet back to gardening and her other hobbies yet. While she does not use any walking aides in the house, she does still sometimes use crutches outside as the ground can be slippery and she doesn’t want to risk a fall: “[the crutches] give me confidence”. Mary is trying to swap to using walking poles and hopes eventually to be able to walk outside with no support, except on rural terrain. Mary gets a taxi if she needs to go into town, but eventually feels she will get back to taking the bus.

Mary says her knee is now “absolutely pain free” and that she doesn’t even think of her knee anymore. Her back still aches whilst walking, but Mary says she “can cope with that”. She does not currently take any pain relief and is looking into taking up Tai chi to help with her back. Mary’s appetite has now returned, and she particularly enjoys baking bread for herself again.

Mary feels her left knee recovery was slower than that of her previous total knee replacement, but notes that this may be due to her back problems and the fact that she is six years older than she was for the first knee replacement. Mary is very pleased that she chose to go private and pay extra for the custom-fit knee and robotic surgery. She feels her newly replaced knee bends further than her other knee replacement, and that she “wouldn’t know it wasn’t my own knee”. Mary found the wait for a surgery appointment frustrating at the time, but feels it happened as soon as it could given the Covid-19 pandemic. She says that “it’s been done and that’s what matters.” When asked what advice she would give to others considering a knee replacement, Mary says “don’t hesitate to get it done”.

Mary noticed she was keeping her painful knee straighter. This affected her posture and how she walked.

Yes, I think I’m aware more and more when I’m walking, I’m limping more, I’m limping more because [sigh] I don’t, my knee that needs doing, the bad knee, I don’t bend it more than I have to.

So, I walk much more with, with that leg straighter than what you would normally walk, you know how you bend your knees when you walk. And, and I keep that one straighter than I would have done in the past.

And, and that’s making me slightly, instead of walking properly it’s makes me sort of waddle along a little bit, you know. If one leg’s stiffer, you’re keeping it stiffer to stop it from hurting then you know, you’re not walking in a straight line, you’re, you’re walking well perhaps not, that’s not the right description, you’re limping more.

You’re swinging one knee out slightly more and I think that eventually that would have an effect on my hips, and it certainly has an effect on my posture. Because you tend more and more to bend forward. You don’t walk straight as you should, or as I should.

And that’s all the result of having a bad knee - it affects your gait, if affects your posture, and it affects yes - I waddle along rather than, or limp along, rather than both legs going in a nice straight line forward.

Mary managed public stairs differently. She couldn’t hurry stairs and she came down with the same leg leading.

And then I would find that-, well it’s not easy to hurry with it. I can walk at my own pace with it, but I can’t hurry with it.

And I often tend to come down stairs like even on a, like a railway station, I’ll come downstairs with the same leg leading.

So, you can land one, and one, and one, and one - instead of, you know, like you used to be able to do, just run down the stairs foot over foot.

I couldn’t possibly do that now.

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.”

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.

After having one knee replacement, Mary’s surgeon asked her if she would like to be put on the waiting list for her second knee replacement.

The surgeon who operated said, “Oh well, you know, you will need the other knee doing sooner or later,” and he said, “Shall I put you in now?” But I didn’t think I needed it at that stage and so I said, “No, not yet.”

And it’s only these last-, oh I don’t know, I was alright for two, three years and then [sigh] I thought ‘yes you really do need to get this other knee done.’

And I have a slight worry that if I left it too long, they might say, “Oh you’re too old to get it done or it’s got too bad to be done,” and so I thought ‘no I really need to get this on the cards.’

And I’m glad I did because but as fortune would have it, of course we were into lockdown. And although I was asked, “Do you want to come and have it done?” And I didn’t want to go into hospital because of the Covid situation and I said, “No, not ‘til, you know, not ‘til things are safer.”

But I think now I mean, it’s a long way from being as bad as the other one, but I think, well I’m sure it needs doing. And they’ve looked at my X-rays and yes and I’ve been told that I’m on the list to have surgery.

Mary very rarely took painkillers for her knees. She tried not to push her knee to the point where she needed pain relief.

No, I haven’t, I don’t take any pain relief, for my knee. Except in very, very, if I’ve really had to walk a long way then I would’ve taken a - not aspirin cos I can’t take aspirin - a paracetamol.

But I just don’t push my knee that far, I keep it within the limits, because if you over-use it and it hurts you don’t do anything for a day or two. You just sit and feel sorry for yourself until the pain goes.

So, I keep within the boundary of what’s - yes it does hurt as I come down, down the hill, but I come down slowly and steadily and yeah, and if I was going to, I wouldn’t go for a walk which was afterwards going to cause me pain. And so far, it’s just been, and I mean that’s my main exercise for the day on the allotment or vegetable garden - it’s just pottering around whereas that is a piece of pushing myself.

And yes, I probably won’t do an awful lot for the rest of the day - read, play my recorder, look on the internet, just do general things around the place, around the house. So yes, I don’t often have to take painkillers, very, very rarely. But that’s because you know, because I’m being careful to keep within the bounds of where the pain will start kicking in.

And when the surgeon, the consultant I saw at that point, where I was being told realistically I was going to have to wait because there was such a big backlog because of Covid - I was looking at waiting another two years, cos a lot of people which were a lot worse than I was.

But ah, but of course the fear is the longer you leave it, the less able you are to cope with surgery as you get older. And I, I did think well how am I going to cope for another two years? And he [the consultant] said, “Well, you know your GP will be able to manage this with painkillers, and you can have stronger and stronger painkillers.”

But I’m not the kind of person - I don’t want more medicines than I have to have - I certainly don’t want to be living my life on painkillers. And so yeah, I’m I just, I thought - let me get this done before I get to that point of having to have painkillers daily or something.

Mary agreed to a referral appointment in a private hospital, paid for by the NHS, which was further away from home.

My knee - I was obviously - all last summer I was hoping that I would get a consultation for my knee. At one point, yeah, I’d been offered the chance to have it done at a private hospital at the expense of the National Health, and I was asked if I was prepared to go to a hospital further away.  And I said yes, I would do that - but nothing, nothing materialised.

And then I think it was in the October time - it might have been a bit before then - I was rung by this hospital and [they] said, was I still happy to do that? And I said yes, I would be happy to do that, and they said that someone would ring me the next day.

Well, the next day by coincidence I got a, someone rang me and offered me a consultation, and in fact I assumed that it was the person who’d rung me the day before, at least he referred to the same, was referring to the same hospital as the day before. But in fact it was from the hospital, can I mention the name of the hospital or should I-?

That’s fine yeah.

Yeah. It was from [another hospital] offering me a consultation. Anyhow, so that day I got offered two - one from the private clinic and one from [another hospital]. And as the first one that rang me that day was the hospital, I accepted it there, and therefore I gave up my place on the second one that rang, which was to have it done privately.

So, I got it in writing, the consultation, where it was going to take place, but then it was cancelled, as a lot of things have had to be cancelled, you know? I assume because of Covid or something. But anyhow it was cancelled.

But then I thought - well I’m not going to worry because I’m obviously near the front of the queue if I’m being offered a consultation, with the National Health, so I waited, and a few weeks after I was offered another consultation at the, with the National Health.

Mary plans to take advice from the surgeon about how her atrial fibrillation might impact knee replacement surgery risks. She decided to pay to have her surgery done privately.

You’re happy to go with whatever they suggest around atrial fibrillation?

As long as it’s a clear-cut decision. If he says, “I think you need this and I think you would benefit from this and I think that you are not going to be put at any great risk, more than what it would be. There’s always a slight risk with every operation but, you’re not going to be put at any undue risk because of your, your heart,” then I would say, "yes, I would."

But if you said, “Oh well I’ll do it if you really want me to, but you really ought not to be having this operation with your heart,” then I would probably say, “Well in that case, I’ll live with my knee.”

So it really depends on the sort of weighting, doesn’t it, of their recommendation towards risks and benefits?

Yes, yes, indeed. I mean I’m hoping there won’t be a particular risk, but.

It was just the first time when I went to that pre-op and it was a nurse who was doing the pre-op, and she said, “Ah well you were supposed to come in on - I think it was two days later - for your operation, but they might, they might decide they don’t want to do this now because of your heart. So, go home and someone will ring you.”

Oh gosh.

And so they said, “Yes we will do the operation.” And so I suppose that might - that rings a warning bell that they might say, “Look you ought not be having this surgery because of your heart.”

I want-, I mean I want my knee done, but I want to be alive after this operation. I want to, you know, I yes, I want to come through it, I want to come through it safely I think is what I’m saying. And to be able to pick up my life again.

They weren’t offering me surgery, they were saying, “Yes, your knee does need doing, but realistically you’re not going to be able to get it done on the NHS.” Well - they didn’t mention the NHS, “but you’re not going, the waiting list is, is very long and you’ll wait realistically, you’re waiting some time for this.”

I mean, [sigh] either not even going privately, it wasn’t a case of, “Right we’ll have you in next week.” It - there was a bit of, not as long waiting list but there was, there was a couple of months waiting list for it to have it done privately.

So yes, I mean he looked at my knee and wiggled it around, and he said, “Yes, you know, it does need doing but -” and he did say, “I will do my best if you’d like me to find a hospital who might be able to offer you a shorter waiting time.”

But I think, as soon as he said about another two years, I thought, ‘I’ve waited long enough for this.’ And I didn’t need to consult my children because they’d already made their feelings clear,  so I just said, “No. Let me get, I’ll go privately and please would you do it.”

Mary has a heart murmur and she is worried about having a general anaesthetic as she knows “things can go wrong” but “you’ve just got to hope for the best.”

Well, I don’t expect I’m on my own in worrying about being given a general anaesthetic, I just want to wake up again, and, you know, things can go wrong but, you know, you put your trust in the people who are doing the operation and hope that it’s alright and that you don’t have a-

I think my one great fear is - and this isn’t necessarily to do with surgery - but my one great fear is to have some kind of stroke that would leave me severely handicapped.

I used to go and sit with a lady, wonderful lady, very intelligent woman, and she’d had a stroke - and I used to go and sit with her once a week to relieve her husband while he did the shopping. And she couldn’t speak, she could just sit. [sigh]

I think I have a horror of - not a conscious horror - but I think that would be a dreadful thing to happen, and I just hope nothing will go wrong during the operation. But then, you know, it’s just one of those things, isn’t it? You’ve just got to hope for the best.

It’s just the anaesthetist and everybody else knows what they’re doing, and will look after me to the best possible-, well they will, really. The National Health Service is a wonderful service, and will do their best for me.

After having her right knee replaced, Mary can no longer kneel on it so she expects the same will happen for her left knee replacement.

My only, I won’t say concern, is I know from my other knee it’s very difficult to kneel on an artificial knee. It’s very pain, well quite painful, I presume because you’ve got metal and it’s not just flesh and bone which you were born to kneel with, you know it’s, it’s different.

And when you really notice that is when you’re kneeling down. Well, I’ve always been able to kneel on, have one good knee to kneel on - now I won’t have any natural knee, or knees to kneel on, which make a difference when you want to get down to sort out the bottom cupboard of your kitchen cabinet and things like that.

But I will manage, I will sit on the floor, and do what I have to do down there. So, it won’t be an insurmountable problem, but I know that that will, I’m pretty sure that will be the case.

So, but apart from that, well even with that, that’s a small price to pay, to have a knee that doesn’t hurt at all, and that you can bend and do what you like with.

After being told she would need to wait two years for knee surgery, Mary decided to pay privately for her knee replacement surgery.

So, I went to that consultation and I was really disappointed because it was explained that there was a very, very long waiting list and that there was a really big backlog of patients needing knee surgeries and other surgeries, hips etcetera, and that there was very, very little chance of me getting it done for at least another two years. Well, I’ve already been waiting two years, so that that was a bit disappointing.

The person, the consultant was very, very kind and very good, and did say well he could explore the possibility of other hospitals to see, but it could be anywhere else, any other hospital might have a shorter waiting list, but I felt I’d been waiting such a long time and my family had been saying, suggesting that I go privately, and I had rather - I had not really wanted to go privately, obviously because of the expense, but at, I suddenly thought, ‘No, it’s, this needs doing. If we’re talking about two years with one hospital, we’ll probably talking a similar time length with another hospital.’

So, I asked if I could go privately.

But even to go privately I was told it would be unlikely to be done, well for at least six weeks or so, perhaps two months. But I made, I’d made up my mind and I thought, ‘No, I’m not, I’m not messing around any longer with this, I’m going to pay for it and I’m going to get it done. And that’ll be fine.’

So I did, I got into the private system, it would be the same, the same person who I’d seen at the, with the National Health, but he has a private clinic as well, and I was very happy with the thought of him doing it because I liked him, I trusted him.

And I thought, ‘Yes, he’s obviously a very capable person.’ But again, he really was extremely willing to explore all the other possibilities of me having it done without having to pay for it to be done. But I just, I just felt it was, I just wanted to get on the private list and get it done.

During the pre-operative health assessment Mary discovered that she had a heart murmur. She was referred to see the cardiologist but expects to still go ahead with the knee replacement surgery.

Unfortunately, when I was admitted, until this point, I hadn’t actually met the anaesthetist and I’d only had the pre-op a few days beforehand. I don’t know whether it was the first time he saw the cardiogram reading - well I don’t know if it’s cardiogram - but the readings they’d taken of, of my heart - but he didn’t look very happy about that.

I knew already from the last, from about six years ago when I had my first knee done, I knew that I had an atrial fibrillation, but obviously I’m six years older than when I had that done, and ever since that was discovered I’d been on warfarin, but obviously I’d come off the warfarin for, to have the operation some five days earlier.

I, and the anaesthetist listened to my heart and he went away to consult with the consultant, and they came back and explained that they wouldn’t feel happy going ahead with the operation until I’d been seen by a cardiologist. Just to clear it that I was, you know, it wasn’t something which - well the heart -  if there was a further problem with my heart - they used the word ‘heart murmur’ - and they said they wanted me to see a cardiologist first.

Well, I managed to see the cardiologist this week, and I haven’t had an echocardiogram, which is what the anaesthetist and consultant wanted, but I’m going to have that in four days’ time. So that’s all, all booked.

But the cardiologist said that I don’t, I had a heart murmur, and this probably needed some monitoring in the years to come, but that he didn’t think that this was any reason not to go ahead with the surgery. So, I’m hoping that once I’ve had the echo- ECG, it’s called, isn’t it? That once I’ve had that then I’ll be able to be on the list to have my knee done.

But - unless this ECG throws up something - which I don’t think it will - but something different or something more serious than the cardiologist was able to hear, then he didn’t think there should be any reason why my surgery, knee surgery couldn’t go ahead.

So I, and he, I think they’re all aware that yes, I’m eager to get on with this, and oh - and the really - I was surprised about but very, very delighted, because as soon as when I was admitted, as soon as the consultant and the anaesthetist began to talk about seeing a cardiologist that’s when my heart sank because I thought, ‘Oh dear, if I’ve got to go on a waiting list at the NHS the NHS to see a cardiologist how long is that going to take?’

But the consultant explained to me that this was necessary before they could do the knee surgery and therefore at no extra expense to me, it would be included within the package, that I’d paid for the knee surgery.

So, I would see a private cardiologist and that would be all be paid for. So that was good, otherwise it would have taken a lot longer if I’d had to go onto an NHS waiting list, I think.

Mary says “you can’t afford to lose fitness as you get older.” She spends a couple of hours pottering around her vegetable plot when she can.

So yes, you can’t afford to lose fitness as you get older.

So not as fit as I would like to be, but very reasonably fit, and I’ve spent a couple of hours today - no three hours - pottering around on what I sometimes call my vegetable plot and sometimes call my allotment.

I, in theory it’s my allotment but as it’s only about 300 yards away, it’s almost like an extension of my garden. So, it’s not, it doesn’t take much walking to that.

Yes, but I’ve been able to spend two or three hours on that today, just pottering around, doing things, you know making sure that - pulling up a few weeds, getting it ready for the new season. Cos it’s a lovely thing to be doing at this time of the year when it’s spring and I feel life is be going to very soon open up again for me.

So, I’m feeling very optimistic.

Mary is preparing for the operation by doing some stretching exercises to keep her knee flexible and practicing walking with a crutch.

But I know I shall have to do some exercises with my knee once I’ve had the operation.

There’s, with physiotherapy you know you need to work at it to get it mobile again, so I’ve begun to do some of those exercises in advance, and I’ve been practicing walking with a crutch and things like that.

And I started doing a little bit of ah, oh dear I won’t say yoga, but a little bit of stretching and moving in the morning, perhaps just for ten minutes, just to make sure everything’s - yeah - to keep things flexible.

Because I know I’m going to be out of action for at least a couple of weeks, aren’t I? And then I’ve got to learn to walk to gradually get off the crutches.

Mary trusted the healthcare team would look after her, she read the leaflets she was given, and although it was daunting signing a consent form, on the day she said “you just go with it.”

As long as I came through the operation all right, no, I didn't think-, have any worries.

I was-, I knew I was in good hands and, yeah, that I trusted people to look after me, – and they did.

I had leaflets, and then the staff, I could ask them about it, the nursing staff.

Yes, no, I had what I needed. And lots of leaflets about aftercare, and what to do and what not to do. No, no, I wouldn’t-, and I was given all the information I needed.

In the end, you know, it’s always a bit daunting when someone says you have to sign a consent form, and you know think, ‘oh, I hope I'm going to come through this.’ But then that’s natural with any operation, isn’t it?

And once you get to the day, you just go with it.

 

Mary’s private healthcare operation which she paid for was robotic assisted surgery and she had a bespoke prosthetic knee made.

I knew my knee was all right, I knew it would-, he’d done a brilliant job. I had the robotic assistant-, assisted-, I had-, I'm not sure what they call it, but it’s robotic assisted operation.

And the knee replacement was-, the bespoke knee, then they took a CT scan and made it exactly to fit my knee. And I was so pleased with it.

I did pay extra for that.

But then I was paying for my knee anyhow, and I thought, ‘well, if I'm paying for my knee, I might as well pay a bit more, and get the best outcome.’

I also felt that because they've had to-, in my first knee, I've had to have one slightly bigger, I thought, ‘well, this will be a bespoke knee, and so it will absolutely fit.’

And it just meant having, a CT-, is it a CT scan they call it? You know, the scan for that, a few weeks beforehand, and so they made the knee. No, I was really glad I went for that option, yes; very glad.

Mary developed severe back pain three weeks after her total knee replacement and was unable to exercise or walk.

So, I came out, and my daughter came down to look after me for a few days, and I was making really good progress. Not as quick-, the progress wasn’t as quick as with my first knee, but then I was, you know, six years older, so.

But I was making good recovery, and I got as far as walking on one crutch as far as the end of the village, which is about 300 yards away, but then something went wrong with my back.

Now, I had had a bit of a problem with my back in the months leading up to the surgery: there was-, I think I picked up something that was too heavy and I felt my-, something goes in my spine, which recovered after a couple of weeks, but every now and then, I had a reoccurrence. But I-, we still went ahead with the surgery because it wasn’t my back that was being operated on, it was my knee.

So-, but this time, after the surgery - nothing to do with the surgery, except it might have been that I was walking on one crutch and therefore walking rather oddly – I don't know. Or I might just have twisted – I don't know, but I had a very, very great pain in my back and literally couldn’t move without my back going into spasms.

Oh gosh.

So, when I was supposed to be doing all my exercises for my knee, I was-, [sighs] I could hardly move, and was spending most of my time in bed, because just to move in any direction was so painful, and I couldn’t-, I couldn’t get anywhere for help because I-, it was too painful to get into a car.

And that was about June time, early June. My family came down and looked after me for a bit. And to cut a long story short, because my back has taken a very, very long time to heal, and this became the predominant problem, not my knee, my knee was fine: my knee was healing nicely, it was bending nicely, but I became crippled with my back.

I eventually saw a doctor - my family insisted on it - and came down  to get me to the doctor. Bloods were taken, and it turned out that my sodium levels had become dangerously low, and so I was sent into hospital while they sorted the sodium levels out.

While I was in hospital they took some X-rays of my back, because until then, I’d assumed it was a muscular problem, but it transpired that I had multiple ridge fractures in my spine, and-, [sighs] and basically it’s been a - you know - been in a difficult place all summer, but I am improving.

I am now walking half a mile on crutches, and I'm beginning to wean myself off the crutches and using walking poles instead because they hold me more upright, I don't lean down on them so much as I was doing on the crutches. And I don't use crutches in the house, and I can walk 100, 200 yards without them, but I don't walk easily.

And that’s where I am now, but I'm no longer in that terrible pain that I was in with my back.

And I've seen-, I've now had my follow-up for my knee, which I couldn’t have-, you know - my back took precedence over everything.  I've had the follow-up for my knee, and the cons-, surgeon was very pleased with it.

So I'm just now getting stronger and getting walking again.

Mary’s private total knee replacement operation was robotic-assisted surgery and she had a bespoke prosthetic knee made.

Well, I think in the long run, I think I'm glad that-, because although I might have got it-, it would have been nice to have got it done sooner, yes, but on the other hand, I don't think I would have had the option, if I hadn't gone privately. I wouldn’t have had the option of the bespoke knee, of the robotic assistant operation, and that’s been such a good outcome that in the long run it turned out for the better.

Can you feel a difference between your knees?

I can in the way that they bend, yes. The new knee is so much better, it bends further, and that’s without me doing many exercises. So-, because, you know, I couldn’t-, I was trying to do exercises for my back rather than for my knee, so no, it was-, it’s really, really, they've done a brilliant job on this knee, I'm very, very happy with it.

Good, yeah.

Yes.

In fact, I wouldn’t know it wasn’t my own knee.