Norman
Norman began having problems with his knees around age 18 and went on to have total joint replacements on both knees. He has additional issues with his heart, eyes, and hands. Norman is unsure about a revision surgery for his left knee as his pain is manageable, but he worries about further damage to the joint.
Norman is a returned insurance accountant. He is widowed, and has one son and two grandchildren. His ethnicity is White British.
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Norman first started having knee issues when he was aged 18 and his left knee began giving out whilst playing rugby. Soon after seeing a doctor, he had a procedure on the knee’s cartilage, which helped for several years. Decades later, Norman went back to the doctor as his knees started having more problems. He was referred on to a surgeon, who advised that both of his knees were bone-on-bone from osteoarthritis and needed total replacements. The surgeon performed a total replacement in 2007 on Norman’s left knee first. While the surgery went well, Norman’s knee sustained further damage after having a fall during his recovery period. Norman’s surgeon attempted to re-bending the knee and he was put on a machine that continuously bent the knee. This helped with his mobility, but Norman’s knee still has a limited range of motion. Norman’s right knee was operated on in 2013, and the joint has “worked perfectly” since.
Norman’s left knee currently causes him pain and discomfort on days where he is especially active. He enjoys activities like playing bowls, but finds that his knee swells up after spending time on his feet. As it is Norman’s left knee that is most affected, he has recently ordered an automatic car to help ease any discomfort with driving. Since his knee was “getting progressively worse”, Norman decided to mention his knee to his GP during an annual test of his heart. Norman received a referral and is currently awaiting an appointment.
Along with his knee problems, Norman has had issues with his heart, eyes, and hands. In his mid-50s, it came to light during the pre-entry checks for a gall bladder operation that Norman had been having ‘silent’ heart attacks. He underwent a quintuple heart bypass and has since had additional heart surgeries to unblock his arteries. He is also diabetic and takes tablets to manage the condition. Norman has had surgery for cataracts and carpal tunnel, as well as steroid injections for trigger finger. He continues to have issues with his cataracts and is waiting on an operation on his right hand to relieve carpal tunnel.
Norman is uncertain about pursuing revision surgery for his left knee as he feels able to live with the current pain levels. He manages with an ice pack and occasional paracetamol. He is open to taking stronger painkillers and would like to hear more about other non-surgical options. Norman also plans on asking the surgeon if delaying surgery could cause any further damage to the knee. The recovery period is also a concern for Norman, as he is a widower and lives alone. He plans on asking his son and daughter-in-law for help after the surgery.
Norman considers his health issues to be “all sort of separate” from one another. Previously, Norman had a mix-up where he wasn’t told to stop taking blood thinners before his right knee was replaced. This meant that the surgery was done with general anaesthetic rather than epidural. Norman found this “a very nice way of having” the surgery done as he was pain-free for several days and he thinks it might have helped with his recovery, and he plans to discuss anaesthetic options if he proceeds with knee surgery. He trusts his doctor to assess the risks and doesn’t “overly worry” about his heart causing problems with the surgery. Norman reflects that “there’s always risk whatever they do”, and he is encouraged by how helpful his past knee replacements have been.
Norman began experiencing pain and swelling when he was active about 12 years after his total knee replacement.
Norman began experiencing pain and swelling when he was active about 12 years after his total knee replacement.
The left one was the first one to be done, that was a little bit problematic in the fact that it was done quite well, it worked quite well and I was undergoing physio and then I was sent home.
It would have been round about Christmas time and went out with my son - came and sort of said, “Oh, look Dad, you've been in the house for a long, long time, let’s go out and have lunch somewhere.”
So we went out to a pub, had a very nice lunch in a very warm pub, I then came out of the pub and I immediately blacked out.
That transpired to be low iron in my body system had caused that, but I fell nastily on my left leg. Went back to the hospital, continued the physio with them, but the knee began to set itself in almost an unbendable position. That led to the surgeon taking me back in and forcibly re-bending it—and I then spent three of four days on an automatic bending machine.
I don’t know whether you know of them, but sort of you're strapped into it and it just continually bends your knee backwards and forwards. That worked to a degree but I’ve only got a limited movement within that knee. It doesn't go back and bend as far as it actually should do.
The right knee - then they decided they wanted to do the right knee - that was beginning to- to play up. The right knee: fine, I had that operated on, it’s worked perfectly and is absolutely no problem at all.
The left knee is the one that’s causing the problem, and it’s a case of, as I say, I play a lot of bowls, I spend a lot of time on my feet walking backwards and forwards and after a while I suddenly find that the knee begins to feel as though it’s getting a little bit warm, it begins to grind and it begins to swell.
With an icepack it will all go down again, but it’s just somewhat debilitating.
And how long has your knee been doing that? So where it’ll swell and- and be quite uncomfortable?
[sighs] Oh, probably about three or four years, something like that. But, you know, getting progressively worse.
Yes, yeah—
Yeah, yeah. To- to the extent that I then decided, ‘well, I think maybe ought to go and see somebody about it.’
Norman’s knee pain affected him most when he walked a long distance. He bought an automatic car to make it easier to drive.
Norman’s knee pain affected him most when he walked a long distance. He bought an automatic car to make it easier to drive.
No, because the problem isn’t bad enough, it occurs when I sort of do a lot of walking, just generally and going around, you know, sort of walking and then sort of resting.
It- [sighs] it niggles, I’m always aware, and I’m aware of it now, I’m aware that there’s a little feeling of something in the knee—that I can feel it now that it’s not 100% like the other one is. But it’s not debilitating. It’s only if I walk a long distance that I suddenly find that it’s beginning to get a bit more painful now and I probably need to give it a rest.
Well, we go back to playing bowls because, as I say, that’s sort of three hours on- standing, by then it would be- you know, it would be beginning to play up again, and it might on some occasions sort of affect me slightly in going to sleep because there would still be pain in it.
But normally during- you know, a normal day it doesn't affect me.
So, it’s not affecting me in my normal day-to-day work, although I have just ordered an automatic car because I am finding with the restriction on the bending, that I can’t- you know, it’s- I’m having difficulty changing gear with it.
Because it’s that leg, isn’t it? It’s the left side that you would be- yeah—
It’s that leg and whilst I’ve been able to do it before, I’m now finding that, you know, pulling it back to get it back onto the pedal is— I think what it means is that the movement is probably getting a little bit less than it was before.
Because I’m finding it more difficult to actually operate that foot pedal.
I can drive, I know I said I’d ordered an automatic, that’s purely for my benefit and my, you know- I can still happily drive at the moment—although as I say, I do realise that the car needed changing and it was probably a good time to switch and make it an automatic, so... but I’m not at a situation at the moment where it is seriously affecting my ability to drive.
Norman would like to put off having revision surgery as long as he can but he wants to be sure he is not further damaging his knee
Norman would like to put off having revision surgery as long as he can but he wants to be sure he is not further damaging his knee
Well, the topic he’ll discuss with me I hope, is my knee, and what they feel that they can possibly do for me and [sighs] I would want to discuss with him the possibility of being able to have something done with it without having surgery, and how long that they might consider I could go with it as it is without it seriously needing surgery, if you understand what I mean?
So, your preference would be to put it off- avoid it altogether or put it off as much as possible in terms of surgery?
Yes, yeah. Yeah, but that is for my own personal circumstances, because as I say, I live here on my own at the moment, and it becomes difficult once you're in a situation whereby you've had that operation, in being able to look after yourself, that’s the only thing.
I’ve got [sighs] no problems with having the operation, and in fact if I speak to anybody about my knee op- my knee operations, that are complaining about their knees, I seriously tell them to consider having it done because it’s one of the best things that you can have done.
But as I say, at the moment my knee is at a stage where I can live with it, it is- it does become somewhat painful, but I can live with it.
But the reason for seeing the specialist, or mentioning it to my doctor and then being referred, is I want to see whether living with it at the moment is causing serious damage to it that you know- or can I carry on as I am at the moment, bearing with the discomfort that I’ve got and not be doing more very serious damage to my knee.