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

So once you've had your knee surgery and you've been through that process in hospital of getting to the point where you can go home, be it on the same day - day case surgery - or after 1 or 2 days, you'll go home and your rehabilitation starts. And I think it's important to focus down on this first six weeks after the operation.

So there's no doubt after total knee replacement that this is a difficult period because you've got to balance getting going, walking and getting the best out of the function of your knee, but also that the operation itself will produce swelling and a painful joint and if you push too hard to go too quickly with your rehabilitation, it's a really painful experience.

So the first six weeks, with help from the physiotherapy team who provide a plan for your rehabilitation, will be building up the amount of walking that you can do. You will use crutches to help your balance, but you'll be well to walk and fully weight bearing your knee. But you're balancing doing too much so that it's a bit too painful versus trying to do as much as you can to get the knee moving and to get the knee bending.

And I think we used to be-, we used to go too hard early on for patients to get the knee bending. And what we've realised is you can be a little bit more relaxed in that and it's what happens at the end of the six-week period; as long as the knee is starting to move, you're starting to get a range of movement which is now up to 90 degrees, so you can sit comfortably in a chair - that is the aim at the end of that six-week period.

But be aware that if you talk to patients who've had a knee replacement, everyone will say the same thing. It's a period which does have some pain associated with it. And we need to manage that with medications. We're much better at doing it. But that characterises that first six weeks.

A couple of things happen in the first six weeks. Typically at two weeks, you'll either come back to the hospital or visit your GP to have your clips removed or the stitches removed. So the wound checked and the sutures removed. Then at six weeks in many, I would say most, places where this type of work is done at the hospital, you'll come back for a check to make sure that all is well, that there are no local complications. Infections are not a problem. There's no blood clot, and everything's moving in the right direction. And at that point, you continue with your rehabilitation.

And at the six-week point, from that point forward, over the next 3 to 6 months, you make much more progress in terms of your mobility. By the six-week period, although your knee is still a little warm, swollen and tight, may feel a bit sore, your osteoarthritic pain in the vast majority of people has gone, and that that's such a relief to patients that they really see that and they feel the benefit.

Then getting over the operation and the swelling and tension and tightness in the knee takes another 3 to 6 months. When you see most people at six months, they are really very comfortable, moving well, and they've got a lot of benefit from it.

At the six-week period, you almost certainly don't have to use crutches or walking aid. You're able to drive and you can fly and move around and travel if that's what you'd like to do. So you're out of the early phase but you're now in this period of developing your ability to get back and do all the functional recovery that you would like. You know, where you're aiming for.

I think it's fair to say that if you are a frailer, more elderly patient, that another factor is that you are knocked back quite hard by the operation. You'll feel tired and washed out maybe for 3 to 6 months. If you're slightly younger, then you'll get over that bit a little bit quicker.

But when you see everybody say nine months to a year, that's when you see the real benefit in joint replacement. Their osteoarthritic pain is gone. They've returned to the level of function that they've achieved and in most cases it's higher than when they started out. And they feel very happy with the improvement in their quality of life. So I hope that gives you a kind of little summary of what to expect over these periods: in hospital having the operation, immediate recovery once you get home, that first six weeks which are tough, the next three months, which are gaining more and more confidence, and then by six months to 12 months where you just get on with your life and you've recovered essentially from your knee replacement.

So I think it's important, you know, just if we just focus a moment on that group of people who earlier I said perhaps who are slightly frailer, say, the more elderly population, or patients who have multiple other medical conditions. That the recovery dependent on those medical conditions and what happens in relation to them during that initial period of having the operation, your recovery can be slower.

So for a patient who has, say, a very strong cardiac history, has had a heart attack before or has a problem- a long-term problem with their heart. If you add to that, say, you have diabetes and you have a problem with your breathing, that patient doesn't recover at the same rate as a patient who doesn't have those other issues.

Of course in the shared decision making around deciding whether to have the knee replacement or not, these are all factored in. So these are not surprises to the patient; when you come forward to have it, these will have all been discussed with you. But that patient who does have other conditions going on, the recovery is a slower process. And of course we need to make sure that there's not an exacerbation of one of those conditions. For the patient who has Parkinson's disease, for instance, that may be more challenging in terms of your mobility. You may go backwards before you go forwards in terms of your ability to move.

The patient who has a problem with their breathing may find that it was very tough to get going early on because they're short of breath, but they slowly catch up.

So I think the speed of recovery in that first year is partly determined by some of these pre-existing conditions that you need to consider and need to be discussed at the point at which you're deciding to have the knee replacement. They need to be brought out and emphasised at the pre-assessment process before you have the operation, and then they need to be considered in your recovery.

Working hand in hand with the GP, the hospital and the GP working out to understand that that those patients may go a little slower. And as long as everybody's aware of that, the correct supports put in place to get them a good outcome. But I think it's also fair to say that as long as these things are managed well, that some of these, you know, multiple other diseases and the person who has a lot of health care burden is still eligible to have a knee replacement as long as they understand the risks and what it means for them.

And, you know, we are probably much better at managing this than, say, if you go back certainly 20 years ago. The key important thing is to understand that it's about the individual patient. And their issues around other healthcare conditions in the decision making and then in the recovery.

Thank you.

How was your experience of coming round from the operation?

Oh, it was great. Whatever they gave me I think I was really high, I was just like, “Oh right, have I had the operation?” [laughs]

And then they said, “Oh the physiotherapist is coming,” and they’d got the stairs, and I was walking up and down the stairs, and doing everything they told me to do, and then I thought, ‘Oh my goodness, when all this wears off around the knee, it’s going to really hurt.’

[Laughs] Which it did, but I thought, ‘Oh I wish I could have this feeling all the time.” It was lovely.

Well, I wonder if I actually felt too good, ‘cos it was a weekend when I went in, it was a bit thin on the ground with physio care or any doctor coming to the ward.

The physio, two young women came to the ward, they were physios, and they just sort of said, “Are you able to do anything blah, blah, blah?”

So, I did some of the exercises that I’d read about in, in the booklets that I’d had from both the hospital where I couldn’t have the operation and then the one where I could, so I’d been doing the pre-ones, and then I was doing the after-ones, which to be fair there’s not a great deal of difference when you’re bed bound, cos at this time I’m in bed. So, you know it’s lifting the knees, the feet off the bed and that sort of thing. And you know it just all felt so easy.

And I do kind of wonder if I did too much because, you know, since then it has been a really slow recovery, and since then I’ve seen the physio lots and lots and lots, and she’s sort of prepared me more for the coming one, not to really go crazy cos she said, “You’ve got to remember you’ve still got all that stuff in you that they’ve pumped in. So that’s why you can’t feel anything.”

Yes, so whether I did do too much or whether all of what’s happened would have happened anyway, I will never know. But by the next morning, cos I was early morning going to the operation, so this would have been in the afternoon of the first day, so in the morning I couldn’t lift that leg off the bed, it was just like so, you know as if it was a ton weight

I just couldn’t lift it at all. And well we’ve had a slow job ever since then really.

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.

I had my surgery on the 1^st of August. That went okay. I was-, after five days in the [hospital] I was transferred to the community hospital where I was supposed to have rehab.

I didn’t think [it] was very satisfactory because they gave me a-, I was there for about, oh, nearly a week, and then I couldn’t walk only for about as far as half a length of the bed. And they came out with an elbow frame, which is awkward, and told me to walk across the room to the toilet, which must have been about, 30 feet. I had to walk, though I’d never walked before.

I was in absolute sheer agony. I was going along saying, “Well, no pain, no gain I suppose.” And that was it. And then I just did that every couple of times; I couldn’t walk both ways, as they wanted me to.

I never went to the physiotherapy bit. I never walked along between parallel bars or anything like that. I never had any massage, nothing like that. And then they said, well, after two weeks of battling on, I did manage to wash myself and so on with help, but then I was a bit better at it, as long as they wheeled me there, because it was too far for me to walk without being in agony.

A few of the doctors came round about once or twice a week and they changed my medication, or altered it, whatever, and then after two weeks, on the Friday, I left, and I said, “Oh, I can get my sister to pick me up,” and they says, “Oh, she can’t pick you up because we haven’t shown you how to get in a car.”

Anyway, so I came home by ambulance.

And after that, for about a day I’d say I couldn’t feel anything from my waist down, but I could move, but there’s no pain until the next day, or I think the pain started to come back during the night.

And it was my fault that I didn’t ask for any morphine, because I didn’t want to get hung on morphine, or I was a bit sort of wary about it, yes, about having too much morphine, so I thought, ‘oh well, I’ll try and go to sleep,’ but it wasn’t much pain, it was more of an annoyance pain, you know, where…

Wife: Well, you didn’t sound brilliant [chuckles].

Yeah. I mean I-, wife came to see us-, what it is, I think it was the afternoon,—

Wife: I saw you on the Saturday morning and afternoon.

—yeah, and she come to me in the afternoon, of the day, and then I said, “Oh, it’s great, you know, it was really great,” and—

Wife: The morphine talking.

—yeah, and course the next day, totally different, I was more or less-, not that I’m uncomfortable, my leg’s aching, and this is aching but the pain didn’t last long.

I think it will probably be about a month afterward, because obviously, you know, with the healing and everything, that’s always very painful and I remember the first few weeks being very uncomfortable in bed because I couldn't-, I didn't know where to put my leg, you know, to get it comfortable and so on.

But I suppose after about a month I knew that things were better because the pain was starting to ease off and I could move my leg better, so I suppose it took about a month, yeah.

It was good actually, and I must admit I recovered very quickly. I'm not saying it wasn’t painful, because it was, but you know, pain fades. You do the exercises and stretches whatever it has to do, and as long as you do them, you recover quickly.

I know because a friend of mine didn't do all the exercises and didn't persevere with them and she can’t get her leg straight.

I think that was the most painful part, is getting your leg straight properly you know? Being able to bend it back the full- I think is it- is it 90 degrees? Something like that, that you have to get your leg? It’s that stretching part of bending your knee so much and pulling it back to this- to that degree, that was the painful part.

But that’s all part and parcel of you being able to walk properly afterwards.

So, I did have the operation. I was delighted to have it, obviously there was the normal amount of pain, I wasn’t able to sustain the strong pain killers for longer than a week as they had nasty after effects, so I maintained paracetamol at 8 paracetamols a day.

And how quickly did you start to see sort of the pain go away and sort of see some benefits from your knee replacement?

Well, I should, I likened it not to having a bad cold or flu, generally you know if you  have flu, and once you start getting better you know you start getting a little bit better every single day. And the graph goes straight upwards. I did find however with this that it wasn’t the same. I had good days and not so good days.

And one day if you like I’d feel, “Oh you know this is feeling a lot better today, a lot less pain today.” But then the next day I could then be, you know the pain could return. So, although I felt that the graph was generally moving upwards, it was zig zagging upwards, if I could put it that way.

Oh, I mean it-, well, I mean soon after the surgery, coming out of hospital obviously, the pain, you know, gradually decreased. Obviously in the first couple of weeks, you know, it’s all swollen and bruised, your knee, so that takes a while to go down.

And then I think the last sort of pain I had with it was usually during the night and I think it’s because sometimes in the night, you're lying in one position maybe for too long and so it wakes you up because it’s painful.

But I used bags of frozen peas on my knee to ease the pain. I didn't want to take - once coming out of hospital, personally - I didn't want to take any more painkillers because while I've been in hospital, obviously you are given a lot of medication, and I’d ended up very constipated, and I hate it, so when I came out, I got off painkillers as soon as I could.

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.

When you first came out of hospital you had some painkillers that you were sent home with, but you tried not to take quite so many of them - is that right?

That’s right, yeah, they give me codeine, which is about 20 milligrams, and they gave me some morphine as well.

Yeah, and so when the physio came, she said morphine is a quick-acting, but the morphine-, only if you’re in extreme pain and it’ll take the pain away, you see? So, I didn’t take any morphine.

And then I did talk to my doctor about it, I did phone the surgery and they weren’t too happy about codeine really - but anyway I think they gave me 21 codeine or something like that, or something in that region - three weeks. But I took over two weeks and then I stopped.

Then I was taking-, they spoke-, and the surgery sent me some more co-codamol, yeah, so I - yeah, yeah.

And that was your choice - you just didn’t feel that it was necessary? That you could manage with the pain you had at that time?

Yeah, yeah, right. The fact-, and I wanted to cut down and taking too many pain-, because of my age as well, you know, you don’t forget.

You know, a younger person and a body who could tolerate it, but I don’t want to-, I’ve got to put up with a little bit of discomfort and all that because it’s to do with- The painkiller is-, it’s not a cure, it doesn’t cure anything, does it? [chuckles].

Yeah, and the painkiller - what I had was just to take the pain away so I can sleep or relax. So, I took it, I took as long as-, I think you could take-, you could take four tablets-, four tablets a day: I was taking two.  I wasn’t even taking-, yeah, that’s right. And they gave me two-weeks’ supply.

I could take four, but I cut down more or less straightaway from four to two every six hour-, I actually I was taking two for two weeks, then I stopped that, and then I was taking one, I think, and then I stopped that. I was just taking co-codamol, yeah.

After the surgery how quickly did you start to feel things were improving for you?

I’m not sure. Maybe about three weeks, I thought, you know, I wasn’t getting so much pain, and you know I had the stitches out, and I was just able to sleep. It was horrible not able to move really in bed, 'cause I couldn’t bend my knee, and it was, it would throb at night so, yeah it was, it was altogether quite quick.

When did you stop taking pain relief?

Well, the doctor gave me another prescription for it, but then he wouldn’t give me any more, and he explained to me that they were opioids and he didn’t want me to get addicted.

So, I kind of understood that, cos the tablet I was on, I can’t remember the name of it, but it was the equivalent of morphine. But yeah, so, but I did manage, but it’s just it got me to sleep and all that sort of thing.

And I must admit it’s very painful. Not now, but it, that that first two or three days very painful.

Can you tell me a bit more about that? So, the first couple of days, what

Well, they give me two crutches, I had sticks to walk on, fair enough, well I did, and I walked on those, and they give me painkiller in a jar. And I had to inject myself for ten days with something, I dunno, I suppose to stop infections.

So, I mean that was, yeah, they give me when I left the hospital  - injections and all of that. Which, no problem I just, you have to inject yourself in the stomach - which was okay I mean, to be fair I had to do it with my missus when she got ill, so I done that alright.

My two daughters stayed for a week, over a week. It was painful. They give me a pamphlet all about knee replacement and so forth, and the exercises to do, which I started doing, well I suppose, the day afterwards.

I was stupid - I should have had the painkiller. I had the medicine and all that, I didn’t take enough of. My own fault because I thought, ‘No, I can do without it.’  But you couldn’t do without it, put it that way.

But then I, dunno, [after] a week, a fortnight doing the exercises I then started walking up the road with the two sticks.  And then in the end I left the sticks alone and just had one walking stick and I walked up the road and done that, and walked round, a bit of fresh air and exercise.

Well on the, I had the operation I think early Saturday morning, and by the time I came to and it was Saturday afternoon, because I was still anaesthetised from the waist down, quite honestly it felt absolutely brilliant. And I was able to get up and I was hobbling around on crutches and a team of physiotherapists came along to see me, and even I was going up and down the stairs and they said I was making remarkable progress and that I could go home the following day. So, I was absolutely delighted about that. But of course, then what happened during the evening and during the night of course the anaesthetic completely wore off and on the following morning of course I was in quite a bit of pain.

And I couldn’t do the what I did the previous, the previous afternoon.

So, I did go home and to be perfectly frank with you, I think I went home a bit too early because when I did get back home there were difficulties particularly, I had great difficulty and I was extremely worried about actually just getting up the stairs. But eventually I did manage that, but there we are. I was on strong, still on strong painkillers, so that was my return home.

Yeah, and then Monday the physio came, [chuckles] and then they went to the stairs.

I said, “I can’t go up those stairs I’m too-,”

“No, no, you can.”

Then they took me down a flight of stairs and, oh dear, I probably something about 12 steps or somewhere, and then I was walking and the ward doctor said, “Oh, you’re-, you’re doing okay,” I said, “Yeah, yeah.”

And then he came and see me, he said, “Look, let’s stay tonight-, today, and you can go tomorrow.”

So, I was there six nights.

Six nights, okay.

Yes, which really—

And did you...

and I was-, I was happy, I appreciated it.

One thing I would say a hundred percent - do the exercises.

Because they - it’s bad enough but - I mean it is painful to start doing the exercises, I must admit, but you must do.

I mean I was doing them two or three times a day. And it does make a helluva of a lot of difference, but everyone I talked to said exactly the same thing. You’ve got to do your exercises. And if you’re not happy, let someone know.

Because, you know, it is a big operation, I didn’t realise how big the operation it was, and I mean well, I think the main thing is if you’re in a lot of pain you’ve got to have the operation. You will be in a lot of pain for perhaps a week, after - a big pain, I mean when you’ve got to take painkillers.  But if you go back along with what to do, it’s gonna help you a helluva lot.

You know I mean it’s - and as I say everyone I talk to has had the same thing - they said, “Well you must do the exercises.”

Because remember - if you don’t you ain’t going to get, your knee is gonna get locked up, isn’t it?

Well, when I went to the physio, they're a big department, I mean I was already-, because I’d been delayed a fortnight, I was already walking without a stick, etcetera, so they were quite pleased about that.

Really all that happened was they got me up onto the bed, measured again the bend in my knee, which apparently was very good, but there was still a problem when my knee was very flat on the bed.  I hadn't got it completely flat behind my knee, but my knee at that point was still very, very swollen, you know, so it was quite painful.

So, all they suggested was one exercise which was pushing my foot against the wall so that I was stretching the back of my leg, and also, I think bending and stretching.

I was only there about 20 minutes, and then I went home and the next appointment I had was the same really, they were just checking to see whether the bend or the stretch had improved.

And in between, yes, they just said, just keep on doing, you know, this particular exercise, and obviously keep moving, just to try and get that leg straighter at the back.

But I appreciated the instructions to, to do my exercises, it was impressed upon my mind very, very strongly that if I didn’t do them then the whole thing could have been a waste of time and the whole thing you could be back to square one, again, and there would be no chance of putting it right. So, if I didn’t do the exercise then forevermore, I would be in pain and in trouble.

So that was an incentive to do the exercises as you can well imagine.

And do you think that that’s part of the reason why it has been such a good outcome for you?

I think obviously it’s I think first of all it was the skill of [name of surgeon], of which I’m eternally grateful, and, and secondly, yes, I think it’s the, the exercises and also the I, initially I, I had written exercises to actually do, but then when I got to the classes that really was a great help.

Was that in terms of someone being able to sort of check that you were doing the exercises correctly, and sort of giving you advice as you go?

Yes, I think so and the fact that there were some other people there as well, you, you wanted to keep up although it wasn’t always possible to you know if we had to do something, I dunno, twelve times, you did your best but alright you, you, if you had to give up you gave up after ten, whereas if you were probably by yourself, you’d have probably given up after I dunno six or seven or something.

But you had other people to do it with sort of you know keeps you going a bit and you think to yourself, ‘Well come on, keep going, don’t be a wimp.’

So [laughs] I think that that’s actually good that you, you’re actually exercising with other people.

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.

The facilities were first class. The staff were first class. The care was first class. The surgeon was a genius, and the operation went as sweet as a nut. One little issue was I had snagged one of the staples, in the knee, because of the-, you have to perform immediate exercises, and the exercises opened up the wound.

And they couldn’t have been more meticulous with regards to the application of these-, a specific type of bandage which withdrew impurities from any of the wounds, and I needed three of those, and each time it was applied with meticulous precision and care, and, you know, basically the health service was fantastic.

It took a little bit longer to heal the wound because of that-, the rest-, you know, there’s a great significant scar across your knee, and it was just this one little area that kept bleeding. But apart from that, the whole thing went as sweet as a nut. I was up and about grass cutting almost within-, you know, within a matter of weeks.

Tremendous, absolutely couldn’t-, couldn’t speak more highly of it, really successful. And it’s given me absolute, you know, mobility in the knee, it’s just transformed my life, and I just wish it could have happened sooner.

And it was your left knee, and it was a total knee replacement, is that right?

That’s it. A total knee replacement. Absolutely brilliant health service; first class.

Brilliant, brilliant. And the bandages that you explained about when the sort of wound opened up, is that mostly-, that was to kind of avoid infection, but there was-?

It’s to avoid infection, yeah. That’s exactly what it was, because they're really concerned about sepsis and stuff like that. And seriously, it couldn’t have been-, and they're pretty expensive these bandages as well, you know.

It’s like a massive long, extended bandage which applies on with adhesive round the wound, and there’s a tube attached to it, and that tube is attached to a pump, which you carry round strapped to your waist, and that works constantly to withdraw any potential air from the wound. It just pumps out all the time, you know?

It’s a phenomenal piece of kit.

Yeah. And how soon did that happen, was it sort of quite immediately that-?

Oh, I did-, it was my fault: I bent the knee. I was getting back into bed, you-, [chuckles] like, they give you these paper underpants to wear, and it was removing those - I bent my knee too far to actually get the old underpants off and my own ones on, and I think I did it then.

So next time when I get it done, I'm going to be more careful in not stretching the knee initially. But it was just one-, they're metal staples you see, and it was just one metal staple, and I just couldn’t get it to stop bleeding. It was just one area, the rest healed up dead quick, you know?

But-, other than that, you know, fantastic, absolutely fantastic. And it didn't take long after that for it to heal, you know. It was-, but it did extend the period of being able to get up and about, which was a little bit of a frustration. But never mind, we're up and done. Fantastic.

And I will not be so hasty to just want to be up and about: I'll do-, I'll be a little bit more pragmatic about the process, because now I know how long it really will take, I won’t want to think I can do it all in five minutes.

I just wanted to be up and about and doing things too quickly, so I'll do-, I'll be a little bit more, as I say, pragmatic about the process, because I know that I'll be able to do it within the six weeks; I wanted to do it in three. And six is adequate, you know? So I'll be working my way through the process properly as opposed to trying to do it in 20 minutes flat.

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.

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.

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.