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

Anyway, the last night, we thought ‘Okay, we’ll give it a go’. We hadn’t jived for a year or more. So, we were going great guns. Absolutely great guns. Then suddenly my knee cracked and went, “Oh my god, what was that?” And that was it. That started me off on the path of going to the doctors initially. And then I had a couple of bad falls. It just gave way, it wasn’t there, and finished up with an x-ray and got a referral. And that was in the August 2020 and yes, I’ve been sort of waiting since for the knee.

And so, it was quite soon after you came back from holiday that you went to see your GP about the knee problems?

[Inhales] Yes. It was, I remember, ‘cos I started going to see an osteopath for my back and I must admit he was very good. And he told me, more or less where the problems were in my spine before I had the MRI scan.

Oh right, wow.

And I was, you know, when I gave him the MRI scan and [name of osteopath], I think he said, “My God,” he said, “I’ve never seen such a detailed report in all my life.” He said it was brilliant. ‘Cos it itemised the whole of the spine down, which was good. However, I went back to him with my knee, told him about my knee and all that. Anyway, I had a couple of sessions with him and he said, “Look, it’s not responding to anything.” He went, “You have to go and see your doctor, and go down that line.” And that’s how I, what happened.

We started talking about it I would say possibly 18 months to two years ago.

And it got progressively worse.

And the doctor I was telling you about, she’s a very nice lady, she said to me probably about nine months ago, maybe a year, “If you want me to refer you to the knee team I will.” And I said, “Well you know we’re in the middle of a pandemic, or at least the pandemic’s started, so I don’t really want to go into that sort of situation,” ‘cos my wife was shielded.

And, you know, at my age with a few medical problems I’m at risk, so I said, “well I’d like to do it at some stage but I don’t think this is the right time”.

And then I contacted her more recently and said my knees are such a problem that yes, I would like you to refer me to the knee team.

And so, she then referred me. And then out of the blue six months later she wrote a letter to the knee team saying I referred [participant’s name] some time ago and I note that he is yet to appear on the list and she was quite, you know she was quite unhappy about it.

And I was amazed that she’d actually picked up that I hadn’t appeared on the list because it’s not her job if you know what I mean? The knee team is one department, the Orthopaedics’ another.

But she had noted that I hadn’t appeared on the list. But it’s my fault entirely that I didn’t - that the whole thing didn’t get going a bit earlier.

No, my GP, when I mentioned it to him before, he said, “Well, you can’t have an operation because of your heart.”

Which sort of put me out a little bit and that’s why I stopped going to the doctor about my knee, but it was getting so painful after a while I thought ‘well, I’m going to have to bite the bullet and get a referral to the orthopaedic hospital’, which is where we are at now.

I got up in the middle of the night one night and I couldn’t walk - something had gone in the back of the knee. That has since righted itself somewhat, but I mean the surgeon was telling me it was almost bone-on-bone back in 2000 and- well, I suppose, ’15 or ’16 when he finished my check-ups.

And was that the sort of trigger event that happened, and then you saw your GP wanting some more investigations?

Yes. Yeah, because the surgeon had always said to me- when I felt the knee needed doing, because he already has one X-ray on file already, although I will be having another one on Friday. He said, “Just get your GP to contact me directly, you don’t need to jump through so many hoops to get to me,” he said, “you will know.”

And I’m on, you know, I’m on the books, as it were [laughs].

Do you mind me asking a bit more about that appointment you had with the GP? What was that like, what sort of topics did you discuss?

Right, first of all I had a phone appointment—and then she said, “Oh, I think I need to see you.” So, I went down to the surgery and she did quite a thorough physical examination - poking and prodding and stretching, and seeing how far I could bend things.

From what I remember that’s when she prescribed me the ibuprofen gel.

She was - I thought she was good, she was only a young woman and I didn’t know her—but she did take her time, you know? She took time to do it—and I was quite glad to be seen quite honestly.

I asked her to refer me—explaining to her that this is what the prof had told me to say—that he sort of knew about it and knew it would need doing and just told them to refer as soon as I said.

I’ve had two X-rays. I mean one was about, I don't know, a year, 18 months ago. It said a slight arthritis.

I had another X-ray ‘cos I said to my doctor, “Well, we'll get another X-ray on your knee.” So, I had another about a month ago, three weeks ago. And he turned round and said that, “Yes, it’s still arthritis, but not, you know.”

And he seems to think it’s not that bad. I said, “Well, see the prob-, I live on my own now, which is obvious. And I’m scared I’m gonna fall over in the shower. I live in a small house and the shower you couldn't get two people in in my bathroom- then I’m gonna be left there because no one’ll know I’m there."

I mean I’ve been with the same surgery since 1942. Mind you, it’s changed with a lot of different doctors as well. But I’ve always, I mean, like I say, I’ve been lucky with my health because I haven't used the doctors hardly at all till the last say the last ten years sort of thing. So, again, getting old. But, yes, he’s been very good with me.

My GP, I would say is one of the best I’ve ever had. I mean like I said, I’ve been there since I was born, so that’s nearly 80 years ago.

He’s caring. He tries to look after me.

No, I said although it had started in the February, I’d kept on going because it was the height of the pandemic and, you know, you couldn't access doctors very easily. But by the time it got to November of that year I was in such pain, I mean it wasn’t just the knee, I’d got this pain starting at the back of my knee which was, you know, more like sciatica and, and so I was just desperate to try and get some kind of relief.

That’s why I contacted the doc - and I thought ‘well, if I had an X-ray and somebody can say to me, 'this is definitely something going wrong here," you know, perhaps something could be done about it? But that’s when they suggested I have the steroid injection.

So, I went for another steroid injection in my knee.  Unfortunately, after about two to three weeks it gave no respite at all, it didn’t seem to give me any comfort whatsoever, so I just carried on with taking paracetamol at that time to try and cope with the pain.

And then, yes, the last one, I think it was the last November about, I think, I rang up again and they did suggest having another injection, but when I got to the doctor, I explained that the previous injection had no effect at all on my knee, and in the interim I had had an X-ray and the doctor said he agreed with me.

There wouldn't be much point as really, I was bone-on-bone now, there was nothing, just one bone rubbing against the other, so that’s when he suggested that he would put me forward for the [hospital] and he also recommended, maybe, I could take stronger opioids, but I’m not keen to do that.

But I already knew that I needed a knee. And they told me that, you know, “Yes, you need a knee after the hip”. And I’m thinking that you know, my husband is not doing as much driving as he was. You know, maybe I’m going to need to take on a lot more on that side.

And really, leaving it a long time would perhaps be foolish. I feel I’m young enough, if you like [laughs] still to be able to heal. I don’t want to get to the stage where I’m really at my wits end before something is done about it.

I have a feeling it’s going to be quite some time and therefore I feel it’s right to go ahead now to make sure that I can get on a list however long it is, it happens to be.

At least I’ve got something to look forward to if you like, you know? I know that something will be done. I don’t really want to wait until I’m so desperate that I can’t move around in which case if you go then, and you still have to wait which you - one waits for a long time anyway.

I think with my knee originally, I waited for a year and a half in the end. I think from my first saying, “I think I’ve got a problem.” In fact, I’m not sure it wasn’t longer than that. I think it’s nearly two years, [from] the first talk to the GP. I don’t much feel that, you know, I’ve got another two years on top of everything.

So, if I had the discussion now, they’d say, 'we’ll put you on a list, but you’re a long way off,' then at least I feel I’m on a list and at some stage something will be done and I don’t have to wait till I’m literally at my wit’s end beforehand - before, you know, it gets taken seriously.

I still want to be able to go and enjoy time with family. We had a family get together, not last weekend, the weekend before, post-Christmas family get together, post-2020 Christmas. It’s the first time- the family got together.

Oh gosh, so it’s nearly the next one [laughs].

We did walk around and do, you know, we went on walks and they were very patient waiting for me [laughs]. And taking easier routes and things like that. But you know, at least at the moment I can do that, but it’s not gonna be that long before I’m gonna find that is impossible. And I know that I can’t do it the same as them.

And thinking about your left knee - how long ago do you think you started having problems with it before you went to go see your doctor about it?

Quite a long time, actually. I was naughty. After suffering with the right, I should’ve gone before, but because of Covid and that, you know, I didn't. I should’ve gone. I think I did go before Covid hit, but when Covid hit I let it slide, if you know what I mean? I didn't keep on, ‘cause I thought, I can’t because you can’t ever [have] one-to-one with the doctor anymore and all that sort of thing stopped, you know?

And I thought, if I can’t talk to anybody about it, I can’t just you know, do anything. But just walk and do the best I can. So, yeah, it went on a long time before I actually reported it, which was silly of me, really.

Was there sort of—

In the end, the pain was so bad that I just said, “I think I ought to have an X-ray.” And that’s when the doctor said, okay.

But the one I do see, which I do accept-, I make sure I see her on, she’s an old-fashioned GP so it suits me. So I try and make sure that, and then they said to me, “Well why have you chosen her?” And I said, “Well I’ve chosen her 'cause,” I said, “I’ve had two appointments with her, that’s good going.” So, I said, “If I can go, keep going to the same one, would help.”

I don’t know why they can’t see it doesn’t help.

But, you know, there are some GPs are very good but I still think you should have the same GP all the time, if possible.

I know that, you know, they fall ill, they have holidays and so on, and I recognise that if you want a GP that day, 'cause you’re concerned that day, then you have to, you have to just have who’s available. 'Cause they now have a rota of who’s on a day-to-day one.

But as I said, if you’re having a sort of appointment every six weeks or whatever, can you please see the same person?

There’s been a number of changes of doctors, so that the doctor I’d seen before left, and it was another doctor, and then another doctor.

We’ve had a lot of changes—so it’s difficult. People don’t really know- don’t know- they don’t get to know you—and you don’t have everything on a list.

I mean I know it’s on their computer, but whether or not they can really get everything just in those seconds before you go into the appointment, I sort of have some doubt to be honest.

Well, it literally, when I wake up in the morning, I don’t know whether it’s gonna be my right knee or my left hip giving me trouble, both together, one or the other or sometimes neither, it really is as random as that.

And I know that it’s been difficult to speak to your GP and you sort of saw them separately about both the hip and then the knee at different points. Is your GP aware that you’ve got both ongoing?

Oh, probably yes, yes because the last, you’re normally only allowed to discuss one problem.

And so, you know, like I say - you make an appointment with your doctor, you get a ten minute slot - and you’re lucky if you get one within four weeks.

So, what I did when I was talking to him about the hip, I sort of slipped the problem with the knee in at the same time really, which you’re not supposed to do but how else can you get to talk to anybody about it really?

I mean it, I don’t blame my doctor it’s just the system at the moment.

As I say, you go on and you’re sort of thinking ‘well it’s a bit like the other one’ but then you think you tolerate it and think ‘maybe I’ll get away with it?’ But I think as I was talking to the doctor, I felt I ought to mention it especially with the way things are and waiting lists. I thought, well maybe I ought to get myself on a waiting list? I can always make a decision later down the line.

I saw the NHS physio, yeah before.

Before that? Okay.

Yeah, months, oh physio, a few weeks before yeah.

It was only two or three weeks, two weeks before, or something like that.

And he was, he didn’t take x-ray, he thought he’d just, a lot of people have arthritis.

And he said, “Look-”  I said “I need to w-”  He said, “No, no, you probably don’t need walking sticks, start using, start walking now.”

And then I thought look, maybe he knows something and I, maybe because of pandemic I thought I haven’t been, well yes of course because of pandemic we haven’t been out a lot. You know that made matters worse because we were scared of getting the virus.

So I thought maybe I haven’t been exercising. I’ve let my, you know? Maybe I need to do some exercise. So, I said, “Look, well let me give it a good go. And I started walking and then my knee kind of you know, became very painful, flared up. I could hardly walk.

Well I didn’t go to A&E. I thought about it, but I didn’t, because of pandemic, you know? You don’t want to go there and catch the virus.

So I just phoned, you know the, this chiropractor. And I went there and he took an x-ray and we saw it. And then I phoned the doctor.

So I went to see my GP and he looked. “Now,” he said. “OK then, what I’ll do is I’ll send you for an x-ray to a local hospital.”

And then two or three weeks later he got the results from x-ray, he phoned me and he said, “Yeah, you need to have a knee replacement.” So, then he referred me. He said, “You went to [hospital]?” I said, “Yeah, that one. Send me back to the same.”

So, then he referred it.