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

So, the way I look at steroid injections depends on the stage of the osteoarthritis really. So, as I think I mentioned earlier on, in the early stages of osteoarthritis where the joint is not too damaged, if you like, degenerated - it's the sleeve around the joint that's largely responsible for the pain. It's called the joint capsule. So, for patients with early osteoarthritis, it makes sense to me that if you inject steroid, corticosteroid, local anaesthetic into that joint, bathe the capsule in medicine, they're much more likely to have a good outcome because you're- it's the capsule that's causing the pain.

As the osteoarthritis advances, the capsule is still inflamed, that's for sure, but it becomes more about bone-on-bone pain. Which patients often describe as different. Now if you put steroid into a severely arthritic joint, you're likely to get temporary relief because while you’ll bathe the capsule and settle the capsule down, you're not going to do anything about that bone-on-bone pain. Certainly nothing prolonged, so the pain will come back. And what we tend to see – there’s not a lot written about this but some clinicians have noticed that when you give a patient with severe osteoarthritis a steroid injection, when the pain wears off, sometimes it appears to be worse than it was before. We don't really know why that is but it's called rebound pain. So therefore, steroid injections are generally limited for people with severe arthritis unless surgery is not an option for health reasons or the patient doesn't want an operation. In that situation, yes, it's worth a try. But we just need to make sure that the patient's expectations are aligned with ours.

It’s so unpredictable. In the morning, before the walk, I was taking painkillers before I went all the time. But I did recently have the injection, the steroid injection.

It hasn’t been quite as pain relieving as when I had it about two years or so ago. But it has made a considerable difference, though I haven’t had to take-, I only take paracetamol. I have been prescribed something stronger, but I delayed it because of the glaucoma operation because there are side effects, as there are with most tablets.

And one of them was to do with eyes. So, I thought well, I’d be a bit stupid to start something that gave problems with your eyes when I was just about to have [laugh] an eye operation.

So, I left it and, so far, haven’t had to resort to the stronger ones. And at the moment, I’m only taking the paracetamol in the morning before we go because okay, it’s not very long since I had the injection but you can tell it’s sort of beginning to wear off, it doesn’t actually last all that long.

I’ve always had knee problems for some reason, but, oh, quite a few years ago, probably about the same time my GP gave me cortisone injections and they worked really well for about- I only had one lot and they worked for about four years and then I had them again - and then I’ve actually forgotten the timeline - I think I had two lots with him.

And then last summer I was going on holiday and my knees had got quite sore, so he did them again - but he said he couldn't do any more. I don’t know whether that’s the National Health or what, I didn’t even ask.

So because they’d worked so well before, I didn’t think it would be anything urgent and they worked straightaway. But then by November my knees had got incredibly painful, so to the point where I could hardly walk.

I knew he wouldn't do any more injections, so I- a friend of mine had known a [knee specialist/surgeon] and recommended him, so I went to see him privately and he injected one knee, my left knee, and said that he could inject them every three or four months. But he thought with modern, more recent technology, they could probably operate on them, so he referred me back to my GP for treatment under the National Health.

So that was where we were at, and then they got painful again recently - about three weeks ago - and I decided I would just go back to him, and I went back to him and he injected both knees this time, and touchwood, so far, they’ve been fine.

Oh good.

But I do now have an appointment at the orthopaedic hospital under National Health.

Yes, I had one in in that knee years ago when I was, lived in [town]. And I went in there and had the injection, came out and I thought ‘this is good. I can’t feel a thing’, you know. It was absolutely fine. It was brilliant. On this occasion now, with my right knee, the first one the doctor gave me it didn’t do anything, it didn’t do anything at all. I think I’ve had; I think I’ve had three altogether. And no, they haven’t done anything at all. Steroid injections in my leg. But it did initially, years back because I suppose years ago, my knee wasn’t in such a bad state that it is now. And the steroid injection helped. As your knee gets worse, it degenerates and what have you, so on and so forth, steroid injections don’t work.

Well, I had it four years ago when I had my other knee done. And, years ago, you used to be able to get it, you could get one every six months.

So, I had one in six months and it definitely helped and I had one another six months and it helped. And then the next time I had it, it didn't work, so when they done the X-ray, they seen there was no cartridge left for it to go into.

So, when the doctor said, they send me for this, I was hoping it would work, but it didn't.

As I say, then when they X-rayed it, they said, “There’s no cartridge there to put, you know.” So that’s when they said they’ll refer me to the hospital.