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

Osteoarthritis is a very common condition that affects many people. It's age related. So it's more commonly seen in people, say, over the age of 50. And that is because it's a condition which is related to your genetics. So you have a predisposition to it. But you can also develop it without any sense of genetic predisposition.

So it's very common. It's a condition which is characterised by certain features within the joints, which produces a clinical pattern of symptoms which really relate to pain, stiffness, swelling and therefore loss of function. So loss of ability to walk around easily, do activities of daily living. And there are a number of factors which contribute to that.

Some of them we know a lot of information about. So, for instance, we know that age is related to the development of osteoarthritis. We also know that weight is associated to the development, and contributes to, the kind of process of it deteriorating.

We also know that there are certain other things that can happen to a person which may affect your ability to develop arthritis. So if you have injury to the joint, if you damage the meniscus – these are the sports cartilages inside the knee - or some of the important ligaments in the knee, that can predispose you to developing osteoarthritis. If you have had a previous fracture, that can predispose you to developing osteoarthritis. And there are other conditions which, in certain circumstances, may end up with you developing an osteoarthritic pictures. So you may have-, you may previously have had an inflammatory arthroplasty. And then later in your life, if that settled down, you may subsequently develop osteoarthritis. So there's an interplay between some of the other arthritis problems in osteoarthritis.

The severity of the disease I think you could consider that in two ways. The severity of the disease that I think is probably most important to patients is how painful and how disabling the condition is. So there's something about osteoarthritis, which is unusual, is that the amount of damage that you see within the joint, say, on an X ray or an MRI scan, doesn't always correlate to how bad the symptoms are. So you can have a patient who has a very damaged disease process, a very damaged knee with loss of cartilage, new bony growth and deformity. And it's sort of easy to understand that that patient might have very severe symptoms.

At the same time, you can have a patient whose developing osteoarthritis at the earlier stages of the disease who can also have very severe symptoms. But their structural damage, you would describe as not being as severe, ao it's earlier in the process. But I think if I were to kind of to sort of summarise the key bit, the severity relates to your symptoms. So if you are very disabled through pain, swelling, that is a severe osteoarthritic picture.

It's interesting to think if there are any other things which are associated with its development, and we know that weight is associated with the progression of arthritis. So if you're above your ideal body weight then there's a higher risk that your symptoms will progress and the structural damage will progress.

Interestingly, there isn't any specific data or research which supports specific foods being related to a risk of developing or progressing osteoarthritis. There are lots of speculative work around that, but nothing where there's hard evidence to suggest that it's related to anything specifically the we eat. So the issue around weight is a more general thing that is a very important factor in managing osteoarthritis.

I think it’s natural progression because I think that I’ve had a partial knee and I was told by the hip chap who does knees and hips when he examined me that it’s - he took an X-ray of the knee just for interest and said that arthritis was coming in the other half that, you know, the outer part of the knee has deteriorated with the arthritis. And that’s probably what’s causing the problem.

The knee was never a great success at the beginning, but I didn't know until six months later when I had the second one done - which was brilliant - just how bad the first one was.

But they said that it’d been left a long time before anything was done. And it was touch and go as to whether they should’ve done the partial or the whole knee.

But they decided to go ahead with the partial because it was done under a trial.

I used to do a lot of sport, dance, I was always active. And I think, I don’t really know what I did, or if I didn’t do anything to cause it, it’s just - again - it’s my right leg.

So you tend to move with your right leg I suppose. I don't know. And it was I think it was dancing, and I used to play squash, badminton. I used to run years ago.

It could be ‘cos I’m weighty now. I’ve put weight on. But I wasn’t weighty then. As my leg’s got worse, so my exercise has slowed up and I gained the weight in the last ten years, you know? So that’s, I think that could be a reason.

It’s got quite a lot of weight on it to start with, and you know, that’s what started it all.

Yeah, I’m getting pain in my right one as well. You know, I think it’s wear and tear. ‘Cos my job, my main job was in the construction industry. And I was a bricklayer.

Oh yeah.

And when you’re bricklaying, you swivel all the time, if you know what I mean. You pick up your brick and you swivel to the wall, and that wears your joints. I’m almost sure it does.

Yes, yeah. Yeah, very hard work.

Yes. And the left leg which is gone is the one I used to rely on because I’m right-handed. And that’s the one you swivel on more than anything.

Well, this is how I think, years ago when I was working a car knocked me off my bike,

Oh no.

And that knee - so I’m on the floor yeah, my bike, and my leg is bent up and on his bumper.

Oh gosh.

If you, can you see that? As he come round the corner, he took me off my bike and that [knee] was pushed up, under my chin. My right leg.

And I think that fall I had last, last March at [granddaughter's place], it was just before lockdown, or just, yeah, I fell over her front doorstep which had a metal piece.

Oh gosh.

Yeah, yeah. And it all started from there. And I think it was trauma on trauma.

My biggest problem is my left knee. I’ve had trouble with both knees, both caused through injury. The- on the right knee I had a skiing accident when I was learning to ski and that damaged the tendons, so I had steroid injections for that; that worked, that was fine.

My left knee is more- not so exotic: my granddaughter’s Husky dog ran straight at me and pushed my knee straight back, which split the cartilage.

And although it’s been -  it was a problem to start with for quite a while but then it seemed to sort itself out; I had a fall and it seemed to straighten itself out.

Then over- about, probably about five months ago, I found I couldn't bend that knee anymore, and I did wonder if something was blocking, if it was debris or something blocking the- I can’t straighten the knee.

As a result of not being able to straighten the knee and walking with a permanent bent knee, it has now affected my hip and my back.

I’ve had what was originally prescribed as rheumatoid arthritis for probably 30 years or so.

But strangely enough it developed into osteoarthritis and the signals, whatever they are, of the rheumatoid seemed to perhaps lessen. They say this can happen but I’m not too sure of the medical situation there. But the effect of that is that I suffered for years with aches and pains. It wasn’t so much joint pains, it was just general aches and pains - legs, shoulders that kind of thing. And I took strong medication for many years which eventually after thinking about it and discussions with various consultants, I weaned myself off of that.

But I still, I still have aches and pains.

The knee problems came along in more in recent years.

You know, my legs ached, but the oddest thing was I didn’t have joint problems, and they always found this strange. It was more like my muscles and you know various other parts of my body that sort of ached really badly.

When, when I was walking, I mean my lower legs were dreadfully painful.

And they never really worked out what it was because every time I saw anyone, and they would say to me, “And how are your joints now?” And I would have to politely say, “I have never had a joint problem,” which most medical people find a bit strange, you know.

My joints are even now, apart from my hands are getting a bit stiff, are pretty good, apart from my knees, you know, they’re the main problem at the moment.

The pain in the back goes up and down. Well, it even went down my arm as well. But I presume, you know, things have related with the hip, back and the knee. So, anyway you have to, you know your limitations particularly ‘cos I used to walk. I used to like walking. But I can only walk on level ground now. I find different gradients really demanding, up or down. And I can walk say 50 yards and I can feel the pain across my back, lower back. And obviously the knee. I don’t know whether the knee’s causing problems up into my hip or whether the back is causing problems down into the knee. But the only thing I have noticed is my, this my right knee, my left knee is not far behind. I’m beginning to feel things in my left knee now.

The hip got far worse than the knee and that’s how it sort of started. Funnily enough, when I went to see the consultant about my hip, I was in the room and I was laying on the couch thing there. And he went down the end of the bed to where my feet are. And he looked at me and he said, “Oh, that’s your hip.”

Oh, interesting.

And I said, “How d’you know that?” He said, “I can tell by your knee.”

And I thought ‘amazing.’ [laughs].

Yeah, that is incredible.

Yes, so he did the hip and it was pretty good. But of course, now the knee’s caught up and unfortunately looks like the other knees catching the other knee up, so here we go.