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

It was, it was swelling, swelling and lack of movement like a lack of bending. Trouble with stairs. Then it kept me awake at night. And finding a way to sleep comfortably was bad. And just, just the ability to do things, you know? To not break into a run. And you know, crazy things like that.

Obviously getting in and out of low chairs, that was a no no.

I always had trouble with my knee. Even when I was at school, I used to strap it. I first had an arthroscopy in 1998. I remember my knee was painful. I couldn't walk on it. It kept giving way. And it’s-, was ever thus, I mean it’s just like that to this day.

But that’s really the start of it. The arthroscopy in 1998, I, left one-, that was the right knee.

My left one was done in 2003.

Those were the early symptoms.

However, I think I also did mention that when playing cricket one year, I did in actual fact rick my right knee and I think that was possibly the start of the major problems I had. It was painful at the time for about ten days. But I just self-medicated and it got okay. But I always felt my right knee was weaker of the two and its then in recent years then, as I say, it has got it’s got bad.

Well, I think it, it was, you know, if I did something did a bit of extra exercise, I would I’m a bit conscious of it for a few days and I was, think ‘oh I’ll stick a bit of Deep Heat on it or something, and be alright in a couple a days’ and generally it was. But then the occasions became more frequent and the pain became more constant and that was it. But having said that, it was probably about, my left knee was if you like it’s been the good one. But actually, up until about two or three weeks ago, my left knee has now started playing up. And I feel, you know, I always thought I was putting more I would’ve obviously been putting more strain on my left knee for obvious reasons. And I think that now is sort of been in to say, “Oi, mate.” My condition definitely is deteriorating, where I think I’ve put in my letter to [surgeon], getting on for two years ago now, I suppose or 18 months ago. Where I could walk up and down the esplanade here in in [town] without too much problems and probably walk round the town without too much problems. 18 months ago, it was becoming a bit of a trial. And I have to say that now, just to walk up and down the, I do have sort of good days and not so good days, let’s put it that way. But to walk up and down the esplanade now is quite an ordeal for me. In fact, I don’t, it is too far for me now.

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.’

It was actually - when I looked at my knee, yes it was swollen, it was larger than my other knee, let’s put it that way, but I didn’t consider it, you know, to be dreadful, it was just an inconvenience really. You know, I found I couldn't walk for as long without it starting to ache, but I mean that was initially, that was in the first year.

But through the pandemic obviously I wasn’t going out as much but it did get progressively worse to walk on, and I also found that- I don’t know what was happening, it was pinching at the back of my knee and so I was getting almost like a sciatic pain in my calf and my thigh which made it worse.

And which knee is it that you have problems with?

The right, now. I had my left knee replaced seven years ago.

And does it have an impact on sleep?

Yes, a bit. Not so much, I mean lying down it is actually better than standing up obviously, but it does sometimes- yes. If I’ve had a bad day with it, it’s still painful when I get into bed, you know, sometimes it isn’t every night though, it depends how much I’ve done during the day really—and the more I use my leg, and the more I walk on it, usually that affects my sleep more.

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.

Yeah, walking like, they become painful after walking for ten or fifteen minutes, and they are painful sort of stepping up and stepping down stairs and steps. And just occasionally I’m getting one feeling a lot worse, it feels as if something’s sort of catching in it and then it’s very painful to stand on it or straighten it. But that sort of goes off again after resting it.

Have you had any sense of the joint being unstable or sort of falling, because of your knee?

I have fallen, usually sort of on uneven ground and sort of find one gives way a bit on uneven ground.

And do you find that your knee problems and the pain you experienced affects sleep for you?

Affects sleep? Yes, it can do, it can do. It depends sort of what position I’ve got them in.

I mean before all this started, I enjoyed going out on my bike and when Covid struck, I went out a few times, but then I bought something where I could fix my bike- my back wheel into a- like a roller, so I could use it in the house. And it just got to the stage where because of the knee, I just couldn't use it anymore.

That was at the very beginning, if I tried to use it, it just made the knee far more painful.

So, it stopped me doing that, and then later- more recently since it started to bend up the knee, I’ve not been able to do much walking at all, it just hurts too much.

And I noticed - the first time I’ve noticed this - I went shopping two days ago, only a local supermarket, it wasn’t very big, and I used a trolley to hold onto, but I found at the end of just walking round for about 15 minutes, that the leg was starting to drag -I hadn’t noticed that before.

Yes, I had, back in 2013, I had half a knee replacement. And I took part, at the time in the study.

But since then, I had a hip operation - replacement hip - back in November last year.

At the time, I was having considerable problems with my hip and my right hip, my right knee, and it was difficult to know which was worse, to be honest. But I think and I was asked which I needed doing first, which I felt I needed to, to have done first because they would both need doing.

And my feeling was that, for stability and feeling I could actually, yes, feel that I was being stable and not tripping or losing, suddenly losing it’s a, it’s a bit difficult to explain. But the more- it is more for stability.

I felt that the hip would be better, and I know that, in fact, they would prefer to do the hip before a knee.

And that’s been fine. The hip's been very good for a long time. I have had, more recently, some problems with the hip but I think it’s more to do with the fact that my knee does need doing and also now, I’ve discovered my other knee also needs doing.

Okay.

I had a phone call about my left knee which was my half-knee replacement. It was back in November last year. It was one of these research students I think who just telephoned and asked me about how I was getting on and how pleased I was with it and so forth.

I said, “It’s wonderful, I would recommend getting it done. It was brilliant.” You know, it’s made such a big difference, really to my lifetime. And he said, “So you’re not having any problems now?” and I said, “Oh yes, I am. I’m actually, it’s swollen. It’s painful.” But as I was waiting for the hip operation which was due to take place in about a week after the interview I had. I felt that it was probably because I was walking differently, doing everything else differently, so it was putting extra pressure on the knee.

But I didn't realise until after I’d had the knee done and after I’d had the hip done, I, I was that actually I was having problems with my knee. And it wasn’t just that. So, at the moment, I’ve got two knees that are needing some care. I, and I think that probably that is why I was having a certain amount of problems with the hip.

But yeah, I’ve also been told that my other hip is on its way as well.

I think when I have the half-knee done, to start with, I was told whole knee, half-knee, and hips are on the way. So [laughs] you know, that was a sort of overall feelings that, at the time and that was 13 years back, so, you know, I’ve not done too badly. Well, 14 years I suppose, because of the wait to have it done.

Yes, I got up to go to the loo in the middle of the night about two o’clock and I put my foot down to the ground and I did almost fall over then. I couldn’t put it to the ground, I literally had to hop and to get to a place where I could sit down. That lasted probably for about eight or 10 days until whatever it was that had gone in the back of the knee settled down.

But it has left me less mobile than I was, certainly. As I say, it’s going up and down stairs that’s the worst thing.

Do you have any strategies for how to get up and down the stairs more easily or comfortably?

Not really, other than I go upstairs at night and come down once in the morning and that’s it. We have a downstairs bathroom and a downstairs loo and I don’t go up and down any more than I need to.

The other one only started a couple of years ago in March. As I say, I was getting something out the freezer and it was as if my knee went the other way. I was in absolute agony for weeks, but we, we went into Covid about two days’ later. And like the doctor did see me and they give me cortisone but it didn't make no difference. And of course, with the Covid, they weren’t doing anything like knees and everything.

Obviously as lockdowns have lifted what’s been the impact for you of your knee problems?

Well, because of, because we’re going out more and I’ve been out in the garden and everything I do find my leg really bad, especially it bothers me at night, it, it swells and it’s hot and it swells. And I go to sleep. I put a pillow under my knee so it’s raised up all the time and I’ve got painkilling gel for it and I’ve got painkillers for it.

And do you use those regularly, so taking painkillers or using the gel or is it if it just becomes too much or something happens?

That when I use it, well, I usually use it nearly every day I would say the painkillers and the painkiller gel. If it’s not bothering me, if I’ve had like where today I’m not doing nothing, it’d probably be okay, ‘cos I’m not doing anything. But if I’ve been out shopping or somewhere or even pushing the lawnmower or doing something like that, then it’ll play up at night, ‘cos especially when I, which it seems odd, when I’m in bed, doing nothing, that all starts then for some reason, it’s I don’t know, when you get off it, it’s as if it comes to life again or something, whatever.

Does it have an impact on sleep? Getting to sleep and staying asleep?

It does. It does, yes. Some nights I can’t get to sleep. I have my leg in the bed and out the bed, along the pillow and all over the place.