Keith

Age at interview: 71

Brief Outline: Keith had a partial knee replacement in 2014. He was happy with the care and information he was given but feels that physiotherapy should be offered shortly after surgery. He is recovering well and has started gardening, fishing and playing golf again.

Background: Keith is a psychiatrist. He is married and has 2 adult children. Ethnic background / nationality: White British.

More about me...

Around 1994, at a time when Keith was playing a lot of sport, he started having knee pain. He first went to the doctor around 2007-8 and was advised that, although he could have a partial knee replacement, it would be better to wait a few more years when the knee pain and arthritis were worse. This happened again around 2009, and Keith was advised to lose weight, which helped. In 2013, though, the pain became a lot worse, triggered by exercise, and the doctor agreed that a partial knee replacement would be a good idea. 

Keith’s surgery date had to be planned carefully because his wife, who had a neurological condition, depended on him for care. When her care had been organised, Keith went into hospital for his operation. The surgery went well and he was given paracetamol and codeine when he was discharged and advised to exercise. 

Keith was happy with the care and information he was given but feels that physiotherapy should be offered to all patients shortly after surgery because it’s important to recover as well as possible. He visited a private physiotherapist while recovering at home and had sessions as often as advised. Keith would also have liked advice on sleep as trying to sleep at night was difficult. He was prescribed sleeping tablets for ten days after surgery but feels that his sleep pattern has still not gone back to normal. 

Keith has been doing the exercises his physiotherapist recommended and has made good progress. He has gone back to fishing and gardening, which he enjoyed before the operation, and has started playing golf again too.

Keith watched the videos twice but couldn’t remember a lot. They were ‘nicely produced’ and simple. The most useful thing was seeing the implants that would be used.

I saw, I watched it on the laptop with, the physio set it up for me and I watched it. She sent it to me later and I watched it once more after the surgery.

After the surgery?

[mhm]

So once beforehand and once afterwards?

Yes. [mhm]

What did you think of that video? Did you feel that it was helpful at all or did it just repeat what you’d already been told?

I think it was quite helpful. I’ll be honest, even though I watched it twice I still, I can’t remember a lot about it. I think what I found very useful was the, actually, you know, seeing the device. And indeed she showed me one as well, the physiotherapist did. But, you know, seeing and sort of understanding in a way the simplicity of the device was quite useful. And I think for me that was the most beneficial thing. It then talked about, you know, post, what would happen post-surgery and so on. The fact that I can’t remember much about it probably means I found it less helpful. But I can’t be sure about that. But I thought it was quite good. It was a nicely produced video and it was simple. It wasn’t too long, it wasn’t complex, you know.

Were you given leaflets as well at this point at all?

Yes, yes, I was, yeah.

About the operation?

Yes, yes.

Did you read through those or were you fairly familiar?

I did, I did have a look at them, yeah.

Keith kept waking up because of knee pain. His GP prescribed sleeping tablets for 10 days. Other people he spoke to also had disrupted sleep after surgery.

Since I’ve had the surgery and indeed, you know, one of my friends had the surgery at the same time. We were literally in the next bed to each other. I didn’t know, we didn’t know we were both having it. A chap I used to play rugby with... He had the same experience of dis-, of the pain at night, you know, waking up a lot. And I think they should warn you about that. Because that wasn’t mentioned at all. And I’ve talked to other people who’ve said exactly the same thing. I ended up having to go to the GP and ask for some sleeping tablets for ten days. Which he gave me. And then I discovered, you know, other, some other people had had the same experience as that. So I think I wasn’t, you know, wasn’t given enough warning about that.

So being prepared for that would have been helpful?

I think so. I mean I can understand that surgeons or staff may be reluctant to give warnings about, you know, these sort of negative things in case it might put people off. Or it may make them so worried about it that, you know, the experience is even worse. I don’t know. But I think it should be mentioned that “You may have, you may find this. It will last for four or five weeks.” Which is what happened to me. Again talking to other people, it’s what they’ve had, you know, I know they’ve experienced. And then will gradually get easier, yeah.

So it would have been helpful to know that beforehand?

Yes.

Diagrams of the exercises were sometimes unclear and it was hard for Keith to tell if he was doing them right. A physio helped and showed him new ones to move onto.

I think a video would have helped greatly. As I said, I was lucky enough that I was able to go to a, you know, private physiotherapist, who was absolutely excellent. But I think being able to see how you should do the exercises properly. Because diagrams are quite difficult, you know, particularly when you’ve only got one picture of a particular exercise. Sometimes it wasn’t clear to me whether I was, you know, doing it right until I saw the physiotherapist. And some of the things I wasn’t doing right. And so I think, you know, a video could help, yeah.

So you saw the physio, was it a couple of times, before you then went back for your follow-up appointment at the Nuffield [NHS hospital]?

I think I’d probably seen her, yes, three times before I went back, yeah.

And can you tell me how the, those appointments were and how helpful they were for you?

With the physiotherapist?

Yes.

Oh, extremely helpful. I mean she told me, you know, which exercises, initially which exercises of the ones in the booklet I should be able to do, which ones I ought to delay doing because they were going to be a bit too much. And then which new exercises that I could be doing. So, which weren’t in the booklet. Yes, so that was really helpful. It was the sense of progress which was really useful.

Keith did his exercises ‘religiously’ but paid to see a physio for more guidance and reassurance. Positive encouragement and having someone to report to was important.

I was given a booklet of exercises, although I don’t recall any actual discussion of the exercises. So, but as I mentioned earlier, I went to see a physiotherapist fairly soon after and then the private physiotherapist. 

And they very much said, you know, which exercises I should be doing at this stage, which ones, you know, progressing to later. Which was helpful. And I did do the exercises pretty religiously. And I was icing my knee very regularly after, certainly after, any time I did the exercises I would ice it afterwards. And so that, so the whole focus seemed to be on, you know, me doing exercises and icing the knee and... But that went quite well, yes.

So there were exercises in the booklet, which you started doing. But what made you feel that you would like to see a physio?

Well, I felt I needed more guidance on how to do them, when to progress, and when to progress on to other exercises. So, and also, you know, the fact of having to report to someone. Which I think is very important. And I mean as it turned out, the NHS physio, who I saw just once, she actually went in for, the second appointment in fact we, never happened with her. Because she went in to have knee surgery herself. She had warned me she was going to, might be called. And she was called. 

But I mean it was encouraging, I mean I guess this was a week or so after surgery, for her to be saying, “You’re doing really well.” And the same with the physiotherapist I saw subsequently. It was that positive encouragement, you know, at times when one is becoming discouraged. Because, you know, it did feel like it was two steps forward, one step back. And I think I’d been warned that that was the case. So, you know, I’d start to improve and then I would do too much. Like I would go and try and do a bit of gardening or, you know, far too early, and then the next day would pay the price. And, but it was, so I’d start to feel a bit downhearted. But it was the physio saying, “Actually no, you know, this is how it, how progress goes. You’re really on, well on course.” Which I thought was very important.

Some of the nurses said they’d do something to help but didn’t come back. The good nurses paid attention ‘to you as a person’.

The doctors, I didn’t see a lot of them. I guess it might have been nice to have spent a little more time with the doctors. But I recognise that, you know, the pressures on them. The physio was fine. I thought she was very helpful. Obviously one saw quite a wide range of nurses and there were some who I was a bit disappointed with. 

Some were really good and helpful and so on. But there were some who, you know, you’d ask them, “Could you do something to help me, do so and so?” And they’d say, oh, they’d come back. And they didn’t come back. And that happened two or three times. 

And I mean once, for example, you know, the ward was quite close to a road and at night, you know, one wanted the blinds down. And I asked a nurse to do that and she said, “Yes.” Walked off and never came back. And so I had to get out of bed on my crutches and go across and do it. Which seemed unfortunate. So I was a bit surprised, and particularly given the ward wasn’t that busy, that that happened. But, you know, some of the other nurses were great. And, it was mixed.

When you say the nurses, some of the nurses were great, how were they different to the ones who weren’t so good?

Well, I think they were, they seemed to know about one’s personal situation and were just sort of, I felt, better at connecting with you, me as an individual. And in terms of paying, you know, you felt they were paying attention to you as a person rather than maybe just going through the motions.

Regular physiotherapy should be part of the recovery process. Keith feels it’s ‘wasteful’ of NHS resources to have expensive surgery and no physio afterwards.

One of the things I was surprised about was that I wasn’t initially offered any physiotherapy after the surgery. Which seems to me when you’re, you know, having expensive surgery, not to have physio arranged when exercise really is so important to ensuring maximum benefit from recovery. At least that’s my understanding. However I did, after sort of putting some pressure on, I was given an appointment at a local clinic, NHS clinic. I went once. And then the next appointment was a month later and I decided that was too long for me. So I went and got private physiotherapy and was able to see someone on a regular basis. And that was, I found, extremely helpful.

I would say that physio, you know, fairly regular physio appointments should be part of the process. And I’ve been someone who’s done sports and been used to exercising. So for me it was sort of natural. For people who haven’t, you know, and maybe people who are very overweight and find it difficult, they really would need a lot of help with this I think. And I think it’s wasteful of NHS resources in terms of expensive surgery if people haven’t got that back-up. Which, you know, okay, it costs quite a bit, but not that much. A tiny percentage of what the surgery would cost to ensure that they can make, get most benefits from the surgery. So I would say that would be a major recommendation.

Keith discussed his situation with the physio and surgeon. Moving his wife from chair to wheelchair would be impossible when he’d just had surgery.

The physio was very good. He had a, we had a lengthy discussion. And I mean I have complicated personal circumstances. My wife’s disabled with a progressive neurological condition. And because we have carers, there was a whole discussion around how the surgery could be organised such that we could make arrangements for carers. You know, so that, because obviously we would need people in much of the time initially while I was recovering. So there was a very good discussion about that and I think that was very helpful. 

And then when I saw the surgeon in January, we had again quite a lengthy discussion about the pros and cons of the surgery. Which again was I think very helpful. And we both sort of ended up I think agreeing now was the time in terms of quality of life, that my situation had got, you know, much worse. And given my personal circumstances, with my wife’s disability, that I, you know, I was going to find it increasingly difficult to help her, because she needs to be moved from chairs to wheelchairs and so on, with a dysfunctional knee.

So, so you had those discussions. And then a date for surgery soon after?

It took a little while to get the date. Which was worrying because one wanted to make the arrangements for carers. And there was a bit of toing and froing with the surgeon’s secretary, saying, “Look, can you give us a date? We need, you know, I need it to be able to start making all the arrangements.” But then I guess I had about three weeks’ notice of the surgery.

Three weeks’ notice?

[Mhm]

And was that enough time to organise in terms of carers?

It was, yes, yeah [mhm].

Keith bought some sports shorts, a lightweight tracksuit bottom and slip-on shoes that were easy and comfortable to wear when exercising and icing his knee.

Funnily enough I’ve been asked by now friends or a friend who’s about to have the same operation for any advice I can give. And things I found really helpful were, I had a, I went and bought a, I made sure I had some sports shorts and a really lightweight tracksuit bottom. And I wore that more or less continuously for five weeks. So when I was doing exercises, you know, it was easy. When I wanted to ice my knee, I could take the tracksuit bottom off, do it. And I actually found that very helpful and was pleased that I, you know, did that. 

Another thing was I got some open-backed shoes, slip-on shoes, which actually I had already, but I got a new pair. And of course one’s knee swells up, you know, and the leg swells up and I couldn’t get shoes on. I mean so having that open-backed thing, shoes, was very helpful.