Making decisions about knee replacement as an older person with multiple conditions
Hopes and expectations about the benefits of knee replacement surgery
People we spoke to who were being considered for knee replacement surgery told us about their hopes and expectations if they had the surgery. We talked to people about their hopes both before they had their referral appointment and afterwards once they knew whether they were going to be listed for surgery. As well as information given by their surgeon, people’s hopes and expectations were often informed by their own or others experiences of knee replacement surgery and the impact of their other long-term health conditions. This summary covers:
- Improved mobility
- Reduced pain
- Getting my life back
- Enjoying life more
- Changing hopes and expectations
Improved mobility
A key expectation of knee replacement surgery for many people was improved mobility.
Liz and others hoped that being able to walk better would benefit their other health conditions. Keeping active was important for people who also had high blood pressure or heart-related conditions or were overweight.
Liz hoped that having knee surgery would enable her to “walk properly on the moors” and strengthen her back muscles, helping to prevent spinal spasms and improve her circulation.
Liz hoped that having knee surgery would enable her to “walk properly on the moors” and strengthen her back muscles, helping to prevent spinal spasms and improve her circulation.
I’d like to go walking properly - on the moors. That’s what I’d like to do.
Get fitter. More exercise. Because I think, the more I walk, the more the muscles will support my spine, I’ll get fitter, it should help my spine, but I’ll have to walk through the pain to do it.
But if I haven't got pain in my knee and in my back, and I’m not worried about my knees giving way, then I’ll be able to do it better [laughs].
Clive and Jacqueline hoped being more mobile would prevent their health declining, “sitting in the chair all day” and a further loss of independence. Penny hoped she wouldn’t need to rely so much on other people and that she would be able to travel on her own to visit her family.
Jacqueline chose to have her knee operated on before her shoulder. She hoped it would improve her mobility and prevent her going into a care home.
Jacqueline chose to have her knee operated on before her shoulder. She hoped it would improve her mobility and prevent her going into a care home.
I really want something done, so that I can get I suppose life back to something like normality again and not be in pain because it does restrict you. Obviously, if you’re in pain, you, there’s certain things which you can’t do.
So, I’m hoping that afterwards I will be able to do things again. I can’t do long distance walking which I used to be able to do before.
It’s being able to do them and enjoy them a bit more as well, isn’t it?
Well, that’s right. It’s to enjoy life a bit more, isn’t it? It’s when you reach 84, you wonder how much more you’ve got left. I mean I know in this day and age people live a lot, lot longer. My brother-in-law’s 96 this year. So, people are living longer. So, if you go on to live longer, you want to be able to enjoy it.
Although people hoped they would have better mobility after knee surgery, some expected that their other health conditions would still restrict their mobility. Jacqueline hoped to be pain free after knee surgery but since having a Transient Ischaemic Attack (TIA or mini stroke) which affected her balance, she expects she will continue using her walking stick. Others had hip and back pain and expected to still have some mobility limitations after knee surgery.
Reduced pain
The hope that they would be pain free or have less pain after knee surgery was important for many people. Jacqueline expected to still have pain in her shoulders and hand where she has osteoarthritis but hoped that by having knee replacement surgery she would be pain-free in her knee.
Others, like Toby, who lived with other painful health conditions, hoped that at least some of their pain would be reduced.
Toby has lived with rheumatoid arthritis and osteoarthritis for a long time. He hoped knee replacement surgery will fix some of the "pain on pain."
Toby has lived with rheumatoid arthritis and osteoarthritis for a long time. He hoped knee replacement surgery will fix some of the "pain on pain."
I really would just like to be able to get on with my life without my knees being such a problem.
I’d like the pain removed by whatever means they can find. So that I can walk more, and I’m very, very active you know, within the limitations of what I can do, knee-wise and that. I’d just like the pain removed, in short terms.
Whatever that takes.
I’ve been in pain with arthritis and I’ve accepted that for 30 years I guess, and when something like the knees cause problems - which is some considerable time now - it’s pain on pain and people can stick all kinds of pain really but it’s just, I think it wears you down really.
And I simply wish that it could be fixed fairly soon.
Because you accept it, you live with it but it does change the way you are.
And the pain is like that - on top of the general pain I get from the arthritis osteoarthritis these knee pains, the knee pains are fixable, the arthritis isn’t. And so, because they’re fixable it would be a tremendous help if I could get them fixed, you know?
Getting my life back
With improved mobility and less pain, people hoped that knee surgery would enable them to “get back” to aspects of their life before their knee problems started. Many people expected that improved mobility would enable a return to activities they had enjoyed.
Derek is hoping that after knee replacement surgery he can get back to activities he enjoys, like walking.
Derek is hoping that after knee replacement surgery he can get back to activities he enjoys, like walking.
Well, nobody likes to have surgery, but on the other hand if that’s going to make my lifestyle that much better then of course I’m looking forward to it, but as far as that’s concerned, I’m looking forward to being able to be able to go a nice walk, we’ve some beautiful walks around here and as I say my better half is, she’s a walker, and she says, “Well can you come a little way?” Or whatever the case may be, and I do when I can.
But again, I joined the local cricket club and I thought well unfortunately I won’t be able to play cricket anymore. Well, that’s okay, but I might be able to do a little bit of umpiring. Well, it would be impossible quite honestly for me, even just to stand during even a short cricket game to just to stand on my knee, I would be so uncomfortable. So, I’m looking forward, I sincerely hope to it being done and I’ll be able to do these little things which I’m not being able to do at the moment. In particular going on nice walks, and not having to worry and think, “Oh,” and sit down every couple of minutes, or whatever the case may be ‘cos my knees playing up as we term it.
There was a sense that life had been put on hold or not enjoyed to the full. Linda X had only been out occasionally in the past two years and hoped to go out and walk properly without the use of aids and to “get my life back.”
Karen imagined playing tennis again and Dave Y hoped to get back to the gym. Mary wanted “just to live a normal life.” Victoria and Toby felt that, of all their health conditions, their knee pain was one that could be “fixed”.
Victoria feels that getting her knee fixed will "feel like I'll have a little bit more of my old life back."
Victoria feels that getting her knee fixed will "feel like I'll have a little bit more of my old life back."
I find with my knees the way it is and walking with a stick, I do feel all of a sudden that I already feel it’s been a bad year with everything with Covid and cancer and everything. So, I feel like I’ve aged really bad and well, aged a lot in the last twelve months.
And I feel, you know, if I get my leg back and that it gives me a bit more, I think I’ll feel better.
James hoped that having his partial knee replaced with a total knee replacement would give him five-ten years without worrying about his knee.
James hoped that having his partial knee replaced with a total knee replacement would give him five-ten years without worrying about his knee.
I would like them to say, I think, at my age and I’m still quite mobile - to say that we can put a full knee replacement in. Mm, cos I think that would give me another sort of ten years without worrying about it, you know.
Anything else they might suggest yeah, I will be grateful of, but it may be temporary or still leave me with a joint that’s going to go. It’s about twenty-five years old I think, my left knee, half knee, so.
And although it’s always fallen apart from new, you know, it’s, it must, I don’t know whether they wear out or not but.
Because the actual, when [the doctor] swapped me half knee to me full knee that didn’t really hurt that much in recovery, you know? So I would put up with that to have a, another sort of five, ten years of knee free problems.
But I can understand if that’s, you know, with the present situation a bit of an issue, and I would take whatever you’re offering. That’ll go from nothing and just keep an eye on it, or we might be able to do something.
So, you think total knee replacement is sort of inevitable at some point it will be required, even if other measures happen first?
Yes, I suppose yeah. It’s just that I never feel secure with it, you know, if I’m gonna go walking somewhere, even if it’s around a country house, there’s always the chance that my knee will fall apart and I may not be able to get it back together again.
Enjoying life more
Restricted mobility and being in pain limited how involved people could be in activities they enjoyed. Many talked about hoping knee replacement surgery would allow them to participate more. They wanted to have the benefits of knee surgery now rather than wait until they were older.
Simple things, like walking, were important to people we spoke to. Derek, who had been having discomfort and pain in his right knee for about six years, hoped that he would go for longer ‘nice’ walks with his partner without needing to stop or rest. Sue hoped to walk at “a family pace” without others “having to make concessions for me all the time.” Tina wanted to get back to “enjoyable walks”.
Some people wanted to play with their grandchildren more after surgery. Emily says, “I want to be able to take my granddaughter down on the beach and look for fossils.” Eleanor hoped to be able to run around with her grandchildren without having to stop and rest.
Sue would love to be able to sit on the floor, play silly games or kick a football with her grandchildren after knee replacement surgery.
Sue would love to be able to sit on the floor, play silly games or kick a football with her grandchildren after knee replacement surgery.
I think the one thing I haven't said, perhaps, is how much I feel I’ve missed by having knee and hip problems. Because, particularly with grandchildren, it’s lovely to be able to, you know, you sit on the floor and you do this and I can’t sit on the floor.
And if I do get down on the floor, which is very, very rare, it’s the most appalling job getting back up again. It’s bad enough trying to get down. But you know, getting back up is extremely difficult to me – very undignified to say the least.
And, you know, it’s those sorts of things that you feel you’d like to be able to do, a lot more with the grandchildren - the eldest is now 10 and so you know, already you’ve gone through the stages that I missed where, you know, you were playing silly games or doing things or, or kicking a football around a field or whatever, which, you know, I’ve missed out on.
I think that’s quite sad. We do lots of other things.
Changing hopes and expectations
Hopes and expectations had changed over time for some people, particularly those who had lived with knee problems for a long time, people who felt they had aged, or those who noticed their overall health had declined. For them, their expectations could be tempered.
Emily had two hip replacements and a right knee total replacement, and was waiting to have her left knee replaced. She used to dream that she would run again but now she is much older she hopes “I can just walk and not have any pain, you know, walk for more than what I can walk now.” Tina thought it was unlikely she would re-join the gym now she was older but hopes to go on more adventurous walks.
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