Knee Replacement...Only 50 years old

monkey42

So after years of knee pain (arthritis) it became apparent over the last 12 months that there was so much wear and tear around the knee that a replacement was needed. The NHS have not been keen to agree to this based on my age.

Now it's clear for all that this is needed.

So, who has had one. I am happy for all truths both good and bad (scary) and are there any tips to a) be ready and b) be able to recover as well as possible.

I am assuming that keeping my quads in good shape is a good starting point.

Any other good exercises to consider?  

Heartfeltdawn

As written elsewhere recently, I'm 42 next year and it'll be 15 years since a TTT and osteotomy. 15-20 years was the length of time my knee was expected to last before replacement time so you have my sympathies. 

What state in your knee in in terms of ligaments, tendons, cartilage etc? 

monkey42

Heartfeltdawn said:

As written elsewhere recently, I'm 42 next year and it'll be 15 years since a TTT and osteotomy. 15-20 years was the length of time my knee was expected to last before replacement time so you have my sympathies. 

What state in your knee in in terms of ligaments, tendons, cartilage etc? 

Only my replacement ACR is now deemed still holding up.

Effectively I am now bone on bone

Blaendulais

I sympathise - after 2 intra-articular fractures I have started to get pretty bad symptoms that prevent anything but the gentlest cardio and am struggling to maintain a previously high level of fitness.

Is there any chance they can do a partial before having to do a full TKR? It depends on whether the wear and tear is generalised or mainly in one compartment?

As a medic but not an Orthopod -the main thing you could do is maintain quad strength but also keep weight at a sensible level, for the anaesthetic and also post op as overweight people get more of every complication, and the replacement will wear out quicker. Rigidly adhere to the post op physio.  

As a cautionary tale there was a fit active elderly chap at my gym who insisted as he was always fit he didnt need the physio.  Idiotic.  He had a second TKR within 2 years and tbh has never been free of pain

It is a brilliant operation at relieving pain for sure its just not as good as a hip in terms of what you can do afterwards

There are Orthopods here who are better placed to comment as no question being involved day to day allows more intelligent comment

I was cheered by 
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32531-5/fulltext

It seems as though the replacements last longer than previously thought, altho there are issues in generalising

Good Surgeon
Good Hospital (eg SWLEOC (South West London Elective Orthopaedic Centre or similar facility)
Good luck

=Best outcome

breakstuff

My Dad has had both done, both when in his seventies. 

Had them done on the NHS, but carried out at our local private hospital, so the level of care was off the scale. They encouraged him to be on his feet (with support) the day after his op and he was getting around pretty comfortably within a couple of weeks. His second one was done just before Christmas last year and looking at him now you'd never know he had a problem previously. He said the worst time was at night, in bed, because he could only sleep with his leg in a certain position but apart from that, and some mild pain, kept under control with pain killers, everything else was fine. 

If he can recover successfully in his seventies, then you at fifty should walk it (pardon the pun  ) Based on my dad's experience, the improvement to your quality of life will be well worth any post op discomfort. 

Blaendulais

breakstuff said:

My Dad has had both done, both when in his seventies. 

Had them done on the NHS, but carried out at our local private hospital, so the level of care was off the scale. 

NHS level of care is fantastic usually.  I worked in a private hospital, for some conditions they can be fucking lethal as after daytime hours there are only very junior doctors and often no anaesthetist.  I would say that TKR probably isnt one of those but notwithstanding I would want to be near an NHS hospital in case I needed emergency senior input !

Grunfeld

As a physio who did 20 years in orthopaedics before going over to the Dark Side I've seen a few TKRs (seriously, about 10,000).  What @Blaendulais has just said!  I'd just add "Good physio" for the TKR.  When all goes well with the surgery then our job is pretty routine and getting your new knee up to speed is straight-forward.  Bit of graft for you but you can see it making a difference if not day by day then week by week. 

@monkey42 -- yes, get your quads in as good a shape as possible.  Just stretch and strengthen everything in your legs and you won't go far wrong.  The rehab shouldn't be complicated either and to be honest, although it's a generalisation, I'd just say don't be the "typical" younger patient and try and do heroic stuff.  You can't hurry nature so just be guided by your surgeon and the physios.  But fingers crossed you'll have a straight-forward recovery.  Let me use my mum's TKR as an example of a good recovery:

Week 1 -- "Oh god what son of mine would ever have talked his mother into this operation I'll never walk again!"

Week 2 -- Me:  "FFS use the bloody elbow crutch!!" 

Her:  "I am!" 

"No you're not I've counted nine times now!"  [notices mobility is definitely improving]

Week 3 -- "If you don't do these exercises I'm getting you re-admitted."

"You wouldn't?"  "I bloody well will!" [not possible but she doesn't know this].

Week 5 -- jeezus, where's she gone?  OMG, bus pass and shopping bag missing.

Week 6 -- orthopods happy, she thinks Mr S is the best ever and loves her new knee

Week 12 -- driving again, and for all intents and purposes, normal.

axisus

My MiL had a knee op a couple of years ago, I don't think they did her any favours. Took her over a year to get over it but she is 70 and in very poor shape generally fitness-wise which has a bearing. They were going to give her a titanium knee, but for some reason (can't recall?) they couldn't once she was opened up, so while she was out for the count they pulled another knee off the shelf (not titanium) that looked like it would probably fit. I'm not sure it worked so well. She found rehab very painful and also got hampered by cellulitis. Not meaning to worry you but 'stuff' happens sometimes.

On the plus side I see a guy at the gym (he's about 60 and overweight) and his knee op went very well indeed. He says that he was back in action 6 weeks later. Apparently he had it under local anaesthetic and it's a much cleaner/quicker op. Not sure I'd fancy the thought of local!

My hip is wearing out. Very worried about an Op, very worried indeed. Having said that I know a few people who have had them and are in good shape afterwards.

Musicwolf

I have no medical training so this is all layman’s observation based on just two cases.  My mother (in her 80s) has had both knees done, hasn’t pushed herself and isn’t any more mobile than she was before.  A guy, whom I know socially, was a professional Rugby League player and was forced to retire at 34 and needed a hip replacement.  He’d struggled with it for months beforehand, 6 weeks after the op (having done all the physio) he was a different guy.  I wouldn’t dream of taking him on in any sort of physical challenge.

The op is just the start.  Make sure that you do the physio and you’ll get back what you put in.

Woodandwires

I had my right knee replaced three years ago, I was in constant pain before the OP bone on bone as shown in the x-rays. I was honestly having to grab the bottom of my jeans to lift my leg out of the car after twelve hours at work. I had my op at Southmead hospital in Bristol on the NHS and the care and everything afterwards was excellent. I have no pain now, I have a very tidy scar about eight inches long. The comments about physio are completely right, I also went swimming as soon as I was able and cycling to keep the knee mobile. It was uncomfortable when I first had it done, my consultant said take all and any pain relief offered and this was sound advice. The discomfort is nothing compared to the benefit now.

My two tips are buy a long handled shoe horn, and one of those grabber litter picker type things you will thank me later.

Good luck.

crunchman

My Dad has had both of his done in the last couple of years, and my mum has had one done a few months ago (both in their seventies).

My dad's first one went about as well as it could.  He had a few more problems with his other knee.  It was swelling up for a few weeks, but I think he may have been trying to do too much too soon.  He's like that.

My mum, on the other hand has not had a good recovery.  It was complicated by the NHS in Kent switching things around, and she was one of the first to have it done at that hospital.  They didn't have the aftercare sorted out.  She didn't see a physio for about 5 weeks.

Having said that, I think the big difference was their overall level of fitness.  My dad has always been very active - even when his knees were shot.  My mum on the other hand hasn't done any real exercise for many years, and the muscles around her knee were not in a good state.

RobDavies

Possibly a stupid question, but is this something that could be helped with cortisone injections?

My mum is 77 and had problems with her knees. She recently went to the docs, thinking she’d need a replacement(s) but they opted for injections instead.  
My mum reckons it’s almost life changing....

My knees are giving me constant gip as well... I was still playing indoor 5-a-side at forty, and at twenty odd stone, that can never be good for ones weight bearing joints, so was thinking about asking my gp for injections?..... anyone else had them?

Woodandwires

I had cortisone in the years prior to my op, they work for a few weeks, but were just masking the pain and discomfort. You still have bone rubbing on bone and gradually wearing out the joint, I could see this everytime I had an x-ray. So ok short term but not a solution.

VimFuego

my mum (84) is having cortisone injections, she also thinks they are marvelous. 

hollywoodrox

Good luck with your knee operation. My mum has arthritis and it is horrible . She has just had some epidural injections in her back. Hope you are soon back to regular health. Best wishes. Paul 

monkey42

Thank you to everyone and there feedback.

yes unfortunately everything around the knee has near on worn away so the pain is literally bone on bone so although nearly 50 there is no alternatives. Cortisone injections are now pointless.

anyway, the key thing is to get my leg muscles in the best possible state before the op, and thereafter stay rigidly to the recovery physio which I’m determined to do.

thanks once again fellow forum members

Woodandwires

Buy or borrow an exercise bike, I used my mountain bike set up in our conservatory on a stand to keep my knee mobile after the op, little and often, I could not do a full revalution at first so just rocking backwards and forwards on the pedals gauging my improvement, then increasing the resistance. This also helps getting your quads back to support your new knee joint