Knee joint replacement

[oleinone]

Rather than hijacking the knee brace thread. I would be interested in feedback from those who have had this operation. I'm 71 years old and play very often. I'm making a last ditch effort with hyalouronic acid injections but realise that I'm probably just delaying the inevitable.

 

[RichA]

Rather than hijacking the knee brace thread. I would be interested in feedback from those who have had this operation. I'm 71 years old and play very often. I'm making a last ditch effort with hyalouronic acid injections but realise that I'm probably just delaying the inevitable.

I've no medical knowledge, but 10 years ago the orthopaedic surgeon who lives next door to my mil told her not to let them cut unless she literally couldn't walk. Maybe the likelihood of a favourable outcome has improved since then, but his feeling was that many surgeons are a bit too keen get the knife out.

 

[Ethan]

I haven't had the op, but I am currently (literally, as multi-tasking during a conference call on the subject) working on some (non-surgical) treatments in this condition.

The knee is, fundamentally, not a very well designed joint, with surfaces that do not fit together in a mechanically robust way. The hip is a much better designed one, with a nice socket and ball that fit neatly together. Knee is the joint most often affected by osteoarthritis (OA). Current treatment guidelines advise non-pharmacological treatment such as physio, exercise and weight loss, since this is an axial weight-bearing joint, followed by topical or oral NSAIDs (ibuprofen etc), and if appropriate injections into the joint of hyaluronic acid and/or corticosteroids. The evidence of effectiveness for hyaluronic acid is not great, so the NHS does not usually fund it.

The problem varies between patients. In some it is mostly pain, so a new effective form of pain relief can postpone the need. In many of those patients, the joint is not actually in terrible shape, it is just that the pain is disproportionate to the damage. In others the main problem is function, the knee breaking down or sticking. That usually implies some serious damage to the joint. Some people have a mixture of the two.

Surgery is usually a "last resort" option, but is quite effective for most. Some patients do not get as much relief from pain as they would want from surgery, and some need revision surgery to adjust the fit. Rehab is important. People are usually mobilised the day after surgery and out of hospital within the first week. Physio is needed to get fully mobilised. Surgery is usually done under a regional anaesthetic rather than a general, so patients don't have to be as fit as a fiddle for it. 70-ish is not a bad age for it. A lot younger and you face the possible issue that the joint will need redone in much later life, they last about 25 years or so, and much older and the rehab gets harder. I don't think any orthopaedic surgeon will be rushing people into surgery, given the current waiting lists and backlogs. Private guys may be a different matter.

 

[Maninblack4612]

Two friends in their early 60s had both knees replaced. One had played centre forward for a first division football team. He was known to be lazy in training & failed to do the post operative physio properly. He finished up riding around the course on a buggy for the rest of his life. The other one, similar build, height & weight did the physio conscientiously & is still walking around the course over ten years later. He said the physio hurt a lot but it was obviously worth the effort.

 

[Imurg]

I had most of the cartilage in my right knee removed over 3 surgeries in the early 00's..
Surgeon suggested that I'd probably need a replacement within about 10 or 12 years...
Well, touching wood furiously, 20 years later and its in better nick than my left which has begun to be affected by arthritis meaning I need a support on it whenever I go out.
With a bit of luck it'll be a good few years before either need doing.

 

[chrisd]

If it needs doing it needs doing!

I had 4 cartledge ops and clean outs on my left knee before they did an ACL repair, I've had both hips resurfaced and without all that I'd definitely not be golfing. Have it done, do all the physio, look after it and hopefully everything will be fine

 

[Ethan]

If it needs doing it needs doing!

I had 4 cartledge ops and clean outs on my left knee before they did an ACL repair, I've had both hips resurfaced and without all that I'd definitely not be golfing. Have it done, do all the physio, look after it and hopefully everything will be fine

Arthroscopic lavage (clean outs) are not really done any more because the evidence that they help is rather lacking. Clinical trials were done where patients had a GA, and half received lavage, the other half had a hole in their knee (a sham procedure) but no lavage. Results were the same in both groups.

Individual results may vary, though.

Hip resurfacing can be pretty good, though.

 

[jim8flog]

Ditto to Ethans comments about rehab. Do the exercises they tell you if you want to get your mobility back it is important not to let the scar tissue form in the wrong position. I have two mates who did not and now need buggies to play.

 

[chrisd]

Arthroscopic lavage (clean outs) are not really done any more because the evidence that they help is rather lacking. Clinical trials were done where patients had a GA, and half received lavage, the other half had a hole in their knee (a sham procedure) but no lavage. Results were the same in both groups.

Individual results may vary, though.

Hip resurfacing can be pretty good, though.

Luckily at the time they did my left knee cartilage a couple of times and the clean outs, which had little effect but I was able to wait about 12 years for the ACL graft which, by then, was a more reliable operation and I've played golf, tennis etc ever since. The hip resurfaces are just awesome as Andy Murray will no doubt testify ??