For many people living with osteoarthritis one possible solution is a complete joint replacement in the impacted joint. The idea of undergoing surgery to have a joint replaced can be intimidating for many. So we spoke to Ursula Malewski, 77 years old, who underwent a total knee joint replacement procedure back in 2016 to give you an idea of what it involves, the recovery process and whether or not joint replacement surgery is right for you. So whether you’re awaiting joint replacement surgery or are thinking of speaking to your doctor about it as an option for your joint pain, we hope this article might offer you some key insights.
PLEASE NOTE: this is not a medical advice piece, this is the point of view of someone who has undergone joint replacement surgery.
How did your joint pain first manifest itself?
In 2007 I was on a ski trip in Canada and fell over. It was a nothing fall, but it was in deep snow and as a result my right ski popped off but my left ski didn’t, which meant it caused my left knee to twist while the rest of me stayed still. I later found out that the accident had caused an anterior minuscule tear, which is essentially a tear in the cartilage.
What was the initial treatment of the anterior minuscule tear?
Looking back this was where things started to go wrong. They did an X-ray and told me about the tear but said that for now the best treatment was painkillers. As a keen tennis player I took the painkillers and continued living my life. But every time I played tennis my knee would swell up and I’d be in a lot of pain.
So after a couple of years the pain was getting progressively worse and I was referred to a physiotherapist who said that I might need an arthroscopy. Which is a procedure to scrape out the debris in the knee. I had that in 2010 and I have to be honest I didn’t feel like it helped me very much.
When was a knee replacement first proposed?
In 2012 I went back to the doctors and after further scans I was diagnosed with osteoarthritis. At that time the NHS suggested it was time for a knee replacement. But in my mid-60s I felt I was too young at that point, I was still leading an active life and I didn’t want to stop that at the time. So I went for a second opinion. Being originally from Germany, I moved to England in 1971, I went to a German specialist who recommended PRP (Platelet-Rich-Therapy – in which they inject your own blood back into the joint to promote healing and tissue repair). And for a while after that treatment my knee felt better, not back to its best but much more manageable.
When did the pain return?
By mid 2015 the pain began to return. My son-in-law mentioned FlexiSEQ to me so I started using that and it definitely took the edge off the pain but it was still there and I knew that things had progressed in the joint. I went back to the clinic in Germany and they said we could do PRP again but there was no guarantee it would work as the knee joint was now bone on bone. I then went back to the NHS and was put on a waiting list to have my knee replacement surgery at the end of 2015.
How did the surgery go?
I had my surgery on the 1st March 2016. It’s a pretty big operation, if you think about what they have to do so I was in hospital for five days. Obviously I don’t remember the surgery itself as I was under general anesthetic but the five days after that you’re kept on a lot of painkillers to keep the pain post-surgery under control. They gave me a morphine-pump so you’re essentially self-medicating to manage your own pain levels. Immediately after surgery you cannot use the leg at all. But I think it was 24 hours after the surgery they made me get out of bed to put weight on the knee.
How did they know you were able to leave the hospital?
It was on the fifth day they asked me to go up and down stairs, once I showed them I could do that I was free to leave the hospital. But I knew there was still a lot of recovery and rehabilitation to go through so I didn’t go home. Instead I went to a private Recovery Clinic. I felt going home, when I was still on crutches, and having to go to physio daily was not conducive to a good recovery. That might not be an option for many people but I’m so glad I did it. I had all my physio on site everyday which included hydrotherapy. I think that hydrotherapy was key because you’re in water, you’re able to get the joint moving without any impact thanks to the water. While there I was feeling quite well on the road to recovery.
How were you managing pain after you left the hospital?
I’m very lucky because I have a very high pain threshold. Even doctors have mentioned this to me. During the day time I was in pain occasionally but able to manage it with a bit of paracetamol. I would say, during the day, I needed pain relief a couple of times a day for the first 6 weeks and thereafter I was fine. The nights however were a different experience. At night I was in a lot of pain so the doctors gave me co codamol. Because I’m allergic to ibuprofen and needed something stronger that was the answer. I relied on that to lesser and lesser dosages for the first 6 months after leaving hospital and after that I was able to manage without painkillers. I should say I am someone who will actively try to avoid pharmaceuticals where possible, I’ll try to find alternatives where I can.
How was it when you got home?
When you’re discharged you are given exercises that you have to do everyday. It sounds like a chore but I can promise you, if you do them you’ll be grateful you did. It really does help the recovery process which, given the magnitude of the surgery, can take many months. Something else that really helped my recovery was I bought a cryo cuff cooling system. You put ice in a bucket and then a sleeve or cuff around your knee and the ice water flows around the sleeve and it really helps reduce the swelling. I used it several times a day and it really helped me.
What kind of exercises do you have to do?
It’s all around reconditioning the muscles and acclimatising the new knee to your body. So there’s lots of seated exercise like raising the knee and getting flexion back.
How long did it take for you to feel like your knee wasn’t in pain anymore?
I started to feel like the knee was doing much better within 6 months and by the end of that year I felt like I had a new knee, which, of course, I did. Suddenly stairs weren’t an issue anymore, I could go for walks without having to worry about my knee. I felt like I could rely on it to support me. I’ll never have full flexion of my original knee back but I’m able to do things I definitely couldn’t do after the accident.
Were you glad you underwent joint replacement surgery?
Oh, definitely. The same year I had the surgery I welcomed my first grandchild so knowing that by the time she was old enough I was able to look after her, hold and be present in her life without worrying about my knee was priceless. It’s been nearly 10 years since my operation and I’ve never looked back. I’m glad I waited until the time was right for me but it’s worth it in the long term.
Do you have any advice for someone thinking of having joint replacement surgery?
Always get a second opinion. Never take the first diagnosis at face values. It really is worth seeing one other specialist to see if they agree with the first specialist or if they would suggest something different. As medicine develops there are lots of options available to you. But the key thing is if you do go for joint replacement surgery you have to be strict about the rehabilitation process. It’s a little bit of pain for a long-term gain.