Weak at the knees?


ADVANCEMENTS Medical advancements in surgical techniques, prosthetics and pain management have improved post-surgery recovery.

Andrew O'Brien

A couple of weeks ago I got one of those early morning texts that possibly should have been a phone call. It was from my mum in Australia, and it just read: ‘total knee replacement coming up on 28/4/2021’ followed by several emojis. She’s not one for wasting words, my mum.
Having had a nagging knee issue for several months she had tried to go for a walk a few days earlier and didn’t make it ten minutes from the house before she was almost in tears. Mum had seen a consultant before Christmas who said she shouldn’t need surgery, but she couldn’t handle being so restricted, so she rang him again. The result: “You need a knee replacement and we’re doing it in ten days’ time.”
All things considered she was pretty chipper about it at the time, and now that it’s all over bar the shouting (at her physio in Australia rather than me, thankfully), everything seems to have gone pretty well.
I won’t put you off your coffee with details, but I have been in theatre to observe knee replacements being done, and it’s a strange mix of medicine, carpentry and Meccano. The old bits are chopped out and the new ones hammered and glued into place.
The recovery isn’t all beer and skittles either, although advancements in surgical techniques, prosthetics and pain management have improved things.
In the past you could expect to be in pain for at least six months after a knee replacement, but that time frame is now more like six to twelve weeks.
On top of that, knee replacements were previously considered to have a lifespan of ten years or so, meaning many patients were advised to delay surgery as long as possible so as to reduce the likelihood of complicated revision surgery down the line. It is expected that 80 per cent of knee replacements will now last 25 years, thus surgeons are operating on younger patients, who typically recover faster and more fully than older patients.
Why then, would anyone in their right mind subject themselves to such barbarism? Purely and simply because the alternative is generally worse from several perspectives.
Take my mum, she’s an active lady whose main exercise involves meeting her friends for an early morning walk followed by a coffee. Take the walking out of that due to a bad knee, and you have a lady who either drives to the coffee shop three times a week, getting very little exercise, or a lady who just doesn’t get out for the meet-up. Neither of those is a particularly healthy option.
Additionally, it’s not unusual for someone who is nursing a painful arthritic knee to limp so much that they stir up other problems. Over the years I’ve had people come in for back pain that was only resolved when their knees were replaced, allowing them to walk more freely. An uncle of mine went to a surgeon to discuss his knee issues only to end up with a new hip instead. The old nursery rhyme is right: the knee bone really is connected to the hip bone, and so on!
The cruel irony for Mum is that my dad has objectively worse knees than her. Twenty-five years ago, he had the last piece of cartilage taken out of his knees and was told he’d be back before long for a replacement. He spent the week of mum’s surgery visiting museums and eating alone in nice restaurants near the hospital with no problem beyond being slightly knock-kneed.
How did Mum get so bad she couldn’t walk for ten minutes while Dad is still walking relatively normally 25 years later? Who knows? There are simply too many variables to even try to answer. Instead of trying to figure it out, for Mum it came down to a straight choice: an ongoing saga of managing painful flare-ups and having to modify her lifestyle significantly or three months of pain with a light at the end of the tunnel. I’ll take option B, thanks very much.
Until then she’s keeping me informed. One sentence at a time.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.