Total Knee Replacement (TKR) - Case History

For anybody considering a Total Knee Replacement (TKR) I say don't expect it to solve all your problems and in fact it can lead to other issues. I reckon you can compare it to replacing a part in your car that puts pressure on the next part down the line, which will need attention soon and so on!

In my case prior to the surgery the knee would literally slip out of joint, which was very painful. I would fall to the floor, wriggle and writhe until I managed to get it back in place. I'm sure people in the street thought I was under the influence many times. I couldn't walk far and was always in pain, registered disabled and granted a disability badge.

My TKR surgery was on January 31 2014 so less than six months ago and in retrospect I am glad it was done, especially now that I am recovering. That said I would not recommend anybody to have it done unless it was the last resort and you have been advised by your medical team to undergo surgery, as was the case with me.

Your knee is totally worn out they said, but in my case there was additional risk if the dormant infection from 58 years ago were to wake up! As it turned out it didn't, but that alone was a worrying thing to have to consider. A biopsy was taken during surgery to deal with it and they hoped to have an antibiotic ready should it be the case.

I recall very easily the pain after surgery. I was screaming as I came round from surgery to intensive care, the bags of ice to help keep the swelling down, the unbelievable heat in the leg at night, the worrying redness around the scar that might be cellulitis, being unable to bear the weight of sheets and/or the quilt on it, being unable to bend it very far, the difficulty turning over in bed, I really did live hour to hour for about two months before any real sign of improvement.

My GP at Morland House Surgery in Wheatley, Oxford Dr Anshi Alvi and the team at the Nuffield Orthopaedic Centre (NOC) in Headington, Oxford were fantastic all round from initial advice at the Surgery to Hospital admission, aftercare, physio, no complaints whatsoever, but now that the knee is on the mend I realise and experience other problems that TKR brings.

Even with regular exercise I still can't bend my left knee beyond 90%. Okay, that's a plus I suppose because the knee bend is now pain free (but the muscles around it still hurt) and the other knee is nearly as bad, with plantar fasciitis (dropped arch) also known as 'Policemans Heel' in the left foot now not liking the fact that the new knee has allowed me to have a straight leg for the first time in probably forty years or more, with pressure in my spine now also, because the new knee is working so things do change.

Now if I sit around too long, say four to six hours at the PC for example as once was the case, the leg and the ankle create fluid, which according to Doc Alvi will likely reduce in time, but may take up to a year. He said elevate your leg and put me on Furosemide a diuretic (Nurse, quick I need a bottle!) to help reduce the fluid in the short term and suggested that as I became more active it would help me. So from being virtually totally disabled through pain and unable to walk far, I am now able to get a bit of work done, but herein lies another problem because I get a disability living allowance, so at what stage does working a bit to help repair the body, become contrary to the DWP regulations? I don't know the answer and guess I will have to write to them for clarification. How long might it take to get back to 'normal' if indeed that's possible. How hard do I work before I notice any difference apart from reduction in the fluid on the leg/ankle, will my body allow it to happen, it's very difficult to determine I think.

But the knee pain aside for a moment, I also suffer the Dercums disease for which there is no known cure and for which the referred to allowance was also paid. The Dercums gets worse virtually day by day with new 'lumps' (angio lipomas) appearing like an overactive Mole in the garden, but especially so in my back, arms and legs. I also have osteoarthritis throughout my body and an enlarged heart and can safely say that without considerable painkilling medication 24/7 I wouldn't go anywhere or do anything, least of all any kind of work, cutting the grass for example where the petrol mower is faster than I am, or helping out a mate for a while, after which I am totally exhausted with aches and pains that just 'appear' again if I then sit still too long! So there it is you see, I have gone round the inevitable cirlce because I had a TKR. I cannot recommend it, would never have another knee replaced and will have to continue to take enough painkillers to put a horse down just to get by each day.

Doctor Alvi at Morland House Surgery in Wheatley, Oxford has really effectively balanced the pain medication with me taking MST (slow release Morphine) twice daily, Oramorph for additional occasional quick top up pain relief and Paracetamol 24/7 without which I really would not get through the day or night.....thanks Doc!

Well there you have it, a case history showing how replacing one part can lead to problems elsewhere. I consider I am very lucky with an excellent GP and an equally excellent local Hospital in the NOC, Headington, Oxford.

Very interesting read Ron. My eldest daughter was on Oramorph and Morphine in quite high doses when she was having alll the problems with her back. I don't know how you cope with the painkillers, she was never quite herself, it seemed to effect her ability to function properly during the day. She was constantly tired and her concentration levels were dreadful. She's off them now and she's back to her old self again. Sadly it seems as though you might be on them for a long time.

All the best Ron from us both - try and keep cheerful  

A very interesting post --very similar to my problem??something to look forward to eh.

 Gosh Ron, talk about going through the mill. With all that you have still managed to keep an eye on us unruly mob and run your Pest control site so the days have been full on many counts. What us folk have to cope with is quite a scary thought and one wonders if past history of what we have done in life is the cause or is it just the hand we are dealt. Whatever , keep taking the tablets and we can only hope the future now has some of the issues under control and life can continue with some sense of stability- Chons Da ha Oll an Gwella Ron.

        ( Good Luck and All the Best in Cornish ) 

Thanks for your comments dear friends. This morning I received a response from DWP that states:

Dear Ron. You are allowed to work with DLA as long as it is not an improvement of your claimed illness.

Regards GA (name witheld for data protection purposes). Correspondence Team, Blackpool Benefits Centre, Warbeck House, Blackpool

So there is the answer for anybody in a similar situation.

Typo corrected

Really don't know which way to turn. The new knee bends to about 90% but is very painful still. Should clarify that I suppose meaning the muscles around the knee are painful. It has also started 'clicking' and the other knee is not bearing up as I had hoped it might.

Somehow the tkr has affected my other leg/knee, both feet with plantar fasciitis, ankles with fluid building up a soon as I sit down and my back aches too.

With an amount of Morphine/Oramorph and Paracetamol going down the throat 24/7 you would think I would be painfree, but no such luck. That said I don't know how I would manage without it, bearing in mind I have lumps popping up like mushrooms thanks to the dercums to contend with also.

Keep taking the tablets eh, but good getting old innit?

Thanks Neil but I think I have these conditions for keeps.

Osteoarthritis alone makes life hard enough without all the other stuff going on besides, but thanks anyway mate.