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Knee replacement criteria

(31 Posts)
notentirelyallhere Fri 26-Apr-19 21:39:10

Would Gransnetters be kind enough to tell me how bad their knees were before they had replacement knees inserted.

My GP told me today that the criteria is 'severe pain'. I've been active and sporty all my life but now one knee especially pains me a lot. I can't walk more than a couple of miles at the least and pay the price in pain and stiffness. Running, even a few feet, is out of the question. I can't kneel anymore and I've just had a fall which injured my foot badly because I tripped and my knee gave way.

The GP stared stonily at me throughout and said physiotherapy and focused exercise was the recommended treatment now. Any comments? Thank you.

maryeliza54 Fri 26-Apr-19 23:17:40

not some ideas for you
1) contact your local clinical commissioning group and ask if they have produced criteria for knee replacement ( I bet they have)
2) google - especially NICE - they will have guidelines
3) if you can afford it ask for a private referral to an orthorpedic surgeon specialising in knees- initial consultation will be c £250. He will know if you meet local criteria
4) then see a different GP if you can

Jane10 Sat 27-Apr-19 06:38:26

There is criteria. Check the Oxford knee scale. It's widely used.

annsixty Sat 27-Apr-19 08:56:55

Answering that totally honestly my score was 8.
The day I saw the Surgeon my name went on the waiting list.
I couldn't do my own shopping never mind walk two miles.

notentirelyallhere Sat 27-Apr-19 09:31:33

Thank you all very much for replying. And thanks annsixty for the relative measure of how much pain you were in. The GP made me feel like a nuisance! I do such a lot of things to help my knees, a twice weekly visit to the gym for an hour's cardio because I know 'keeping the muscles strong protects the joints'. I go to yoga weekly and have bi-weekly private yoga sessions, I stretch every day and walk and cycle but my knees are getting worse. I have more pain and stiffness and sometimes I just feel so fed up with it. I said all this but it fell on deaf ears. Sigh. Thanks again for the comments.

Jane10 Sat 27-Apr-19 10:31:56

Sometimes the cartilage has just gone and all the exercise in the world won't help. When you're bone on bone extra bony spurs grow which adds to the pain. Do the Oxford test and take the print out to the GP.
You can make a private appointment with an orthopaedic consultant directly. No need for GP referral by the way. A private consultation will cost around £250 ish but won't include X Rays which are necessary and would bump the cost up even more depending on the type requested by the doc.
Good luck.

GrandmaMoira Sat 27-Apr-19 10:37:50

If the GP is recommending physio, ask for a referral. The physio will assess you and recommend to the GP that you need to see an Orthopaedic surgeon.

maryeliza54 Sat 27-Apr-19 10:39:45

Jane in my area the consultants at the private hospitals require a GP referral letter as I found to my irritation recently. I then also paid for a knee MRI - I think current thinking is that xrays are just not helpful enough

maryeliza54 Sat 27-Apr-19 10:40:36

Well again in my area you’ll be waiting until kingdom come for a physio appointment to materialise

cornergran Sat 27-Apr-19 10:45:32

My GP was kinder, explained an x-ray followed by physio assessment was stage 1 in this area. The physio looked at the x-ray and suggested a group 6 week exercise/information session in the hospital gym. At the end we were all asked what we would like to happen next. Some opted for referral to a surgeon, others thought the extra knowledge and exercise regime was enough for the time being. I suspect it’s a usual approach in many areas.

For myself I opted for acupuncture (from the physio department) which has held swelling at bay, so far I can manage the pain. My GP is open to an onward referral when I think it’s needed. I’m sorry yours was less helpful notentirely. Your CCG will publish referral criteria, pain is very personal and if you use the Oxford test that will provide detail of your reality. Don’t give up, see another GP if you can or as has been suggested a private consultation if it can be resourced would give you more certainty. With regards to walking my pain clinic consultant (I have other issues) said if I got to the point when I had to stop after 10 minutes I had left it too long.

maryeliza54 Sat 27-Apr-19 10:58:22

It’s because all ccg set their own policies ( although many will be broadly similar) that you need to get a copy of yours as a starting point.

FlexibleFriend Sat 27-Apr-19 11:59:18

I was due to have mine replaced last september but it was postponed due to being admitted to hospital with something else. As for walking two miles blimey I can just about hobble to the loo. Standing is so painful but my knees are now numb where I think I've damaged the nerves by continuing to hobble around at home. I was told a year ago I had no cartilage left so have been bone on bone for at least a year. I can honestly say it hasn't got any worse in the past year but still waiting for the go ahead for knee surgery after my hospitalisation last year. I'm considered high risk due to my auto immune condition so I'd rather wait and be safe than go ahead too soon. My decline was very sudden, no gradual deterioration. I went from going to the gym most days to being unable to stand overnight so we're all different.

Charleygirl5 Sat 27-Apr-19 12:22:38

The xrays are graded 0-4. 0 being normal, 4 being bone rubbing on bone.

I have had both knees replaced, 5 years apart and the last one operated 11 months ago. For other reasons I could not get my last knee replaced when it should have been so my knee deteriorated so that I ended up with a valgus deformity which means my lower leg was at a slight angle to the left which had to be corrected when I had my left knee replaced.

On both occasions I returned to my GP when I had pain at night- difficulty getting to sleep and also pain waking me.

I also suggest you do some research and look up an orthopaedic consultant locally who does hips and knees only. You do not want somebody who operates on everything and is master of none. You also want a younger fellow, not one close to retirement who has kept up with the latest developments.

I do not advise you seeing somebody privately because you may have to pay for xrays separately- they are not always included in the fee. A lot depends on where you live, in my area, it is now around £350 for an hour.

I would find another GP.

Jane10 Sat 27-Apr-19 12:31:08

Obviously things are different where you live Maryeliza54.
I made direct appointment and also saw my X rays. Perfectly clear on both occasions. No need to move to MRI.
I've had a very good outcome having had both knees replaced.

maryeliza54 Sat 27-Apr-19 12:36:06

Yes that’s why I suggested getting the local ccg policy as a starting point. Having read that it may actually be clear what the chances of getting a referral are or what the pathway would be. Seeing a consultant privately is an option if you don’t meet the critetia for a referral or the wait is very long. But until you know what’s the local position, it’s hard to make that decision.

maryeliza54 Sat 27-Apr-19 12:38:14

Every case is different re MRI/X-ray - in my particular circumstances an MRI was necessary and I didn’t want to wait for an NHS appointment

FlexibleFriend Sat 27-Apr-19 13:26:20

I had xrays and was diagnosed with mild deterioration which seemed mad because I was unable to stand. Paid for private MRI's which showed severe deterioration and no cartilage.

maryeliza54 Sat 27-Apr-19 14:01:37

Good point FF - shame it was necessary but you trusted your judgement.

stella1949 Sat 27-Apr-19 14:04:34

You're lucky that you can still walk for a couple of miles ! I could barely walk at all before I had my replacement.

janeainsworth Sat 27-Apr-19 14:32:24

I think the point about an MRI is that it gives a 3-dimensional view whereas an XRay is only 2-dimensional, so an MRI gives much more detailed & valuable information.
The knee joint is much more complicated than the hip joint too.

Jane10 Sat 27-Apr-19 15:02:39

I'm quite sure MRIs give more detail if required but are not always required! Sometimes, as in my case, the problem was crystal clear. There's a huge jump in price for an MRI. Perhaps if surgeons are using mako robotic equipment they may need MRI prior to that? My knees were not suitable for that method.

maryeliza54 Sat 27-Apr-19 15:09:44

No ones saying that MRIs are always required. Sometimes they are and as FF demonstrates, an X ray was inadequate and she persisted because she knew herself there was something definitely wrong. So you weren’t in that category Jane so what? We are giving our individual experiences on here, not saying what should happen in every case.

notentirelyallhere Sat 27-Apr-19 15:30:58

Thanks again for the useful replies. I will walk through pain but obviously it's not severe. The Oxford 10 test is very good, I'm a mid score. I suppose being able to get up from kneeling OK on one side is acceptable!

The answers here do show how varied NHS provision has become. I'm lucky to have a minor injuries unit, to which I went when I injured my foot. I had been in pain for 24 hours and to my mind, my foot was swelling enormously. The doctor I saw after a couple of hours commented that as I'd walked into his room (albeit leaning on my husband's arm and hobbling on the side of my foot on Crocs which were the only shoes I could get on my foot), then I had not broken anything so the answer was ice, rest, elevate and take pain killers. I saw a private physio the next day who gave me some ultrasound and strapped up my foot whereupon my pain levels decreased by a good 2/3. It seems sad that levels of care have become so basic if you're not dying. Apologies if this seems slightly off topic.

Jane10 Sat 27-Apr-19 15:39:40

Prior to my replacements I certainly could not have contemplated walking as far as you OP and I haven't been able to kneel at all for years. Standing up from sitting was always so painful. I just got used to it. It was only when I realised that I was planning my life from seat to seat and writing a shopping list that meant the least possible walking around that I finally realised that this was ridiculous and I needed to take action.
It's not fun and recovery is harder that people who haven't had a knee replacement make out but it's worth it. I'm only just getting back to fitness now. I'm writing this while out walking. It's great. No pain!

Charleygirl5 Sat 27-Apr-19 17:34:12

I agree, Jane, I agree, it was well worth the pain. I can now walk to the bus stop and that takes me 10 minutes, a "normal" person could do it in 5 minutes. I can walk around the local shopping centre- before if I reached M&S entrance I could not walk around the store. I have not been able to kneel for around 20 years.