Knee replacement criteria

notentirelyallhere If you are telling your Dr/consultant that you can walk a couple of miles then I am not surprised that he/she is telling you that you are not a candidate for knee replacement surgery.

I imagine however that you are probably walking through a lot of pain before stopping. If so, this is not good for you.

It took me a long time to realise that 'powering through' does one no favours and that the day after will be hellishly painful. As an ex-dancer it is has been hard to accept that I cannot move freely, but accept it I must. I listen to my body and take a rest at the first sign of joint pain. Sometimes it takes me all day to tidy up the kitchen, other days I can tidy the whole house in an hour. I just do what I can, when I can.

If you can walk a couple of miles, pain free, then rejoice in that and the fact that you don't need the surgery. If you are struggling and pushing yourself with gritted teeth until the pain stops you, then you may need to re-think and have another, more honest, chat with your Dr.

Good luck in any scenario

Thanks for this Jane10 - funnily enough I have been to see my rheumatologist today about my knee pain. He was asking a lot of the questions on that scale and in his opinion I am not quite ready for replacement knee surgery. Which I was pleased to hear if I'm honest, although on that scale and answering honestly, I am in the category for consideration of a consult with an orthopaedic surgeon. We are going down the route of additional pain relief to see whether getting me to a point where i can exercise again helps with the knee (everywhere else is fine!)

I agree 100% with Jane

I left it a bit too long before going to see about my knee the first time. By then, as I was bone on bone, I'd begun to develop bony protruberances from the bone ends. These were grating against each other. No surprise as to why my knees were so sore. I'd just got used to it. Ridiculous on looking back at it but it just crept up gradually until I was really in trouble. Don't leave it too long!

I had an X-ray of my very painful knee that showed it was bone on bone. However, whilst waiting for the operation, two things happened.

1. I started taking MSM capsules

2. Everyone I met told me not to have the op if there was any alternative at all.

Four months later when I was called to speak to surgeon and anaesthetist pre-op, I told them there was very little pain now despite the X-Rays showing no cartilage.

They said, 'Shall we go by your symptoms rather than this X-ray? If you start having pain, ring us and we'll put you back on the list.'

That was 4 years ago and I still have no pain and am still taking MSM and swimming twice a week.

When the surgeon assessed me- he said no MRI would make any difference to the outcome, as my kne was clearly cream-crackered. He only took X-rays a few days before the op.

He said it was urgent as I had been bone on bone for so long- I was at risk of fusing. I had been told in UK I should wait until I was 65 - but he said in his eyes it was the wrong advice, and that I should have had it done many years earlier.

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.

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!

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.

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.

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.

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.

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

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

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.

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

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.

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.

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.

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.

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.

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.

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

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

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.