• RATE YOUR SURGEON ON OUR NEW JOINT SURGEON LOCATOR

    Your opinion matters so please click on this announcement to find out how to rate the surgeons you have worked with

    You could also go to the Surgeon Locator via the blue nav bar at the top - find the tab "Surgeon Locator"

Do I or don't I?

Status
Not open for further replies.

Gretchendz

senior
Joined
May 22, 2008
Messages
341
Gender
Female
Country
United States United States
Re: I'm still dithering!

Hi there.

I'm sure no athlete like you, and, as others have said, this must be YOUR decision.

I would point out, though, that many doctors say that your ROM before surgery is your best predictor after surgery. No guarantees, and you might lose some. But my theory would be that losing a few points of ROM is worth is compared to eliminating that pain.

Another point. Many of started losing our gait due to the pain. I know in my case, after the surgeries (both TKRs), friends and family were shocked to discover I was an inch or 2 taller than they thought. They had not seen me walking straight in years. Frankly, it slowed my recovery as I had to relearn how to walk properly. I had waited so long that I had messed up not only my gait, but my muscles--they had to be painfully retrained. If I had done the surgery sooner, I have no doubt I would have recovered more quickly and even more thoroughly.

Consider what you may be doing to your right leg, and posture, and back with that bum left knee.

I'd recommend you factor this into your decision. Good luck!
 

Texas

alpha
Joined
Apr 19, 2009
Messages
8,210
Age
52
Location
United States
Re: I'm still dithering!

Im 42 , I didnt want to wait because why live in any kind of pain hen you can make it better and have the rest of your life with no pain in that knee....You have been thru alot ....I dont see it getting better on its own......We are behind you whatever you decided...............)
 

Linda2

post-grad
Joined
Jun 20, 2008
Messages
1,472
Age
71
Location
Kalamazoo, Michigan, United States
Re: I'm still dithering!

I see no reason you can't do all that you do now--only without the pain. Granted, there will be recovery time when you can't do as much, but then it just gets better and better. My ROM is 140-145 in my "old" new knee and 135-145 in my "new" new knee. Yes, it was more before surgery, but this is fine. All of us seem to do fine if we achieve something close to what we had before surgery. The main thing is that it doesn't hurt like it used to!
 

cindy88fan

supremo
Joined
May 14, 2009
Messages
2,067
Age
55
Location
Indiana
Gender
Female
Country
United States United States
Re: I'm still dithering!

I'm 45 and I had lived with knee pain for a long time. I have been bone on bone on right knee since I was 15 and bone on bone on left knee since I was 20. Finally I just got done having BTKR and that was the best thing I could have done.

My ROM was left knee...105, right knee...88 prior to surgery. I am now at 135 for both knees...last time I checked at least...could be more now. You don't have to give up anything. You are a strong person by the sounds of it which will make your recovery easier.

Just remember, you are the only one that can make the final decision but we are here for you always. Also, if I can get through it, I know you can.:thmb:
 
OP
OP
P

PieMan

junior member
Joined
Jan 6, 2009
Messages
41
Location
United Kingdom
relieved yet annoyed with registrar

Dear Bonesmarters,
Just thought i would lie on the forums cyber couch and tell my tale - went for my 6mthly knee appointment yesterday at the Royal National Orthopaedic Hospital to see my consultant Mr Will Aston ( prev Mr Canon now retiring ) anyway didn't see consultant ( even tho i asked ) but saw a young registrar. He went on to tell me that a TKR would not be recommended until i was in great deal more pain and discomfort ( ie can't walk ), that when a TKR is forth coming ( in his opinion 5 - 10 years ) i may not even be able to get back on my bike and that a ROM of 90 degrees would be expected - i may get more if lucky. Made another appointment for 6 mths where he said he would discuss a high tibial osteotomy ( seems to have ignored my PCL instability ) and the fact that it was discounted several years ago - not keen on one of those i can tell you.
I have seen more degeneration in my knee in the last 6 mths than ever before, my leg is now bowed and the tibia is sinking back underneath my knee joint re PCL issue - OA in left side if left knee and behind the knee cap is making itself felt. I agree that i can last a bit longer but if i last another year i'd be surprised. I know the RNOH is the best place for me to be and in 6 mths i would probably see another registrar who has a completely different view.
I have been left a little confused, not sure i like the registars under Aston and will see if i can get under Mr Briggs ( more a question for Jo ).
Regards
 

Texas

alpha
Joined
Apr 19, 2009
Messages
8,210
Age
52
Location
United States
Re: relieved yet annoyed with registrar

I agree if your hurting and it is getting worse then something should be done why wait i dont understand that............Im from the US and i had that problem.but there are others drs tha understand......Im sure someone willpost from there and help you.........sorry your in pain nd they want to wait just not fair...........take it easy and i wish you the best you can sit on the sofa anytime.......) w all have.......lol
 

Judles

alpha
Joined
Dec 28, 2008
Messages
8,996
Age
69
Location
New York
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

Can't you go to ANOTHER doctor! It's not only annoying, but dangerous to be in such pain!!! No one should have to endure this! FIGHT!!!!!
 

abunnybabe

graduate
Joined
Sep 22, 2009
Messages
900
Age
59
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

Can you explain what is a registrar/consultant. How old are you? Is that a consideration in why they want you to wait? I'm learning alot about the British medical system, it's interesting to see the differences between the countries.
 

Texas

alpha
Joined
Apr 19, 2009
Messages
8,210
Age
52
Location
United States
Re: relieved yet annoyed with registrar

I think that our dr's and or medical asst someone correct me if im wrong.............)
 

RestAssured

Forum Advisor
Joined
Oct 3, 2009
Messages
8,987
Age
54
Location
Texas
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

Hello, I would definitely see if I could seek a second opinion. I don't know how old you are, but it doesn't sound like a wait and see approach is in order.:sct: If you are in a lot of pain can they at least put you in a brace if they refuse to do surgery because of your age?
 

Jamie

ADMINISTRATOR
Senior Administrator
Joined
Mar 24, 2008
Messages
56,929
Age
71
Location
Kansas
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

I definitely think you should see someone else. Maybe Jo can recommend someone. This young man is wrong. You should NOT wait until you are in pain and not walking before a replacement is considered. It makes no sense and you should not put up with that decision. You deserve the right to be pain free no matter what your age!
 

Josephine

NURSE DIRECTOR
Nurse Director
Joined
Jun 8, 2007
Messages
84,927
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Re: relieved yet annoyed with registrar

I am shocked at this antiquarian attitude! Was he English? Jeepers - I saw people of 30 have their knees done at the RNOH.

I would write to the Dept of Joint Reconstruction and request to see Mr Briggs. I always liked him better than Cannon, anyway. Don't know Aston. If you can't get in to see him, go to your GP and ask to be referred again - to Mr Briggs. And when you see him, be explicit that you are not prepared to wait but want your knees done now, that you're not prepared to accept this abysmal quality of life any longer. Sometimes you have to be assertive and state your requirements!
 

Judles

alpha
Joined
Dec 28, 2008
Messages
8,996
Age
69
Location
New York
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

Let us know what happens,Pie Man!!! Good luck!!! :thmb:
:wink:
 

Josephine

NURSE DIRECTOR
Nurse Director
Joined
Jun 8, 2007
Messages
84,927
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Re: relieved yet annoyed with registrar

Terri, we have a different system here in the UK.

Doctors come out of med school and take jobs for 6 months at a time as house doctors. They're the donkeys of the NHS, on call about 4 nights out of 7 and do all sorts of general stuff like admitting patients, doing general rounds making sure patients are ok and signing up any routine tests and scripts the nurses need.

Then, when they've done about 4 years of house jobs, they get senior house jobs where they can help in theatre and clinics and make some decisions. After another 2 years or so of that, they'll choose their speciality (medicine or surgery) and do the appropriate post-grad training. For orthos, this means doing their FRCS, Fellow of the Royal College of Surgeons. No doctor can do surgery of any kind without that.

Then they'll go on to do some junior registrar jobs there they can be first assistant to the seniors and be in a training, supervisory and advisory role to the house doctors. If the senior registrar is absent for weekends or a week, he can stand in for him. He doesn't operate much unsupervised yet. This period varies depending upon how ambitious or driven the man is. It's usually a minimum of 2 years but can be as long as 6 years.

Then he'll go on to do his speciality training on an Orthopaedic rotation courses when he becomes a Senior Registrar. These last for 5 years and involve them spending 6 or 12 months at a time at different hospitals, working at centres of excellence with very experienced surgeons. One such course is run by the RNOH and involves about 6 other hospitals. Whilst they're doing this course, they will begin taking more and more responsibility over patients' treatment but always under the guidance of the consultant. Towards the end, they will be having their own operating lists and start doing joint replacements and other procedures on their own. They must also undertake research and write several papers for the professional journals, in this case especially the Journal of Bone and Joint Surgery. They also need to offer papers to conferences and symposia and present them. The more they do, the better their credentials and this will stand them in good stead and they will have become known around the very small orthopaedic world and have a ready 'in' when they come to apply for posts.
At this point, they are consultants in waiting.

Then they get posts as consultants at hospitals all around the UK. They have their own specialty, their own bed allocation and clinics and take their turn being on call for all the trauma intake for the whole week at their base hospital. Generally, such jobs are for life. We don't often get consultants moving from job to job unless they're really bad!

A consultant in a large hospital like the RNOH may actually be in a team like the Department of Joint Reconstruction at the RNOH. In this case they will have additional positions like lecturers and Clinical consultants. There will be a Professor in over-all charge.

Patients are generally referred to consultants by their GPs and have to wait to get an appointment. Mostly the practice is that new patients are seen by the consultants and follow-ups are seen by the registrars. This seems to be otherwise at the RNOH because when I went there, also expecting to see the Prof, I was seen by the registrar who pronounced that there was nothing wrong with my knee and it was perfectly normal! I saw the xrays he was looking at and that the depression on the medial tibial condyle was gone! I was so delighted (miracle healing, don't y'know!) that I requested a copy of the films only to find - these were not the ones we'd been looking at in the clinic! They weren't even my xrays!

Also, consultants work in the NHS on a 'part-time' basis nominated as 7/10ths of a week, thus getting 7/10ths of the full time salary. The remaining time they can use to have a private practice! If a consultant is employed on a full-time basis, he is not permitted to have a private practice! But IMO, we get the best of both worlds because if they were forced to choose, the best surgeons would opt for private medicine and be lost to the NHS.

Another oddity is that all surgeons in the UK are called Mr! This came from the very old times in 18/19th centuries when surgery was done by barbers. "real" doctors wouldn't lower themselves to do surgery and jealously guarded their doctor title. Surgery was thus considered 'fringe' medicine. It was in the early 20th century that they were finally admitted into the hallowed halls of medicine and as a mark of their difference, retained their appellation of "Mr"! In fact, a UK surgeon would be highly insulted to be called Doctor! This is why I sometimes get confused when you Americans talk about seeing your 'doctors' as to me, that indicates your GP, not your surgeon!
 

Jamie

ADMINISTRATOR
Senior Administrator
Joined
Mar 24, 2008
Messages
56,929
Age
71
Location
Kansas
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

That is interesting, Jo. Thanks for helping us understand how the British system works.
 
Joined
Jan 8, 2009
Messages
5,014
Age
71
Location
Iowa
Country
United States United States
Re: relieved yet annoyed with registrar

Jo,
Thank you so much for explaining all of that. It is hard to believe there is such a hugh difference between the UK and US. When so much of our history is formed by the UK. I was really amazed by the "Mr." instead of "Doctor." And the history behind it. It was all so interesting. Thank you again Jo for sharing.
 

cindy88fan

supremo
Joined
May 14, 2009
Messages
2,067
Age
55
Location
Indiana
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

Wow! I don't know what else to say. That system is so interesting! Thanks for explaining everything Jo!

Pie man...good luck! I hope you get your much needed surgery....SOON!!!!!!!
 

RestAssured

Forum Advisor
Joined
Oct 3, 2009
Messages
8,987
Age
54
Location
Texas
Gender
Female
Country
United States United States
Re: relieved yet annoyed with registrar

Pie Man, listen to Jo. She knows her stuff! Get the help you need. Jo knows all about the UK system as is obvious from that informative post, so press on and get the right "Mr." to treat you!:thmb:
 
OP
OP
P

PieMan

junior member
Joined
Jan 6, 2009
Messages
41
Location
United Kingdom
HTO v's TKR

Dear Bonesmarters,
Went for my 6 mthly outpaitents appointment with my Consultant - was seem by the registrar - they plan to do an exploritary arthroscopy and then make a decision on more "definitive" surgery. They are considering High Tibial Oesteotomy or a TKR - my question is
Given that i have a lax PCL ( this will need tweaking ) would a HTO be appropriate and if it is the surgeons prefered choice what complications should i consider ie recovery and or revisions. Would it be better to go straight to the TKR. Although i am swayed by the fact that i still get to keep my natural knee - albeit faffed about with.

I think it is a pro's and con's question.

Kind regards
Pieman
 
Status
Not open for further replies.

Top Bottom