Lounge Doctor

TKR Need Help?

moosymad

new member
Joined
Feb 20, 2021
Messages
3
Age
44
Gender
Female
Country
United Kingdom United Kingdom
I don't know if I'm posting in the right part of the forum, so apologies in advance if I'm in the wrong place.

My dad is 72 and both his knees are shot and have been for 15+ years. He also has severe back issues after an accident in work in the 80's which resulted in a laminectomy, now due to scar tissue he's suffered with back problems for 30 years. He retired 19 years ago.

Dad is overweight, he wasn't always overweight but over the years the weight has piled on, mostly after my mum's death 12 years ago. Growing up I remember an active dad who would go to the gym and out jogging.

His GP and previous pain clinic consultant both say he won't get knee surgery due to a high BMI, his weight is approximately 130kg now. He was 142kg at his heaviest.

Dad was rather active up until about 18 months and now the pain he's in is massively affecting his quality of life.

He's been under weight management previously and managed to get his weight down to 118kg (2017/2018) and a BMI of 41 this was about three years ago but a surgery referral was refused again because they wanted a BMI of less than 40. Last January his GP noting he'd put weight back on said if he got his BMI back down to 41 he would refer him, I sat there angry but kept quiet.

My dad is wasting away before my eyes, he can barely walk now around the house let along safely outside. His only activity is managing to very slowly walk his small dog with great difficulty and this has been greatly reduced in the last 12 months, although he doesn't give up. However, he struggles outside especially getting on and off pavements and he's had several falls outside over the last 12 months. Before much longer I'm certain he's going to have a nasty fall.

Dad's on a combination of pain meds including fentanyl patches (50) tramadol SR 150mg paracetamol max dose and oramorph 4 times a day. He's also got ibuprofen gel and the pain clinic consultant took him off amitriptyline and 4 times a day tramadol 2 years ago. The pain clinic was a waste of his time.

Dad's repeatedly spoke to GP in last few months due to excess pain which is also affecting his sleep, the pain is so great he can't sleep. His back pain has also got significantly worse, a recent MRI scan on his back confirmed there was nothing they could do other than pain management.

Dad has perfect blood sugar control, is not a diabetic, has controlled high blood pressure and cholesterol, he doesn't smoke and barely drinks. With his previous weight loss he reversed his sleep apnea and came off his CPAP machine after 7 years.

His pain is affecting his mental health although being a man he is not likely to admit it. I see a frail old man whose doesn't bother these days, he can't stand to cook or even use his own bathroom safely. He has a walk in shower with a step but even that is a struggle. He's just been approved for a disability facilities grant for a level access shower but it could be a 12-month wait for funding.

I'm his carer and his only family, I'm struggling mentally to see him like this as well as take on more of his care. I have my own MH issues and most days I wish I was dead.

Dad's due to have yet another telephone consultation with a GP who knows his history on Monday but I expect he'll just be fobbed off again. They keep referring to the risk of anaesthetic due to a high BMI... But I am aware a total knee replacement can be done with a spinal anaesthetic.

I would appreciate any advice or help or guidance.
 

Pumpkln

MODERATOR
Moderator
Joined
Oct 27, 2011
Messages
24,992
Location
United States, West
Gender
Female
Country
United States United States
@moosymad ,
Welcome to BoneSmart, glad you joined us!! :welome:
Your fathers quality of life should determine his eligibility for a TKR, not his BMI as a sole determinant. Sorry you are having to jump through so many hoops to try and find the care your father needs.
My heart goes out to both of you for everything you are going through.

Here is some information about what to do if you are told you are too heavy for joint replacement.
BMI Calculator - What To Do Told You're Too Heavy for Joint Replacement Surgery
@Jaycey lives in the UK and may be able to help guide through the health care system.

Here is some additional information you may find helpful.

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:

Score Chart: How bad is my arthritic knee?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?


And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

Stories of amazing knee recoveries
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
34,591
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
@moosymad Welcome to BoneSmart! Sorry your Dad is suffering with all this. As a person who suffers from chronic spinal issues your Dad has all my sympathy.

The NHS has put many roadblocks to orthopaedic treatment in place. As you found, one pretty standard one is BMI. But there are surgeons who know that weight loss when you are in pain is impossible. You need to find a surgeon who will work with you on this. Unfortunately in this time of pandemic this may be difficult.

Besides his back and knees, does your Dad have any other underlying health issues?

What area does your Dad live in? And who has he seen in the past about his knees? I'll do a bit of research and see if I can help you find someone.
 

Carmencita

junior member
Joined
Jan 1, 2021
Messages
99
Age
61
Gender
Female
Country
United Kingdom United Kingdom
Hi @moosymad i’ve just read your post and my heart goes out to you and your dad. Although I don’t have any words of wisdom, I do hope that Jaycey may be able to help in finding an OS who understands. Like you said, many TKR’s are done with a spinal. I had mine 9 days ago in the UK (spinal), and my surgeon told me that in the UK 80% are carried out with a spinal. I do hope you manage to find a way forward.
 
OP
OP
M

moosymad

new member
Joined
Feb 20, 2021
Messages
3
Age
44
Gender
Female
Country
United Kingdom United Kingdom
Hi @moosymad i’ve just read your post and my heart goes out to you and your dad. Although I don’t have any words of wisdom, I do hope that Jaycey may be able to help in finding an OS who understands. Like you said, many TKR’s are done with a spinal. I had mine 9 days ago in the UK (spinal), and my surgeon told me that in the UK 80% are carried out with a spinal. I do hope you manage to find a way forward.
I wish you a good recovery! :)
 
OP
OP
M

moosymad

new member
Joined
Feb 20, 2021
Messages
3
Age
44
Gender
Female
Country
United Kingdom United Kingdom
@moosymad Welcome to BoneSmart! Sorry your Dad is suffering with all this. As a person who suffers from chronic spinal issues your Dad has all my sympathy.

The NHS has put many roadblocks to orthopaedic treatment in place. As you found, one pretty standard one is BMI. But there are surgeons who know that weight loss when you are in pain is impossible. You need to find a surgeon who will work with you on this. Unfortunately in this time of pandemic this may be difficult.

Besides his back and knees, does your Dad have any other underlying health issues?

What area does your Dad live in? And who has he seen in the past about his knees? I'll do a bit of research and see if I can help you find someone.
No other underlying conditions other than being obese. Heart is good and blood pressure and cholesterol is controlled with medications. HbA1c is also perfect. And previous weight loss has reversed sleep apnea.

We are in Greater Manchester. He's not seen anyone about his knees for more than 5 years, and if I recall that was December 2015 but again it was a fob off - I remember the date because it was the day before I took my driving test! I don't know who he actually saw back then but I do remember them saying weight loss was needed before considering surgery, that was when dad did put an effort into weight loss and did really well but both pain clinic consultant and GP still refused referral with BMI of 41. Now he's immobile just about managing short walks with dog with great difficulty, right knee locks continually and left is just as bad.

Even 4 years ago dad was going to the gym swimming regular for exercise, now it is not an option.

He's spoken to his GP again this morning who is arranging some new x-rays this time I armed myself with information from the NICE guidelines on Osteoarthritis Care and Management as well as some guidelines from Greater Manchester on knee replacement which my CCG have supplied a link to.

GP this morning has decided to reduce Tramadol SR to 100mg from 150mg and start him on Amitriptyline 25mg (despite him previously being on 300mg of Amitriptyline for 20 years!) GP tried to convince him referral would be refused due to high BMI, but dad pushed so this will be reviewed after new x-rays, I am to collect x-ray forms tomorrow from branch surgery.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
20,192
Age
65
Location
Delaware
Gender
Female
Country
United States United States
You might want to look at this score chart and fill it out to take with you to your next appointment, to show the doctors how much his knee is negatively affecting his life:

 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
34,591
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
It's very difficult if your GP is not supporting this. Keep stressing quality of life.

Are you in the position to pay for a private consultation. With both my THRs I saw my chosen consultant privately and then got on their NHS list. I found the private consultation much less rushed. Consultants are much more open to a good discussion when they are not under time pressure.

You might also want to do some research in your area for knee specialists. You could ring their office and ask if BMI is an issue. If you find someone then you can direct the GP to refer to that surgeon either on the NHS or privately.
 

New

Active Antibacterial

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
54,355
Messages
1,421,789
BoneSmarties
33,751
Latest member
MNVeronica
Recent bookmarks
0

Top Bottom