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Surgery refused as knees won't straighten

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hazel

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My Mum spent 13 years on steroids for Rheumatoid Arthritis. Obviously she has bad Osteoarthritis now. The arthritis clinic at the hospital says she needs replacement knees, but the Orthopaedic surgeon has just refused. She is 85.

The reason given for the refusal is that her kness will no longer straighten. He says she will not therefore be able to benefit from knee replacement surgery.

Can anyone tell me if this is true, or is it just because Mum is now too old for them to want to operate in the UK.

Hazel
 

JudyS

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Oh Hazel that is so sad. There must be something that can be done for your mom.
Jo will be on and she is our expert and will certainly be able to advise you if there is something to be done.
Good luck
judy
 

Jamie

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Hi, Hazel.....welcome to BoneSmart. I am so sad to hear that your surgeon has refused knee replacement surgery for your mother.

Our forum nurse, Josephine, should be online here soon with some information for you from a medical perspective. She also lives in Great Britain and may be able to help you find a different surgeon to consult with. That is certainly what I would recommend...get another opinion. With knee replacement surgery, a person's joint is cut out and totally replaced, so I'm not understanding why a doctor would say her legs would never straighten. Because of all she's been through, recovery might be more difficult and longer to get the muscles stretched out and her gait adjusted, but it seems to me she would be no worse off in terms of range of motion than she is now....just no knee pain from arthritis.

We'll see what Jo says....she's the medical expert!

But again...welcome and I'm glad you decided to join the forum!
 

Josephine

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Hazel, that's awful! At which hospital was she seen?
 
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hazel

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Mum (her name is Beryl) has been treated for about 20 years for her arthritis at Furness General hospital in Barrow-in-Furness.

She would be prepared to travel further afield for a second opinion.

I know Derek McMinn in Birmingham, but Mum really doesn't have the resources to have any operation privately (and neither do I have the money to pay for her privately at the moment, unfortunately).

It is so sad that they left her on steroids for so long. She put on over 3 stone in weight and her skin got paper thin. My sister and I had to eventually insist that she was weaned off the steroids. She had just about become wheelchair bound - at least a couch potato and stair lift candidate. She has lost the weight now and is back to 8 st.

When she was out visiting me in Turkey last winter she went to physiotherapy there and improved tremendously. They were aghast at the treatment she'd had over the years in the UK. She was actually on local TV out in Bodrum and made all of the local newspapers there :). Mum is very intelligent and her mind and sense of humour are very lively. She never complains, even though her pain is often very bad.

She has waited many months for some appointments at Furness General and in one case - over a year. They actually sent her an appointment, to keep up with their targets I expect, then sent a cancellation as they were reorganising, then "forgot" to send her another appointment.

I thought we were getting somewhere this summer when Mum's apointment with the orthopaedic consultant actually came round. I took her (travelling back especially!) and she saw a doctor who at least gave her some time. Then he decided to give her cortizone injections in both knees and told her to keep a diary of her pain and excercise and she'd be sent another appointment in 2 months.

For 3 weeks she was brilliant. She had a whole new lease of life. Got up out of her chair, walked up the stairs, walked to the park and the shops - on her own and did exercises religiously twice a day. I understand that, if done regularly, these steroid injections will further wear away the very small amount of cartilage she has left.

She has just been for the follow-up appointment and that is where they told her she was unsuitalble for surgery - because her knees won't straighten.

She has been told they will do cortizone injections 3 times a year - so her best prognosis is that she'll have 3 weeks every 4 months where she gets a life back - and even that will degenerate..... Not good!

Thanks for taking the time to talk to me about this and thanks to the other 2 people who've replied so far.
 

Jamie

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Hazel, what a bright star your mum is!!! I LOVE older people who are firecrackers like she is. Keep rattling the cages. A person with your mom's spirit and drive deserves to have an opportunity for knee replacements just as much as anyone else. I hope Jo can help get you to a more accommodating doctor. I guess you'll have to keep after the appointment schedulers too...waiting a year is inexcusable!

Don't give up!!!
 

Texas

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That is terrible i dont care what age you are yo deserve treatment at any age.........I sure hope someone will do something tell her she alot of people praying for her i wish her the best...........)
 

tom67

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Hi Hazel I'm so sorry about your mom! Kim is right! Nobody regardless of age
or condition should be denied the right to live pain free, that's not fair! As Jamie
said Rattle some cages and don't give up! My thoughts and prayers for your
Mom, Best Wishes,
 

Josephine

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Okay - here are some options nearer your patch

1. Leeds General Infirmary: Tel: Mr Aderinto, Mr Bobak, Mr Calder, Mr McDonald and Mr Stone
2. Center for Lower Limb Surgery, Wrightington
3. Sunderland Royal Hospital: Mr O'Brien

You can get your GP to refer you to any of these hospitals for a second opinion and for surgery. I'm sure you'll find they have a more enlightened attitude.

Incidentally, few surgeons have an upper age limit on any joint replacements. I've nursed people in the upper 90s for both hip and kneed replacements! One patient was even 100! Methods of screening focus more on the mental acuities of the patient meaning would they cope with the surgery and rehab and would they then make best use of the replacements. A patient would have to be pretty senile (or other) to be excluded.
 

Rowdy66

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Sorry, I need to have this question answered. Isn't the point of knee replacement surgery, or one of the points at least, so that we can once again BEND our knees. I sure hope your mom gets a second opinion, today with a bright mind such as you have described she isn't old, but having your dreams of being mobile and having some of your pain eliminated is enough to make you feel it. God bless both you and your mom, I can't help but think you were led to this site and Josephine for a reason. Lots of luck, Jan (R9wdy)
 

cotton1958

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Hi there, sorry about your Mom's dilemma. Sorry I do not have a link, but in the Mercy Hospital (Miami) video surgery of a knee replacement, the Doctor addresses age and this surgery. It's towards the end if you don't want to watch the surgery.

Good luck to your Mom.
 

Jamie

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Here is the link to the ORLive video of an actual surgery. Rather than watch the entire video, fast forward to about the 54 minute mark and start from there. The doctors discuss why it is perfectly acceptable to consider knee replacement in elderly patients if their health can support it.
 

cotton1958

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Thanks Jamie. A little bit further in this same video the Dr. addresses the MIS issue too. Makes sense, what he says, to me.
 
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hazel

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Thanks so much to all who have contributed to this thread. My sister and I have now discussed what has been said here and we will certainly watch the video links you have mentioned. After doing this Kay will then sit down and discuss these options with Mum.

Please all note that "age" was not the reason given for the refusal of the surgery. Rather they said that people whose knees wouldn't straighten would get little or no benefit from surgery. I think my sister said the consultant said Mum may even be worse, and he suggested Cortizone injections every 4 months (giving Mum about 3 weeks with lessened pain).

Jamie addressed this with his comment about it taking Mum a bit longer to recover, I guess that is so that her tendons could gradually get stretched.... but no-one else seemed to think the consultant's suggestion that she will be better off with the Cortizone was worthy of consideration. Is that correct? My instinct was for sure to disagree with him, but I am not an expert. How can we be sure that Mum shouldn't just listen to him?

Thanks again, everyone.

Hazel
P.S. I'll make another thread about my knees when we've solved this thread :).
 

cotton1958

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Hi. Cortisone shots would not hurt to try, if you feel like you are in good hands with your Dr. I think a lot of folks here may not have received help with the shots, because we were bone-on-bone and it doesn't work very well if at all.

Good luck to your Mum and glad she has you all as her advocates.
 

Jamie

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Hazel, God bless you and your sister for doing such a great job advocating for your mother. She is blessed to have you there for her.

Watch the videos, talk about it....but the thing you really need to do is NOT to second guess what this consultant has told you to do. Neither you nor your sister...nor most of the people on this forum...are medical personnel. What you DO need to do is take Josephine's advice and see someone at one of the clinics she gave you. You need additional opinions....from people who can actually look at you mom, her xrays and MRIs and then give you their opinion of whether or not she could benefit from knee replacements.

Since it may take some time to get an appointment, I'd get going on that right away!
 

Josephine

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Well, all I can say it that I've seen some really badly deformed knees get replacements in my time. And, so far as I knew, they did pretty good.

To be honest, cortisone shots for something that bad are a poor second best option. Results are patchy and the people who benefit from them most are those whose arthritis isn't that far advanced to begin with.

It's not going to hurt anything to get a second opinion to start with. The law allowing us to go to any hospital in the UK was only passed early this year - why not take advantage of it?
 

Judles

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I wish you and Mum the best recourse, Hazel!!! Be proactive! You will need to be your Mum's advocate! Just keep her moving and her mind occupied! Keep posting! I wish you both the best of good luck! (:)0)
 
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Hazel,
You are a wonderful daughter!! Your Mother needs a second opinion just as Jo has said. Jo knows what she is talking about!!! Please take her advice to heart. Tell you Mother we are all here praying for her.
 
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