Knee

I hurt my right knee when out on a long run, about 20 years ago, tripping over a tree root and having to jog/limp about 5 miles back home. I had damaged a cartilage, and had keyhole surgery to remove the damaged area.

I suspect that rather a lot was removed, and I have had a bit of soreness and increasing stiffness since then.

I eventually gave up running and started cycling - rotational rather than impact. Seemed to work. Then, during building work at home, I slipped off a low wall and landed on my right leg with my leg straight and knee locked.  Seriously painful, over a couple of weeks the pain eased a bit but by no means enough. So I limped along to the GP surgery.

Very professional and communicative doctor (new to me) who agreed it was a soft tissue injury and recommended a scan. So far so good.... until I received a phone call a couple of weeks later to say that the request for a scan had been turned down, as I was over 55 and my knee was almost certainly arthritic!

Dear NHS - so if you are over 55 and active, but get an injury, you are basically written off as not worth treating?

So I go for an x-ray. No feedback and after a few weeks ring a GP. Someone (new to me) calls back. "Oh, did no-one ring you? You have severe arthritis in all 3 compartments of your knee and probably need a knee replacement".

That was a bit of a shock, but by now 2 months have elapsed and I have started some self-help, having found some knee strengthening exercises on a NHS website and have also restarted a bit of steady, low-force cycling on my turbo trainer.  I go along to see a GP and am told, after internal discussions with the practice expert,  that I will be referred to a consultant to discuss the replacement operation. I'm on another NHS conveyor, at the end of which there is a big sign with flashing lights saying "knee replacement'.

I'm unconvinced. I can't exercise much and don't feel so good as a result.

Three months pass by. My exercise regime seems to be working and I am either cycling or walking every day. I can cycle 20 miles and more, or walk for 2 hours with no limping and manageable pain. No communication from the NHS conveyor.

Eventually I get an appointment. I assume it is with a consultant. But no, and this is good news, I see a physiotherapist whose job it is to assess the injury and make recommendations to the consultant.

It's 6 months since the injury and I'm much better. The assessor agrees and shows me the xrays - quite a bit of cartilage left, some arthritis - but is unable to understand the 'replace it' recommendation. Best bet is that radiologists are trained to look for arthritis, guess what they found? But they do not look at the joint as a whole. So why an immediate recommendation after the xray?

Now the recommendation is physiotherapy. The affected knee has slightly limited range and tips inwards slightly.

I'm told that if the knee gets a lot worse, there is a progression, something like:
Painkillers to manage the pain and allow me to keep active
Steroid injections, although they lose effectiveness over time
Last resort - knee replacement

It's 7 months by the time I get an physio appointment, my knee is pretty good by now.

First physio appointment - fortunately I take along the letter from the assessor as this hasn't made it through to the information the physio has. Various tests and checks, recommendation to strengthen my hips as well (specific exercises) as well as emphasis on various knee exercises. I'm happy with this, but why on earth did it take 7 months to get this far? After 3 appointments I'm passed back to my GP and have a list of exercises to continue.

In my view much time and resource has simply been wasted. But the exercises are helping (and I've just started a pilates class too).

Update after almost a year since the injury. Still improving, a bit of pain but I can walk 8 miles plus, cycle for 2 hours / 30+ miles. Pilates is helping, as are the exercises recommended by the physiotherapist. On the advice of a friend who has had similar knee problems I have bought a Bosu Ball which is helping with joint strength and balance.

Exercise makes a massive contribution to my sense of wellbeing.