You are all such lovely people (well most of you)

Thanks for popping in.

This problem isn't mine it's my Daughter - in- law. She has a dodgy knee, well that's an understatement.

She's not a runner as such, but used to ride horses (and teach riding) as well as play hockey and was generally active. She developed a problem with her knee which was operated on in Belgium. She has been told that they messed up by taking away too much cartilage and she's not been pain free since.

Earlier this year, she went out on her bike and hobbled home in agony. This was an awful time for her, she was living miles from anywhere, she doesn't drive and my son was out in Bosnia which meant she was trying to cope with two young children and unable to walk.

But I'm waffling.

The latest is, that she has had an arthroscopy - the surgeon this week acknowledged that the knee is still very painful and swollen. He shrugged his shoulders and said 'well at least we tried'. He's advised her that a knee replacement is now her only option and as she is just 30 she'll have to wait quite some time unless she has the odd £8000 laying around.

Apparently, there's a degeneration of the inside of the knee. I'm not sure exactly what she means by inside. I know she has a thin cartilage and the knee cap is not working as it should.

In the grand scheme of things, a dodgy knee is not the worst thing that someone has to live with, but at the moment she feels that she is to face a long life of pain and very limited function.

Thanks for 'listening'

Aww, Sue. I knew that your DIL had a bad knee but didn't realise just how bad.

Surgery should be offered on clinical need. If your DIL is trying to cope with a family, I would have thought she was at least as entitled to a replacement as someone older (I'm assuming that the potential delay is not due to clinical considerations otherwise they should not be offering it privately)!

My mum had the same problem, arthritis on the knee, and needed an urgent knee replacement as she was is constant pain.

At 60 she was told that she was too young as the knee replacement would only last 10-15 years.

Eventually I went with her and argued with the doctor that she was in agony on a daily basis and that age shouldn't come into it.

 They did agree to put her on the waiting list and bumped her 6 months up the list as she had already been waiting 6 months.  This is how they get the waiting list times down, they don't put people on the lists until they are is extreme pain on a daily basis.

I'd definately go back to the doctors and argue her case again.

 Good luck

No, it's not about waiting lists. I think you are confusing managers and doctors.

The clinical point is that a TKR works for between 10 and 15 years, once you've done it and it starts to fail, you then need to revise it with more surgery. Once you've done 1 or possibly 2 revisions (in the best hands - I've rarely seen it done), you have fairly limited options - arthrodesis? (fusing a joint - not ideal for a knee, as massively limits mobility) wheelchair? If we can avoid being in that situation with a 50 year old, we would like to.

A knee replacement isn't always the solution people think it is - clearly for a few younger people who are in constant daily pain and have exhausted other options, it is the only option, but those people need to be making decisions fully aware of the implications further down the line. For many other people, aggressive physio, braces, analgesia, chondrocyte implantation etc is appropriate to try and defer a TKR.

Young OA knees are difficult and a specialist opinion sounds like the best way of progressing. Good luck.

Hey Folks - this is my first post but I felt compelled to repl as my mum has had a bad knee for as long as I have memories - caused by a messed up operation when she was fifteen also re:catilage.

I agree to most of what the poster above has said but they used the same logic with my mum for years - she even went to the local BUPA hospital but the consultant there is the same consultant in the NHS!? Anyway fast forward 35 years from the botched surgery my mum is now on morphine daily is confined to a wheelchair because her stronger knee can't cope any longer. Now her weak knee is too weak for a knee replacement because the muscle has wasted and they fear she may still get phantom pains. 

Anyway this isn't meant to get sympathy or to scare you but I would like to encourage you as much as possible to seek as much advice as you possibly can so it doesn't get to the stage like my mums. I know going private is an expensive option but would it be possible to at least get an examination?

Excuse the rant - just obviously quite close to home.

 Martyn

Just a thought about bicycles.

A badly set up bike can be death on knees.  I don't have knee probs as such, but if I wear shoes with thicker soles than usual, and cycle as little as three miles, I will be quite lame for two or three days, longer if I cycle further.  For me, I need to have the seat quite high so I am not pushing down with a very bent knee.

Otherwise, 

I would go for every anti-inflammatory trick known, and when the inflammation is under control, I would go for every muscle strengthening, balancing trick known.  I would pay to see the best podiatrist I could find, and get biomechanics evaluated.  I would get a full sports massage done, and repeat until no muscles are tight and out of balance.  I would do pilates/Franklin method work to make sure that no other postural problems were aggravating the knee.

One of the things I really hated when I was on sticks was hanging around waiting for the medical community to do something for me.  It made me see red when they couldn't do anything useful.  Things got a lot better when I stopped waiting for them.

Some of the ideas require funding, although not in the same league as a private knee replacement, supposing you could persuade someone to do it.   In an ideal world this should be on the NHS, but I'd rather do what I can and give the knee its best chance, than risk early confinement to a wheelchair because I didn't do all I could have done.

Best of luck with it.

Much wise advice here, Lady Sue, and I do hope some of it works for your DIL. If not, and she does need (and can get) an operation, it's not over-optimistic to suppose that medical science may come up with new and better solutions in the 10-15 years before the replacement joint wears out.