New Knees for Young & Old

There is a widely circulated myth, that someone can be too young for a joint replacement. If anyone is crippled by arthritis or other process destroying their joint, it needs to replacing ASAP. The longer a manky joint stays in place, the more damage it does, and the weaker and more dysfunctional the muscles around it become. Hence, if you need a joint replacement, you need a joint replacement regardless of age. To suggest otherwise is lazy thinking and poor medicine.

This myth is rife in the NHS. The only escape is to be rich enough to afford private surgery and then the surgeons will be all over you like a rash. Today, I saw a 54 year man who had been a semi-professional football in his youth and thoroughly trashed his knees. He had also done a fair amount of damage to one of his ankles. By aged 45 years he was in serious trouble. Arthroscopies (internal inspections with a fibre-optic ‘scope) showed a lot of wear and tear. However an, otherwise fit, man then in his 40s was judged too young for joint replacement, instead was offered physiotherapy and a follow up appointment.

A few years later he developed aortic regurgitation and needed a heart valve replacing. This left him on anticoagulants, and thus subsequent joint replacements would be that much more complicated. Then, unsurprisingly, his back started playing up. By the time I saw him, he could barely walk, and even then not without severe pain. Buprenorphine patches, the strongest painkillers known to man, did not touch his pain. It is almost time for him to retire permanently into a wheelchair or mobility scooter.

The Pain Clinic has offered injections into his back, an “epidural” and the NHS orthopaedic surgeons have washed their hands of him because he now has a bad back and bad knees.

HOW COULD HAVE BEEN DONE DIFFERENTLY?

What should happen now? This man, regardless of age, needs knee replacements. Pain is cumulative and summative. The more you have of it, the worse it is. His knees are an obvious means by which his total burden of pain can be reduced. And his ankles aren’t too great either. His back? well that just might get a bit better if his knees were working better and he wasn’t constantly having to adjust the way he walks in order to put one foot in front of the other.

Is this rocket science? No, it’s common sense. Unless this man comes into a large fortune and can afford to consult privately, his situation will not change. Given the pain he is in at present, only money and private medical care will get him moving again. Backs come good with expert physiotherapy and hydrotherapy, and ankles can be fused but one thing is certain, Pain Clinics can only ease your pathway to the grave.