I'm not sure what I was afraid of but I decided that I wouldn't take anyone with me to the hospital, I'd go to the pre-op appointment on my own. I felt this was the best way as, after all, having an operation we are alone. We can have as much support as possible from family and friends but only we can go through it. It does feel like a huge decision to decide to have a part of your body removed and replaced, basically, by cement and plastic. I realise, however, that I absolutely have no choice because I can't straighten my leg and it's beginning to affect my hips.

On the 20th February 2003 I dutifully went along for my appointment at Torbay Hospital which, I had been told, would be three hours long (it was). Everything ran extremely efficiently from having the x-ray, seeing the occupational therapist, having blood taken by a nurse, being weighed, being measured and then speaking to a doctor, who told me exactly what was going to happen. This could have been too much information but actually I'm glad that I know. I was quite surprised to learn that you keep your kneecap! The doctor said I could see a video if I wanted to and I said,
"Oh no, I think that is going a bit too far!"

I was amazed at the amount of information, and the kindness that I was shown. I was assured that I would be given the best care possible when I go to hospital and the aftercare would be good. Because I live on my own, my daughter and son in law will come to stay just before I go into hospital. They will take me in and make sure that I am settled. When they return to Leicester one of my friends will come to stay for at least a week.

I was quite surprised to find out that I would have to wear elastic stockings for six weeks after my operation. I was worried about this because having arthritis in my hands means there's no possible way I could pull the stockings on myself. The occupational therapist said that somebody would come to my home to put the stockings on. I was worried about being pushed and pulled about but she explained that whoever comes will put plastic bags on my feet and will slide the stockings on keeping pain to a minimum. The O.T. also said that I could have a trolley to push food around on and to support my weight and a frame to help me push myself up from the toilet. Accepting all of these things is a new step for me. I've never wanted anything like this before (even though at times it would have been helpful) because I've thought "Oh God no, these are all saying that I'm disabled." Well I have to say now,
"Yes, I am disabled and that's precisely where I am at the moment."

I'm actually looking forward to having the operation so that it will be over and done with. Since I went on my visit I'm not so afraid. It was good to go and speak to the professionals and know that they will do the very best that they can for me.

A few days after I recorded this, the actual appointment came through for my operation. I go into hospital on the 1st April 2003, which is April Fools day, so I'm glad that they are actually going to do the operation the next day April 2nd! My initial response was excitement that the actual date had come, I knew when I was going into hospital and now I could organise my life.

10 March 2003
It's now the 10th March and I must admit I do go up and down. Sometimes I'm a bit afraid; sometimes I just wish it would hurry up. Then I wish the six-week period of the elastic stockings and not being able to drive was passed, but obviously I'm going to have to go through it all.

Friends and family have been very supportive and they are going to have a ring around phone list of people that, when I start to feel better, will come and take me out. The thought of being 'in' for six-weeks, because I can't drive, doesn't exactly appeal but then I don't know how I'm going to be, I may feel like I don't want to go out - I'll just have to wait and see.

I've been having a few, I wouldn't say, sleepless nights, that's grossly exaggerated, but quite restless nights and I do keep thinking about the operation, seeing myself on the trolley and being wheeled down to theatre. I have to say to myself look, 'just don’t think like this, try to think about the sea, the beach, the moors etc. Try to visualise other things.' I can't say that I don't go in and out of a level of anxiety but I think, even before one goes to the dentist there is that level of - 'well, I hope it will all be alright', so, I think it would be a bit odd if I did feel perfectly relaxed about it all.

I've made myself an appointment to have an all over aromatherapy massage the day before I go into hospital. It's with a lovely lady who's very familiar with my medical history. I spoke to her this morning, and she thought having the massage was a very good idea, just to create as calm a space within me as possible before I go. I feel now I've made this appointment, instead of worrying about the replacement operation I can look forward to the massage the day before.

That's all for now - I'll write some more when I'm in hospital.. Wish me luck!

10 April 2003
The operation is over and I'm back at home. I feel fantastic... but let me backtrack. I was very nervous in the lead up to going into hospital. My daughter and her husband came down from Leicester to stay with me for a couple of days before I was due to go in. We laughed a lot and that got me into good spirits.

I was admitted into hospital the day before the operation. This is a very difficult time because anxiety levels raise thinking about what is to come. There were other people on the ward that had already had their operation and it made me think,
'Oh God I've still got to go through all this yet', but the nurses were very kind and everybody was understanding about my anxiety.

In the evening the anaesthetist came into see me. We shook hands, he smiled at me and I think he could see that I was very nervous. He sat with me and explained everything that would happen the following day. Later that evening he came back again and said,
'I think you're very anxious',
He held my hand and tried to reassure me about the operation. I was very grateful to him for this as it made me feel I was being treated as an individual and not just a number that was passing through.

The day of the operation
The morning came, it was nil by mouth and I was very aware that I was looking at the clock. I'd be going down to theatre at 2 o'clock and they were coming with my pre-med at 12 o'clock so I kept looking at the clock and everybody coming and going, just waiting for my turn. The other women that were there on the ward were very sweet, very supportive.

I was given my pre-med at 12 o'clock and went and had a shower. They put me in the white gown and my nerve just went, my whole body shook, there was no going back. Once the pre-med kicked in, however, I was fine and I kept falling asleep. They let my daughter sit by the side of the bed and she said that I was really funny. I kept coming round saying,
'aaahgh I know what I'm doing...'
then falling back to sleep again. Then I kept waking up saying,
'Oh, I shouldn't be this conscious, I shouldn't be this aware',
and then dropping straight off back to sleep. They came and took me down to theatre on a trolley. My daughter was allowed to come down as far as theatre and then I went in.

I saw the anaesthetist that I'd met the day before, he gave me an epidural which was painful but bearable. In fact, that was the only thing that was painful throughout the whole operation. After the epidural I had another couple of injections and my legs started to numb. I don't remember anything else until I came round in the recovery room.

After the operation
When I came round, the nurses were talking to me and I could see my daughters. There was no one else in the room. They had let my daughters come into the recovery room because one of them had to go back to work. After a while I was taken back to the ward. I don't remember much about that day except that the back of my leg, when the feeling started to come back, was very painful. I think this was because I hadn't been able to straighten my leg for at least five years so all the tendons and the muscles were being stretched.

I had a bleeper morphine button that I could use when the pain got too much. It had a light on it that went out when you pressed it and you couldn't press it again until the light came back on, preventing you from having too much. The nursing staff were constantly coming to see if I was alright so I never felt that I was abandoned or left on my own.

On the second day they came and took off the big pad of wadding and bandages that I had round my leg. They also removed the drains which were put in around my knee. This was all very painless. I was just left with a long water-proof plaster that covered the scar on the knee. I couldn't actually get up that day because I needed a couple of pints of blood and had to wear an oxygen mask. It was nothing serious, I was just pretty run down. That day I just felt generally quite groggy.

I was fitted with pumps on my feet, like little soft felt shoes. They squeezed my feet every couple of seconds which helped with circulation and cut down the risk of getting blood clots. They were not uncomfortable at all and it was quite nice to know that they were helping to keep my blood circulating properly.

On day three after the operation the physiotherapist came. She helped me get out of bed and showed me how to walk with the walking frame. It was all a bit frightening and it was pretty painful. Bending my leg was really, really very painful but I managed to bend it a little. That day I stayed sitting up in the chair for a time but I got quite tired so they said it was alright for me to lie down on the bed and go to sleep.

To help bring down the swelling the nurses gave out ice packs. You leave the ice on for a while and it did seem to help. The physiotherapist gave me a list of exercises to do. One of the exercises was lifting my leg up off the bed with the leg out straight. I personally found this exercise extremely hard and didn't manage to get it very far off the bed at all. Another exercise was to straighten the knee and push it down onto the bed. This was to strengthen the muscle in my thigh. I found the exercises very difficult but kept in mind that it was early days and tried not to expect too much progress.

The next day the physiotherapist said that we would try to walk a little using crutches. When she saw how well I could stand she decided to see how I got on with two sticks instead, missing out the crutches stage altogether. Because I'd been in so much pain before I went into hospital I think I did very well on the sticks as I was used to walking being a very painful thing to do. I walked, using the two sticks, round to the shower room for a shower. A nurse came in with me to make sure that I was all right before leaving me when I felt that I would be okay on my own.

On the fifth day I got up and moved around at regular intervals using the two sticks. This helped me not to stiffen up too much. When the physiotherapist came she got me to bend my knee back as far as possible. I could only get it to an 80 degree bend and it was really painful. I found bending my knee the most difficult thing to do.

I'd said to the physiotherapist that I wanted to go home as soon as possible and she explained that I would have to be able to manage a few stairs before I would be allowed to go. She took me round to the practise stairs and showed me how to negotiate the stairs and my sticks at the same time. I went down a few steps and up a few steps without too much of a problem although it was quite painful. The physiotherapist said that as far as she was concerned I was ready to go, which was brilliant.

Before I could be discharged I had to have an x-ray to make sure the operation had all gone well, which it had, and also I had to see the doctor. The doctor was happy to let me go as long as I assured him that I would carry on with the exercises at home, which of course I did. All the appointments were made for the district nurse and for further physiotherapy in my local hospital.

So, if anyone reading this is going in to have a knee operation, I can only assure you that you will be given the best possible care. It was something I was nervous about before I went in.

Back at home..
I have been home a week today and I'm manageing to walk a little around the house without my sticks. I do, however, use them when I go out, they help to make me feel that I'm safe and secure.

I get very, very tired and I can't do very much. I'm still taking the pain killers and I'm still doing the exercises I was given at the hospital. When I saw the physiotherapist last week he said that I shouldn't push myself too hard because, after all, I was recovering from a major operation. Yes, push a little bit to the boundaries but not to where it makes you feel sick, which is what I was doing. I was pushing my knee back to a point where I felt physically sick from the pain. He didn't think that was doing me any good at all. So, since I saw him I haven't been doing that so much and slowly, slowly everyday there is a bit more movement.

7 May 2003 - Five weeks in..
It's now five weeks since I had the operation and I've been able to walk around the house for at least two weeks without any aid of sticks at all. I do take the sticks when I go out because it's still a bit painful and I don't want anyone to knock into me. I find that if I have a stick people are more careful when they pass me in the street. Although I felt I could maybe manage with only one stick the physiotherapist suggested that I carry on with two sticks so that I didn't walk leaning to one side.

It has been quite an emotional roller-coaster. I have found myself getting upset, especially after I first returned home. I'm not sure why that is, maybe it's just a release of tension now that the operation is over and it has been a success or the fact that I'm a little bit anaemic or as an aftermath of the anaesthetic. I think there are probably lots of reasons. I've found not being able to drive very difficult, always being dependent on other people. Friends, however, have been brilliant coming and taking me out and I feel well enough now that I could actually get on the bus.

At night it is quite painful but then I think that's my own fault because I haven't been taking enough pain killers. Sometimes I take them and sometimes I don't, I'm trying not to be dependent on them. I think a lot of the pain is just where the skin is healing. It's not intolerable pain it's just burning a bit.

I do find that I get very tired, I only have to do a few tasks and I'm done in. I have to keep telling myself that it's still not very long since I had the operation and really I'm doing very well.

Well I know I'm only five weeks in but overall it's fantastic. My leg is straight and I'm able to walk much better already than I could before the operation.

I'm really, really pleased that I've had it done.

Jan

   Dear Diary Update 15 months on..
    

Knee Replacement Diary Update
By Jan Povey

July 2004 - 15 months after Jan's knee replacement

What kind of after care have you had from the hospital?
When I first came out of hospital I had a nurse visit me at home a few times. She checked that everything was okay and told me when I could take the bandages off and also how long I needed to keep the elasticated stockings on for etc.

I've been up to the hospital twice, once for the initial 6-week check and then after one year. On this visit they x-rayed the joint to check the replacement was fine. Everything was fine so they said they were finished with me for the time being.

How long did it take you to get over the operation?
I'd say about 6 weeks. At first I was walking around with two sticks then with one stick. I was able to drive again after 6 weeks. It was about 3 months before I really began to feel the benefits of having had the operation. I felt the benefits straight away of course but it took about 3 months to feel the maximum benefits.

Has the pain now gone from the replaced knee?
Completely and utterly! The only time it aches is if I stand still for too long or if I climb steep steps, but apart from that I'm not in any pain at all. If fact 95 percent of the time I'm not even aware it's a replacement, it's completely functional.

How far can you bend it?
I think they say don't bend it more than 90 degrees, and I can do about a 90 degree bend. To me the great thing is that I can completely straighten it.

What's the most striking thing that you have experienced through this experience?
Not having to walk with walking sticks and being able to stand up straight. People who have known me for years have said, "Goodness, I didn't know you were that tall." Just to be able to go to places I couldn't go to before has been wonderful. I can now go out to places without having to check first whether there are any stairs I can't avoid. I can also stay with friends who have bathrooms upstairs which is great. All in all the improvements to my life are extensive.

So, you can now go up and down stairs okay?
Yes, but I have got arthritis in my other knee so I wouldn't say it was totally brilliant, but the knee with the replacement doesn't give me too many problems unless the stairs are particularly steep, then I get a slight ache in that knee, but not pain - I wouldn't call it pain at all.

I have heard some people complain of a clicking noise from their knee replacement - Have you been aware of any clicking?
No, not any clicking. I suppose there is a slight noise but only very slight and I don't ever notice it, but it's not a click.

I know you did have a problem sleeping before the operation. How have you been sleeping since the knee replacement?
Sleeping is now no problem at all. The pain in my knee used to keep me awake all the time. The pain would wake me up every night, in fact I was in constant pain more or less 24 hours a day. And of course I couldn't straighten my leg which didn't help when I was trying to get into a comfortable position for sleeping. Now I can sleep and I'm not really aware of my knee replacement at all. I can't tell you how much that has improved the quality of my life.

How much are you aware of the replaced joint?
I'm not aware of it. Unless I think about it I'm not aware that I've got a knee replacement. The knee feels like it's back to how it was before my arthritis became really bad.

Has being more mobile put extra pressure on your other joints?
Well yes it has, especially my other knee. I think it was because I got a bit excited about the mobility improvement and started going for long walks! Consequently I had to have a steroid injection in my knee (my other one, not the replaced one), which has been really successful so far. So yes, it's best not to over do it and get over-excited about having your life back... which I have got, but you still have to be careful if you've got arthritis in other joints. If you haven't, which is sometimes the case when people have osteoarthritis, you could really get back to having a fairly active life.

If it came to the crunch and you found you had to have your other knee replaced would you be more or less nervous the second time around knowing what you now know about the whole process?
I would be a lot less nervous. I put off having this replacement operation for about 10 years longer that I should have done. It didn't help that I was told I was, "far too young to have this operation yet". For the last 5 years my leg was permanently bent at a 30 degree angle and I could neither bend it or straighten it. I don't think I did myself any favours by leaving it that long.

I can't say I wouldn't be anxious about going through all this again but if I could guarantee that it would be as successful as this one then I wouldn't hesitate. But as everyone knows, there are no absolute guarantees when undergoing operations. However, I wouldn't be so nervous and I would have a better idea of what to expect. Even so I can't say that I'm rushing to have the other knee done. A major operation like this really takes it out of you, both physically and mentally.

How long can you expect your new knee to last?
I was told 10 to 15 years maybe more..

Have you any final words of wisdom for anyone who is about to have a knee replacement?
I think one of the most important things to keep in mind is that you must, must, must do all the exercises that the physiotherapists set you. Doing the exercises is incredibly painful, especially the bending of the new joint but these initial exercises will determine how much mobility you will eventually get - In this instance it really is no pain no gain!

Good luck to anyone who is about to go through replacement surgery. I know it doesn't always work as well for everyone as it has for me but all I can say is - For me it was worth it, I feel like I've got my life back..

Jan