Full knee joint replacement(s) at age 90

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Has anyone had experience of an elderly parent having full joint replacements on one or both knees? My DM has decided that she wants both knees done at the same time and has now found a private surgeon that says he can do this (first surgeon she contacted wouldn't operate).

I'm concerned that she has underestimated the recovery and rehab necessary; she's on her own and plans to go to a convalescent home for a fortnight after discharge, and then go back to her own home. Both my DSis and I live a number of hours away and wouldn't be able to spend long periods of time staying with her. She has little muscle mass and hasn't been able to walk very far for a number of years, and I also suspect just won't want to do the physio.

She wants to rush into getting it done next month. My DSis and I have tried discussing the practicalities but she won't listen. She has had both hips replaced but was in her early 70s then and had my dad around to help (a lot).

Any advice / experience would be really useful.

That sounds highly unrealistic to me.

The recovery time is completely unrealistic for anyone I'd have thought, but certainly someone of that age, even with one knee. I don't understand how she thinks she will recuperate without the other leg to support

Ive had my knee and hip replaced. My knee was done in the new year. I was 31. It is an absolute horrible recovery. I wouldn't be supportive of someone in their 90s getting it done unless they were extremely fit and healthy

My friend has just has one knee done at 49. She said it was incredibly painful and it took her a good few months to get over it. It doesn’t sound at all realistic to me.

Not a parent but a neighbour in his 70s has had a knee replacement - but only 1 ( not sure if the other needed at some time ) and he is married so his wife could help him out with things. From what I could see the rehabilitation was longer than 2 weeks. Some time at home with help , then for a few weeks walking with a stick. I think both knees at once without daily practical help I just would not recommend .2 knees out must be so much harder than one. My mother in her late 80s had a big operation for torn ligaments in one ankle & without my father she would have struggled - even just getting to the loo. She could not even get to the phone which might be a consideration for you and your sister.

Personally I am not surprised one surgeon would not do 2 at once - that might be a clue.

Well, I'm assuming she has full capacity?

If she does, then she's as capable as any other adult of making her own decision. I get it's frustrating and annoying and places a potential burden on family, but it's her choice to make

It’s not so much her age that’s an issue, my worry would be she would need at least a month in a rehabilitation home with physio therapist. She’s been through double hip replacement and will know the pain associated with that, but I believe total knee replacement is better than a partial replacement.

Hip replacements are MUCH more straight forward than knees though.

And who will be looking after her during the long recovery?

my auntie had one done at 70. It was a good recovery and she was very happy with the result.

but two at 90 is just mad IMHO. How long will she be immobile, has the surgeon said?

The Mum of a friend of mine in is a similar position and coming round to the idea of not having it done after all.

She was originally due to have it done about 5 years ago when she was much more mobile and had fewer other health issues but due to circumstances beyond her control and Covid it never happened. The opportunity has come up now but she doesn't think she can go through it.

I know someone in late 60s who is having a slow recovery after 1 knee (8weeks post op). Still on crutches, unable to sit in fixed position for more than 15mins. And this is when recovery is ‘uncomplicated’ and proceeding slowly but normally. So I personally would be wary if I was in her situation. Rates of complications might be high in someone of her age - what did the surgeons say? When does she get pain?

My GMIL had her knees rereplaced in her early nineties, and her last hip rereplacement aged 98 - she had all major joints replaced several times and was a rockstar with the physio. The ones in her 90's worked as she was able to be discharged to a lovely community hospital and get daily physio and care before going home and was totally mentally competent. She was also very active within the limits of her arthritis.
If your mum is deconditioned and won't do her physio then she is destined to fail I'm afraid, and paying privately means its unlikely that there will be an oversight of her discharge arrangements in the same way as if she was in the NHS. Will she be able to pay for longer in a home if necessary?

DP had a half knee done late 50s. Said he'd never been in such pain post op. Took more than 2 weeks for him to really be confident on his legs. Took a lot of rehab- a lot more than for a hip replacement and DP was highly motivated.

Fine to have one knee done and then the 2nd when rehab well underway, but not 2 at the same time. The anaesthetist might have something to say about 2 at the same time as well...

All you can do is tell her how much time you can spend with her. Would she listen to her GP ?

Wow, thanks for such quick replies.

The first surgeon wouldn't operate on her at all.

The second surgeon has said he will operate but we don't know what he has said as we only get what DM tells us, which is more likely to be what she wants to hear rather than what has been said. She thinks he will do both knees at once as this is what her friend had done (much younger, different home set up, different surgeon / hospital). I do know he has said it would be done under epidural due to other health conditions.

I have no idea what DM has told the surgeon about her home set up or whether it has been discussed even. I have asked her to talk to him about exactly what he plans to do and likely recovery time and what needs to be put in place for that period.

She has full capacity but has form for only hearing what she wants to hear and ignoring the bits that she doesn't like. My DSis and I are the only ones that could pick up the pieces, we both have families and jobs and commitments that would make staying long term with her impossible.

Knee replacements are MUCH more painful than hip. I very much doubt any NHS surgeon would do both at once so it's very concerning that a private surgeon would agree to do both at once. If she runs into post op problems eg infection, post op delirium, anaesthetic problems, etc she will be transferred to a NHS hospital.

How much care can she afford to pay for? To have one done and go to a suitable nursing home (my Mum had some rehab in an Elizabeth Finn home after a fall and fracture, they are very nice) might be feasible but not both at once. She should expect she may end up needing nearer to six weeks than two and budget for that. It needs to be one where they really will get a physio in and do proper rehab. The nice ones are too inclined to pleasantly wait on the elderly person hand and foot and no progress or recovery is made. And the not so good will just leave them in their room.

She also needs a call system setting up incase she has a fall. My Mum has a wrist one in the end. My sister's MiL had a long lie overnight as she took off the call necklace and put it in the pocket of her dressing gown and hung on the back of the bathroom floor and promptly had a fall and wasn't discovered til the morning when her carer came in.

My mum had a hip replacement at age 70 and then another at age 83. She recovered reasonably quickly the first time round but this time she's still not walking properly after 6 weeks. it has been a wholly different experience. She is usually fit and healthy, but has had a haematoma and breathlessness and feels like she is seizing up. She ( and I ) and are on our own and it has been very hard looking after her and juggling it with work. Two knees at age 90 sounds risky.

OP wouldn't she have to have carers in for quite a long while after?

I don't know, I'm just trying to imagine it. My mum is 83 and I would have the vapours about her having a double knee replacement.

I wonder if a private surgeon - understandably - has just looked at the surgical procedure, confirmed it is okay and hasn't asked your mum to think about anything at home after?

*she hung the dressing gown on the back of the bathroom door. Not floor!

She has money available to pay for a convalescent care home for several weeks, so at least that is something.

She finally got a fall alert necklace after she had had several falls, despite DSis and I suggesting it long before this point. She won't wear it at night - I did point out that she could have a fall in the bathroom and no-one would know. She relies on neighbours keeping an eye out for her. She has had a referral to the falls clinic that has been helpful.

It's osteoarthritis and loss of cartilage in both knees. The pain is worst when rising from a sitting position. I have suggested getting an OH assessment done for additional aids but she won't do it (it took a long time to persuade her to have a stairlift put in).

Her GP is very good - no problems with getting appointments at short notice - but I don't know how much the GP knows.

Good that she can pay for a convalescent home

this might be irrelevant but just in case - is she wearing a knee support?

I have been asking mum to do this for years, literally. She just started two weeks ago and said it has made a big difference and we even went to a shopping centre today!

@EmmaH2022 No she doesn't wear a knee support - I could certainly try suggesting that, thank you.

@CMOTDibbler She is certainly very deconditioned, which I think is a worry. She can't walk very far at all and has been using a stick heavily for quite a few years now.

I'd think really carefully about this if it were my relative. The recovery from a knee replacement can take up to 2 years in an average person, and most people will have 3-6 months of activity limiting swelling and discomfort.

Physiotherapy (which you say she's unlikely to do) is probably the most important factor in determining how well she does.

At the age of 90, any complication will be many times more serious with a much higher risk of not recovering enough to be able to walk again, or not surviving.

My Wife's grandad was 88 when he had his knee replaced and it was the start of a very rapid decline, and he was a stocky yorkshireman, no major health problems, good cognitive function and still driving.

Of course, the risks need to be balanced on a person to person basis, so it depends how bad her pain and disablement is as to whether or not it's worth the risk.

It'd be interesting to see what an NHS surgeon, or even the same surgeon in the NHS would recommend, I often feel that the threshold changes when fees are involved.

I've just had a hip replacement (in my 40s) and my (private) surgeon looked horrified when I suggested doing both at once. Having had it, I understand why as your non-operated leg has to cope with a lot of extra pressure in the first few months.

I'm still struggling with recovery nearly a year later and I went into surgery with a decent level of fitness and running regularly etc. All the physios I've seen have mentioned how much more painful knee replacements are. And take more rehab.

I have arthritis - presumably your mum has tried steroid injections as they can settle down joint issues for a while at least?

dm had a hip done privately at 85- and all follow up physio etc had to be private too.
all pre covid.
physio is really important- and care afterwards. Would it be worth writing to her gp with your concerns?

@FixTheBone I don't want to appear cynical but if one surgeon has said two at once no - One might wonder whether the fees are a part

Coincidentally I did see another neighbour this afternoon whose husband had a knee replacement ( one neighbour laughed at us being the street of one legged people ) and she said no way in a month of Sunday' would both knees at once be a good idea. Her husband ( guessing late 70s ) has been doing physio but she said having both at once would not have been the slightest bit practical. He needs his other one done but they are waiting till next year because even with one done he can be a little unsteady on the worst leg. Poor chap also needs a hip replacement so that has been put on the back burner also.

I don’t think any convalescent home worth their salt would just send her home after two weeks if she isn’t able to cope. I suspect if you can’t talk her out of having it done you might be able to talk her into a longer stay or a high level of support at home. She may not listen now but I suspect when the two weeks are up she might be more willing!