Full knee joint replacement(s) at age 90

[Dreikanter]

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.

@BasiliskStare The first (also private) surgeon refused point blank to operate on either knee. No discussion. We don’t know what the second surgeon (at a different hospital) has said because DM doesn’t actually know, other than he would operate. She has it in her head that he would do both knees simultaneously because that’s what she wants to happen. It could be a completely different story. She wouldn’t let DSis accompany her to the latest consultation.

Her hip replacements were done several years apart.

@red4321 She has had steroid injections, she tells me that they are a bit hit and miss on how much relief they give.

@thesandwich I could try contacting the GP with our concerns, she is very good but I think she may currently be off on a break.

There is no point in getting knee surgery unless she is fully able to do strengthening exercises on the muscles around the knee both before and after the surgery. They are very painful exercises. My father was denied surgery as they said it would be a waste of time and money as he was incapable of doing them well enough. I’d be wary. And NEVER both at the same time.

@DeeofDenmark Good point about ensuring any convalescent home can keep her in longer than the 2 weeks she has planned.

@Whoopsmahoot She struggles with the physio exercises from the falls clinic as she says it’s too painful to do on one leg. She hasn’t been given any pre-op exercises to do to my knowledge.

Watching responses with interest as I need a knee replacement at 53 and am procrastinating because I'm worried about recovery I have tri-compartment arthritis in both knees and I thought of getting both done at the same time but maybe that's stupid - so thanks for the thread op - useful info here!!

Candy definitely don't get them both done at the same time. Even at your age it's unlikely a surgeon would agree to do both at once. But it's worth getting it done while you are younger and can expect a good recovery and maximum benefit. Anyway given the waiting lists you will probably be quite a bit older by the time you make it into hospital to get it done.

My 90 years old father was at least 10 years too late in deciding he wanted new knees. It’s a very different op to a hip replacement and is quite frankly brutal. No surgeon would look at him as he has poor muscle tone and it’s too painful to exercise. I think if she is struggling to do exercises now that a physio has given her she would really struggle after. The exercises are key to a successful recovery - if she can’t do them it’s a waste of time and money getting it done. I think the key is to get new knees before it gets too bad.

Here's some explanation from a local private knee surgeon. I think he's given up his NHS work recently.

twitter.com/neiltheknee/status/1580560129027903490?s=21

Thanks everyone for your replies - lots to think about.

OP my mum had steroid injections that didn't work

of course, after finally agreeing to try a knee support (the sleeve type) she is now telling everyone how great it is, after blithely ignoring my repeated suggestion for years and years! Grr. So I hope your mum will try those.

interesting that the surgeon who refused was also a private surgeon.

I can't really fathom how double knee replacement doesn't involve a wheelchair as standard.

I can't really fathom how double knee replacement doesn't involve a wheelchair as standard

It must, surely. You need some ability to weight bear on crutches. Plus the challenge of doing physio exercises that aren't lying down. Getting in and out of beds and chairs with two immobile legs.

I now fully appreciate why I couldn't have my hips done simultaneously. My husband's friend had back to back knee replacements within 6 weeks of each other but he had a physical job that he needed to get back to.

red I just googled and it's not mentioned, plus they seem to want them up with a walker quite quickly.

I have had a couple of major injuries including a spinal fracture. I'll never forget the nurse showing me the stairs I had to practise on, saying "you can't be intimidated - this is where an 80 year old with a hip or knee replacement will be as well".

if mum wants a knee replacement it will be terribly hard for her, but she is against it at the mo. She is 83, frail and very underweight so I had thought she would be refused. Maybe not, I dunno.

If she has made her mind up, and insists she wants to go ahead, I would do all you can to dissuade her from having both done at once, if indeed that is what the surgeon is offering. To be truthful, I wouldn't have much faith in a surgeon who is prepared to do a double knee replacement on a 90 year old. You need to be able to weight-bear on the other leg to get around, and in order to do physio and exercise the knee which has been operated on. If this isn't possible, she might as well not bother, and could end up not being able to walk at all.

I don’t know if the surgeon has said he will do both knees at once. She has got it into her head that he will because her (much younger) friend had both knees done at once by a private surgeon “and that’s what they do”.

Trying to get proper information out of her is like trying to nail jelly to the wall.

I highly doubt they'll both be done at the same time. I wasn't allowed and like I say, I'm over 60 years younger!

It's best she gets just 1 knee done at a rime. Its not actually unusual for a 90 yr old to have this operation.

The Hospital will do a care plan with her before shes discharged anyway, and thats what you need to be looking into when the time comes.

DM had same done at 82, her knee issues were impacting negatively, so painful, and operation has given her a far better quality of life.

As an adult whos lived life I think your DM knows what she wants, and you should support her decision. As well as look up information about operation; it comes across as if you dont know elderly people do have knee replacement operations.

I should think the surgeon will advise against having both done at same time if its not feasible

OP "Trying to get proper information out of her is like trying to nail jelly to the wall"

oh my god. I really feel for you.

My mother had a hip replacement in her 80s. She went into it thinking it would basically turn the clock back and make her bionic. I didn’t think it would help her mobility at all as she went in to the op with no muscle and basically housebound.

The new hip did reduce pain so was a partial success but she is less mobile than ever and it took over 6 months before she was even able to walk short distances comfortably.

I know people who have had a single knee replacement and they all said it was much, much worse than a hip and a much more challenging recovery.

My FIL had one knee done in his mid 80's. He was fit and healthy other than his knees. He said it was so painful after it had been done that he wasn't going to bother having the 2nd knee done.

Re the call alarm - my DM used to take hers off at night. We didn't know this until we discovered that she'd got up to go to the bathroom in the night and fallen. She lay on the floor until the following lunchtime when a nurse, who had called to take bloods couldn't get an answer at the door and thankfully knocked at ndn's house to ask where DM was. He said she should be in and fortunately had a key and they found her on the floor. DM said she wasn't wearing her alarm as the bathroom was only a few feet away from the bedroom!

My gran had one knee done and then the other after around 3 months I think. She was around 85 at the time. The healing took quite a long time and my mum moved in to look after her. But her recovery was good and her mobility and pain levels much improved as a result. She found the second replacement a longer recovery from the first.

On the other hand my MIL at 60ish got both done at the same time and her mobility now is awful. I don't know how much of that is due to having them both done at the same time or her lack of following the physio exercises afterwards properly.

my father had one knee done at 89 and the other at 91 he lived till 98 and was mobile until 7 days before death they worked really well for him it kept him mobile and gardening for the rest of his life, he was basically quite fit but in a lot of pain got both done on NHS he was home within about 4 days he had them done with spinal as they thought GA too big a risk as he was on warfarin by the time second was done, he was fortunate I think he was told at his age and the condition of his knees about 70% chance of improvement about 20% no change and 10% they would be worse, both times was a big improvement
he did all his exercises but my mother would have insisted anyway but my Dad was not stupid and generally listened to doctors and was keen to keep up his mobility as he wanted to be able to walk and garden and go bird watching etc
however his younger sister got a hip done but refused to do all the exercises even in hospital she thought she needed rest after surgery despite being told over and over again it needed movement to work, surprise surprise her's did not work as well as my dad's it was not lack of understanding just sheer stubborness at not doing what's she was told

Although a different kind of surgery, I had knee surgery and it was SO painful 😫
I was only 18 and healthy also.
I was once told 'knees ARE painful' and the nearer to the foot the surgery is, the more painful it is (I was told).
Not a pleasant recovery at all and I had to use a wheel chair for a good couple of months after.

Thanks @FannyCann - I'm quite a way along the process tbh - I am under a surgeon now and we've agreed to go for it at the beginning of 2023 so all being well I should have the op by late summer - I'm a single parent so making sure I've got care in place is vital - even though they're teens, they don't cope well if I'm out of action!!

I know that some 90 year olds get knee replacements done, thank you. I’ve read plenty of papers on the topic.

It’s a private op so I have no idea if there will be any kind of care plan - there wasn’t when my DH had a private hip arthroscopy other than a couple of follow up hospital appointments and physio.

My concern is that the first surgeon flatly refused to operate at all, and this second one apparently will operate but my DM is hazy on the details. I have no idea what has been discussed and what she has said about her home circumstances. She didn’t take up my DSis’s offer to take her to the last consultation on a ridiculous pretext, which has set alarm bells ringing for me.

It’s hard to “support her decision” when I’m 4 hours away and getting minimal information from an unreliable source, yet me and/or my sister will be expected to drop everything to manage the fallout as a result of her decision.

My friend turned 70 in September and has just had both knees 2 weeks ago today . In the states . He lost a lot of weight before the surgery , attended the gym 6 days a week in preparation for the last year to build muscle . He was discharged to a centre for physio for 2 weeks but they let him home as they trusted him to do the exercises and also his gym trainer is assisting him . He is in lots of pain . He iced his knees through the day . But he is determined to get walking and back to fitness . The work and effort he put in is phenomenal. The surgeon he used seldom does 2 knees together only on a rare occasion where he feels the candidate can withstand it .

Bilateral joint replacements are much more common in private care systems as you halve some of the ancillary costs.

India in particular, I know it happens pretty frequently, the UK less so, I only did bilaterals twice in my training, so less than 1% of all joint replacements.