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.

You're not awake. You aren't aware of a thing.

The vast majority of joint replacements ive done have been under regional anaesthesia, hence patient awake.

Very few need sedation, most seem to be grateful that I can update them / Talk to them about their surgery, as its happening - I often give a summary as my assistant is stitching.

You don't need to be though. I had no idea and the nurses said it was very rare people remained unsedated at the hospital I had my replacements at. Plus all the group's I am in support the spinal and sedation route. There are very few who say they don't choose sedation too.

The mother is having it done under epidural, not a GA.

OP, my BIL, 90, had a partial knee replacement last year at 89 — just the one — and hasn't been able to walk much since and is now in a wheelchair much of the time. He found it incredibly painful, much more than his hip replacements, and he's lost the upper body strength needed to get around on crutches and pull himself up and lower himself down into a chair. It was nearly a month before he was hobbling around leaning on my (much younger) SIL and a stick. My SIL made him do the physio every day.

She would say that he's worse off now than before. Before the op, although he had pain, he could walk a couple of hundred metres using a stick and get himself in and out of their car and up and down stairs. He could walk into their garden and putter about. He can't do that now.

They've invested in an armchair that practically lifts him to his feet and an electric buggy for going out. They've had to change their car for a bigger, higher one that he can get into with help and that can take the buggy He's now sleeping in the dining room and they've had a downstairs shower fitted in the utility, but trying to get him safely onto the seat in the shower is the current challenge and she's terrified he'll slip and fall.

How your mother can expect to be doing anything independently only a few weeks I don't know. My guess is that she'll need a month in the convalescent home and daily private physio before a carefully planned return home with lots of support and aids. Does she have plenty of money?

On a practical note - would your DM agree to you phoning the consultant's secretary to 'check on details' so you and your sister are 'primed & ready' when she leaves hospital ?

Just an off-chance, but might work...

Not a thing. You just choose how zonked you want to be and I chose fully. You wake up like you've been asleep. None of that awful after general wooziness. That's what I hate.

Thank you. So guess I could opt for no sedation if I chose? Reading the other post about some patients managing with no sedation and chatting/headphones.

I'm paranoid that I might start saying inappropriate things if I'm under sedation...

My dad had surgery for a torn tendon on his knee. He's 70 and it's taken months to get over. And he had my mum helping.

Be careful that you mum hasn't told Jen that you will be around to care for her.

My dad (87) had one knee replaced in March. The surgeon said he wouldn't normally operate on someone of that age but as Dad is quite fit (a lot of dog walking) he did. I stayed with him for 10 days, after 4 days he was getting around on his own. The worst thing for him was the constipions following the op. He also refused to take all the painkillers prescribed (which he later regretted!) and was rather lazy on the physio but he was back dog walking after a month. He doesn't regret it.
I think doing both knees at once would be very ambitions!

Thanks everyone for all your contributions.

Lots of things to follow up with (am seeing DM with DSis in a couple of weeks so will try and get to the bottom of what is happening.

Oh yes you can choose the level of sedation. I don't think many choose low or none though!

If you go private your friendly anaesthetist is likely to give you whatever you want.

My dear Sis had a cataract operation age early 60s. Despite the fact that on the NHS these are overwhelmingly done under local anaesthetic +/- sedation as a day case she insisted on a GA.
Then , afterwards the anaesthetist asked her pain level (no doubt it must feel like a very large lump of grit in the eye) and she gave it a 10 so he gave her some fentanyl which she then complained made her feel nauseous.

I had both knees done at the same time and I was 50 at the time. With what I know now I wouldn’t have had it done. Don’t underestimate the recovery time on this operation . If the first surgeon won’t do it then that’s your answer.

Thanks @Cruisebabe1

As an update, she has now decided not to go private after all and has asked the GP for a referral to the local NHS hospital.

We’ve also talked to her about knee supports and getting an assessment done on the house (grab rails, ramps etc) and she’s thinking about that.

That update is a relief.

I was going to suggest writing to the surgeon to give the true picture. If you're in the same situation once she's under an NHS clinic I would do the same tbh. She has the right to privacy but I'd agree it's highly unlikely the surgeon had the full picture.

DM told me that the surgeon hadn’t asked her about her home set up. But I think we only get bits of what has been discussed and not the full picture.

If the NHS surgeon decides to take her on (which I think is still a big if) then I’d hope there would be a proper discharge / care plan in place.

I am bloody relieved though.

That sounds much better OP, my dad had one knee replaced about 12 weeks ago at 87.
He didn’t have a GA, had a spinal and the NHS have been great with both pre and post op physio. He is happy in general with his new knee but still has a limited range of movement and not driving ( tbh I don’t think he will drive again).
my dbro and I took turns on staying with him for the first 10 days or so but then we both had to return to work ( we live a long way away) but fortunately neighbours and his friends have been fab, and we were going back up at the weekends.

My fil has just had his knee done at 85. He underestimated the recovery and is now wanting to put off the 2nd operation until he's a bit stronger. He's light and pretty fit already. It's a brutal operation.

Saying that he's recovered pretty well and has done the exercises, so has a good range of motion.

Have a look at all the "Talking with Docs" YouTube videos on knee replacements, they're really helpful.

Another update!

DM’s GP referred her to the local NHS hospital and the consultant saw her last week (less than 3 weeks between speaking to the GP and the appointment taking place was pretty amazing).

Consultant had X-rays taken and sent her away with knee braces and instructions to wear them for daily outdoor walking exercise, and come back in 2 months.

Knee braces as in those heavy strap supports? I wonder if she'd benefit from wearing them at home too. Does she have stairs?

I've had a stairlift put in for mum following a recent hospitalisation but her knee pain is gone now, which is a bonus!

Consultant said to wear them when going out for exercise rather than inside at home, but maybe she'll find them helpful and decide to wear them indoors too. She has a stairlift (which took several years of persuasion).