Total Knee Replacement in 40s

[HollaHolla]

Hope that someone can help with some advice/experience, please.
I am 46, and have been having a lot of knee problems for about 3 years. I had an anterior cruciate ligament tear, about 20 years ago, which required surgery, and I now have an extremely arthritic knee. I've had three steroid injections, which only the first worked at all. I have been seeing Orthopaedic outpatients for almost 18 months, and they have pretty much said there's nothing else to be done, except total knee replacement.

However, they're very reticent about doing anything, because of my age, and also because my BMI is higher, at 42. I have been trying to lose weight. but I've put on almost 5 stone in the last 10 years, because of another serious back injury, and the knee, meaning I am struggling seriously with mobility. I am losing weight slowly, (my BMI has improved 3 points in 5 months), but they are really warning me that 46 is very young for a replacement, and that there is the likelihood I'd need another one in my 60s.....

The waiting list is 16 months, so they've agreed to consider me for adding to the list, and that would make me 48 - and I'm going to continue losing weight. I had early menopause, which has made it trickier, but I'm determined.

I wanted to seek experience of others who might have been in a similar situation, to see whether they found it as life changing as I'm hoping it would be.... and if you've had to have a revision in 15-20 years. They've scared me a bit with scare stories of ending up with a total fusion, or even an amputation (!!!) but I am almost non-functioning with the knee I have....Help! I'm having a sleepless night because of this....Thanks

They told me I could crawl in on my hands and knees crying and I’d still have to wait until 60.

I had both my knees replaced whilst in my 40’s, high BMI as well. Absolutely 100% life changing, I can easily walk 10km+ in a day. I had both done with a spinal anaesthesia so I was lightly sedated but could hear what was going on. Back on my feet that evening (with help). In agony for a few hours but morphine helped, paracetamol after that. I am in Dubai so I paid for the best replacement I could do and it should last 25+ years.

My MIL had hers done in the UK 23 years ago and she’s still on her first set of knees. She has a check up every year and there are no issues.

Go for it, as I said to my doctor, he didn’t save my life in the traditional understanding of that phrase but he did give me my life back.

It’s hard for the first 6 weeks but it’s a worth it. Good luck.

I'm so sorry to hear this, @LenaLamont
I think it really depends on your Consultant. Weirdly, he's done one of my Dad's knees, and hips, in the last 5 years.... So I don't know if he knows I understand the recovery, etc. I did have a proper meltdown today with him, because he kept saying 'too young and too fat; see you again in 6 months'. I challenged him and said that I wouldn't suddenly be 55 (magic age.!) and didn't think I would manage for another 9 years. I'm already walking with a stick, and it's really limiting my life, and any enjoyment, as every step is painful. I'm already on significant pain medication for my back, and the effects of the spinal surgeries mean that it's likely contributed to the wear in the knee. It' s essentially bone on bone, and bits are crumbling off, so that's nice.
I did consider going private (most of the life savings), but I suspect the waiting list time would help for letting me lose some weight...

Have you had any help with your knee at all? Steroid injections can really help some people. I was just told mine is too far gone for that now. I hope that you can get some relief - it's really awful to be in such pain.

Thank you so much for this @LadybirdsAreFab . It's good to hear from someone who has had this done at a relatively young age. My Dad has had one of his done, but he was 68, so a different ballgame; but has had a really good outcome. That was 11 years ago (I thought it was more recent!)
I'm in Scotland, so unsure about what options I would have for choice of joint replacement, but I'm being seen at the National Centre for Excellence, so you'd hope that they were fit for purpose!

I've had major spinal surgery, so I know what the recovery can be like, and luckily I live in a ground floor flat, with no steps, and a walk in shower; so hopefully that's fairly accessible. My best mate would come and stay (she's already offered) for a couple of weeks, to help me out.

It's so good to hear of someone else's experience who is in my age/BMI range, and super glad to hear of your excellent outcome. Long may it continue!

My DH has the same problem from an old rugby injury. He needed a complete knee replacement when he was in his late forties. They refused on age instead they did a surgery designed to give him better mobility until he's old enough to have total knee replacement. They basically broke his leg, then turned bone around so it was not rubbing on bone, used a piece of bone from a dead man's leg and sewed him back up. He couldn't get upstairs for over a month and was off work for 6 weeks and could've drive for 8 weeks. It lasted really well. The problem is now 11 years later it's bone on bone again. I'm hoping they will give him a full knee replacement this time as he's now 59. How much does it cost in Dubai?

Your BMI is high and you need to make a big push to get your weight down; it's a vicious circle, bad knee, weight gain, knee worsens.
My DD29 had a full hip done last year and had to lose 2 stone beforehand.

I know my BMI is on the high side. I've lost 8kg since the summer (1 stone, 3lb), I'm also doing Slimming World, and working hard at it. The knee was troublesome before I put a lot of the weight on, but I am aware having less beef to heave around would be good for it. Surgeon seems to be ok with putting me on the list, given the waiting time, and opportunity to get it down further in that time.
Hope that your daughter is doing well after her hip replacement @Kwam31

Gosh! A Franken-knee! Sounds super innovative. @caringcarer
I'm also an ex-rugby player (hence the original injury), but have been told there's really no other option. 😞

DH has total bone on bone arthritis (with all kinds of bone spurs, and other yuck), and although he was told he needed a TKR at 40 (having had surgeries since 19) he is still pushing on at 51 as he just doesn't have the bone for more than one TKR. The absolute game changer for him in managing it has been hydroluronic acid injections which create a gel in the joint, and no limit to how many you can have unlike steroids. And they actually protect the joint, not just reduce swelling/pain.. He's had 7 now, they last about 6 months

I know a couple of men who had knee replacements in their 30s (building site accident and motorcycle accident).

From what I understand, the second surgery is usually done, replacing the replacement, but they can't keep doing it so if you wear out the second I'm not sure if they can do a third.

But surely that has to be balanced with quality and fullness of life now, which will have onward health benefits like getting your weight down?

It's called a Higher Tibia Osteotomy. HTO.

@HollaHolla
Yes, it's been a long haul, 3 months on crutches; due to previous surgery her incisions was larger and in an awkward position so a lot of healing and physio.
She's finally independent of crutches and is back swimming weekly, it's changed her life.

That sounds brilliant, @Kwam31 ! I'm so glad for her.

Have you seen your GP about weight loss. If your BMI is over 35 you may be considered for one of the weight loss drugs.

I know a guy (healthy BMI) who had one in his 20s (volleyball).
Yes it was life changing.
we don't have enough contact for me to know if he's had a replacement yet (1st one was 25 years ago now)

IME, main health problem OP has is the very high BMI.

Thanks all. I don’t disagree on my weight. I’m honestly working on it.
Ironically, if I hadn’t hurt my back so badly, I wouldn’t have piled on so much weight…. And if my leg hadn’t been so badly affected from the spinal injury (foot drop/lack of control/chronic sciatica pain), they reckon my knee wouldn’t have worn out so quickly….

I'm 41 and need bilateral knee replacements however I'm not in a rush to do it. Managing with morphine patches and occasional liquid oramorph.

I've had 7 knee ops and 2 hip surgeries and some have been really good however one knee op left me on crutches for 2 years. My consultant agrees that whilst I can still walk and drive I'm better off managing the pain.

@Dizzy82 I'm so sorry to hear you're in such pain. I have a lot of pain from my spinal issues, as well as the knee - but if I take oramorph, I'm an absolute write off, and can't work/drive/function. Do you find you can get to a level where that's possible? I've dismissed that, because I live alone, and I also need to drive to work a couple of days a week.
I'm trying to manage on a combination of pregabalin (for the nerve pain), naproxen, and oxycodone (slow and quick release versions), on top of the obvious base of paracetamol... It's not really doing the job, as pretty much every step is pain, pain, pain.
Hope you can find a way to extend the time period before you need more surgery.