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So Golfer - You Need a New Knee

 Maybe reading this will help

With each year that passes, the number of Senior golfers increases. Many have taken up golf on retirement, but the great majority will have been sportsmen for as long as they can remember and will have subjected their bodies to untold stresses at Rugby, Tennis, Soccer or any one of a myriad of activities that pressure one joint against another.    I am one of those who took up golf when feet and knees were unable to meet the demands of club tennis, albeit it at the comparatively young age of 34.

On moving to golf, the joints were well able to cope, but as years progressed, right knee pains and referred pain down the shins were telling me that all was not well. A visit to the doctor confirmed Osteoarthritis and a subsequent Arthroscopy brought a comment from the surgeon that a knee replacement would be required within a couple of years.   The clearance of debris during the Arthroscopy gave a temporary relief from pain and, on the recommendation of the several other sufferers, I started to take Glucosamine Chondroitine tablets which, although not a medicine, seem to work.   The Arthoscopy was in 1999 and, whether the Glucosamine was responsible I cannot say, but the knee was kept going until 2007 when the pain again became unbearable.

In contemplating a new knee, I found down to earth information very difficult to come by. There is a wealth of technical information on the internet, but I was more interested in hearing from other patients and particularly other golfers. It is because of this paucity of information that I write this article. For the technical data I found the best information to be the video at: http://www.nhs.uk/conditions/Knee-replacement/Pages/Questionstoask.aspx?url=Pages/Questionstoasktab.aspx

In October 2007 I went to see my GP, my introduction to the new NHS system. After the consultation, it was agreed that I should see the consultant.   I asked, as you are entitled to do, to go to the NHS treatment centre at Barlborough (more of this later) but was told that my GP did not agree with this as it was 'not owned by the NHS'. Sticking vigorously to my guns I was told that 'against his principles' he would include Barlborough on the list of options on the NHS computer.   For those not familiar with the new NHS system, you are then given a computer print by the GP that has a number to ring and a password to get you accepted into the system. Don't be deterred. Stick to your choice, you are entitled to do so!!

Calling the NHS a couple of days later, I immediately became entangled in the 'TARGETS' nonsense.   We were scheduled to spend a couple of months of winter in a rented house in Portugal (http://www.travelwatchdog.com/Winter%20in%20the%20Algarve.htm) so thought that it would be sensible to get the prelims out of the way before going and to get the operation on return. When did 'sensible' ever fit in with a Labour policy? I was told that I would have to wait to get into the system because what I was suggesting, although on the face of it sensible, would screw up NHS targets in that the time before the operation would be too long.   Moreover, Barlborough was not on the list of options supplied by the GP. To his credit, the NHS call centre operative said that this was not unusual and would fix it, which he did.   Several more 'glitches' followed, but the new system is clever enough that you cannot complain. Even the letters you receive do not have an address or an e-mail address; just a telephone number where the chances are you can never get the same operator twice. It is almost impossible to discover the location or postal address of the call centre.

In February 2008, on return from Portugal, I again set the system in motion and was contacted by the Barlborough NHS treatment centre. From this point I was out of the NHS management system and things went like clockwork.   An appointment was made at Barlborough for   23rd March at 8 a.m.   I set off, expecting to arrive at 8 a.m. with the rest of the limping population of Lincolnshire for a day of waiting. Wrong!! Check in at the desk and the system swings into operation. Physical examination, blood tests, X-Ray and interview with the surgeon all came along at a pace. The Anaesthetist, the weak link in the chain, took a further hour, but at 11.30 a.m. I walked out with a date for Surgery of 18th April 2008. I was buoyed by the efficiency of every stage of the assessment.

A couple of weeks later, the Occupational Therapist from Barlborough made a home visit to measure furniture, bring explanatory literature and describe the post-op measures necessary to successful recovery at home. She also delivered crutches etc. and gave instruction on how they should be used.

With 18th April scheduled as the day of the operation, the option of checking in on the previous evening was gratefully accepted. This was a wise move as there is a lot of preparation to be done and it gives the staff a little more time.   On 18th April it was an early morning shower and into theatre at 7.30 a.m. The recommended anaesthetic was a spinal block concurrent with a strong sedative. The recommendation was based upon the spinal block being as effective as a general anaesthetic, but with reduced risk of DVT etc.   I was aware of talking to the Anaesthetist on arrival in the theatre, and that there was activity the other side of a curtain, but for all intents and purposes I was 'out' until reaching the recovery room an hour and a bit later. After a short stay in the recovery room I was taken back to the ward where, unusually for most hospitals but standard for this one, a couple of staff members were with me for the next two hours, constantly monitoring recovery progress and keeping a wary eye open for problems.

Various drips and painkillers kept discomfort to a minimum over the next 24 hours and the level of post-op pain was surprisingly low. On the following day, 19th April, it was 'out of bed' with the aid of a zimmer frame. At this stage the pain level was practically zero.   However, the arrival of the Physiotherapist for the opening stage of the recovery process soon takes care of that.   Most patients go home on day 5, the day of the operation counting as day one. That gives the physio just a couple of days to get the patient moving again and to teach the necessary skill to enable the patient to cope with stairs etc. to an acceptable standard. However, pain levels are surprisingly low and, except during exercise periods, the pain level was often zero or just a dull ache.

Despite the contention of some physicians that golf is not exercise, as a golfer I have strong leg muscles and reasonably good upper body strength. Accordingly, I made fast progress on crutches, was able to meet the required mobility standards and the operation site was healing well, so I was able to go home on the afternoon of day 4.

At home, there is a regime of exercise to be followed to restore the mobility of the knee. If it has been a problem for any length of time, there will be muscles in the leg that have been protected from use and they need to be recommissioned. However, it is amazing the level of mobility that is restored. Crutches must be used to avoid damaging the new joint, but on the second afternoon at home I unthinkingly arose from a chair and took three or four steps before realising that I must get my crutches.

Barlborough supply pain killers etc for your recovery at home. They also supply a drug called 'Clexane' that is designed to prevent blood clotting and DVT. This is self-injected into the roll of fatty tissue around the midriff. It sounds dreadful, but the drug is in pre-filled disposable syringes and instruction is given prior to release.   I am squeamish to the point of hysteria but, amazingly, this has not been a problem. Patients are also fitted with elastic knee length stockings that must be worn day and night for six weeks. They are very fashionable but damned uncomfortable!

A few days after arriving home, the Barlborough Nurse visited to change the dressing followed by a further visit a week later to remove the 'staples' that keep the incision together after the operation. Another week and along comes the Barlborough physiotherapy aid to check progress on the exercise programme and to add a couple more to the requirement.   By this time the incision has healed and it is a temptation to walk around without the use of crutches, a development forbidden by the physio who insists on the continued use of one crutch for the next three weeks.

The worry for most patients is post operative pain.   To this point, I have had very little at any stage during recovery and have been taking only half of the prescribed pain-killer dose.   If there is any discomfort it is at night when one does not have full control over alignment of limbs and I have awoken to find it necessary to make a quick adjustment. However, as soon as that is done there is a fresh, pain free start!

About Barlborough (http://www.barlboroughtreatmentcentre.nhs.uk/site/2/home.html )

Barlborough is an NHS treatment centre. It is owned by Partnership Health (http://www.partnershiphealth.co.uk/about_us.asp), South Africa's leading supplier of private healthcare, who also manage NHS Treatment Centres in Plymouth, Maidstone and North East London and are the preferred bidder for further Centres in Southampton and Lymington. Staff are generally from outside UK, with many of the qualified nursing staff coming from South Africa.

Barlborough specializes in hip and knee replacements and covers a wide area including Yorkshire, Lincolnshire and the Trent Valley. Being a small, newly built 36 bed unit, the hospital offer superb patient care.   It is exceptionally clean and free from the infections about which all patients are concerned and patients will be constantly aware of the very visible efforts that are in effect to keep it so.

This type of unit makes very good health care sense.   It is of a manageable size and not over-burdened by the government's QUANGO obsession. It is managed by experts, not by amateurs, and it shows!

June 2nd a significant day for me. This morning I got back to some chipping and putting and hitting a few balls into the net. On Thursday I shall play my first full round since the operation, using a buggy only because I am not yet certain of my aerobic fitness. Some people take a lot longer and 3 months seems to be recognised as the norm. How have I got to this point? Well, since coming home I have followed a rigorous exercise regime involving three or four exercise sessions each day. I bought some exercise weights and have gradually been increasing the load on ankles and feet for leg lifts etc. More recently, I have added some increasing daily walks. Others may achieve the same results by other means, but this worked for me. Before I had the operation someone told me that the recovery was dependent upon the following work/responsibility contribution ratio: Surgeon & Nursing Staff - 3 Days, Physiotherapist - 1 day, Patient - 80 days

Regrets? Just One. They kept the old knee and I could probably have sold it on e-bay.! Someone would have bought it!