What’s really important after joint replacement is regaining a good range of movement. And a physiotherapy [exercise] programme is critically important in doing this.

Anything which allows you to try to get your leg moving in a full arc of movement is to be encouraged. And this strengthens the muscles around your knee and in the end improves the functional recovery that you get.

In a small number of cases, patients struggle with their range of movement. And what wed like to do is to intervene early in that situation. And that’s one of the important checks at 6 weeks is to make sure your movement is coming back. And that’s a key part for us.

Sometimes when people were doing their exercises in the early stages of recovery, they wondered if they could damage the knee. Is there any way that they could damage it or is that highly unlikely?

If you follow the guidelines for recovery following joint replacement and specifically partial knee replacement, there are very low risks of damaging a knee replacement.

The thing that wed wish to avoid are falls. And falls can lead to damage or sometimes fracture around a knee replacement. But that’s very, very unusual. And most people recover very steadily and avoid those sorts of issues if they stay within the realms of the recovery programme we lay out.

If someone did accidentally fall, who should they see first?

Well, I think once you’ve had a fall, if you’re able to get up and everything seems fine, then I think you can monitor that yourself.

If you have a fall and you feel new pain or theres swelling in the knee and it’s clear that something more serious has happened, then I think initially the person to contact is your GP. And your GP tends to assess that situation and will refer you through the appropriate channels.

The exercises, I tried to do the exercises at least four or five times a day. Because they did say, Do small amounts often rather than a huge amount. And you do get a leaflet telling you what to expect two we-, after two weeks, and then four weeks up to six weeks. So I did follow the book and I did do the exercises because I wanted it to get right as quickly as possible.

I think having the assessment in six weeks would have been better than having it in eight weeks. But I’m sure theres a reason for that. Just to know that I’m doing the right things. Because having the book and speaking to someone on the phone, it would be easier perhaps if it was on the video, showing you the exercises, or seeing someone. Just for that reassurance that, I’ve been doing these exercises for four weeks. Am I doing them correctly? When I went for the assessment, sorry, when I went for the last appointment, for the eight-week assessment, I couldn’t bend my knee. I was still 5 degrees off what it should be. And I couldn’t bend my knee flat. So she did give me some exercises that I’m doing now. Which I could have known earlier as I’ve gone two weeks not knowing that.

You mentioned you’ve been doing your exercises, but in a way you’ve had to motivate yourself to do that?

I’ve had to really motivate myself to do that. I find, especially now at six weeks on and you can do really all the things, I can do all the things that I could do before. And so then your day becomes busy. You know, you start doing your jobs, you start working. And the only thing I haven’t done is the hoovering because that’s not, I don’t, that I can feel is uncomfortable. And so then you think, you get up and rather than doing your exercises you think, Oh, well, I’ll just put some washing on. I’ll just peg some washing out.

Before you know, it’s lunchtime; you haven’t done them. And I’m still struggling to motivate myself to do the exercises actually. And we have got a friend who’s a physio, who just come in to see me the other day. It’s the first time shed been in to see me since my operation. But she did just say, Well, you know, you must do this and you must do that. And you’ll benefit more if you do. So, yes.

So you had a little booklet with the exercises. Would it have been helpful to have them on video or anything else?

Oh, yes. Now that would have been good. I would have liked that actually. If you could have, it’s, yes, if you could put something on and do it with them, I think that that would motivate you more I think. It’s as if theres someone doing it with you. Yes, that’s a good idea. I hadn’t thought of that. It’s quite a lonely thing. You know, you’ve got to get on the floor or on your bed or whatever and, you know, do these exercises.

I think a video would have helped greatly. As I said, I was lucky enough that I was able to go to a, you know, private physiotherapist, who was absolutely excellent. But I think being able to see how you should do the exercises properly. Because diagrams are quite difficult, you know, particularly when you’ve only got one picture of a particular exercise. Sometimes it wasn’t clear to me whether I was, you know, doing it right until I saw the physiotherapist. And some of the things I wasn’t doing right. And so I think, you know, a video could help, yeah.

So you saw the physio, was it a couple of times, before you then went back for your follow-up appointment at the Nuffield [NHS hospital]?

I think I’d probably seen her, yes, three times before I went back, yeah.

And can you tell me how the, those appointments were and how helpful they were for you?

With the physiotherapist?

Yes.

Oh, extremely helpful. I mean she told me, you know, which exercises, initially which exercises of the ones in the booklet I should be able to do, which ones I ought to delay doing because they were going to be a bit too much. And then which new exercises that I could be doing. So, which weren’t in the booklet. Yes, so that was really helpful. It was the sense of progress which was really useful.

So before you left were you given a booklet about the exercises to do?

I, a tiny I think actually it’s upstairs because it’s what I do is I take if I do them downstairs, usually in the morning I do the ones upstairs, sort of in bed and, yeah I was sort of going through these and they weren’t very explicit. Some of them said hold for a count of five or the one I didn’t, which I completely got wrong was the standing one where it says step onto the, put your foot onto the first step. And I’m thinking, ‘Why am I doing this, what’s it doing for me?’ And then realised I was supposed to lift my back, the other leg up, probably. It didn’t actually, you weren’t, it didn’t say put your full weight. I may be wrong even now on saying that, that’s what I was supposed to do.

So you were given the booklet but it wasn’t always clear how to do all of the exercises

No, no it wasn’t and it’s not a booklet, it’s loose sheets that have been photocopied and, as I say, it was sort of clearer the ones that I had when I’d gone to the hospital, to the physio here in [place name]. The instructions are much clearer but unfortunately I never kept that, I didn’t have it still and it was all on an A4 sheets, not lots of loose pages. But, as I said, I had so much information, I then foundsorry if I’m going away from youI found this book a long time afterwards and is this the one that’s got the, and it had better pictures, more exercises to do and I’m thinking, ‘Where did you hide that Helene?’

Where was this book from?

This was given to me by the, actually on the I think this was given to me on pre-op assessment.

Oh right, right. So that was helpful but what would you have really liked in terms of, you know, doing the exercises?

I think actually it might have been a better I didn’t see any videos of the exercises. Now that might, because you’ve got somebody, a physiotherapist actually talking saying, you know, sort of, “One Mississippi, two Mississippi” these are my seconds, Mississippi, saying how long to hold it, exactly how to do it and, you know, sort of wrong and right. Even doing sort of wrong and right whilst they’ve got somebody, the model, and doing it for them. So yeah again it’s just the aftercare, it’s so kind of lacking.

If you’d been given a DVD would that?

Yes, yeah that would have been good, the same yeah, yeah.

And maybe information, because you said that you weren’t sure – ‘Am I doing enough, am I doing it OK; after two weeks what should I be doing after two weeks?

Yes, yes, yeah this is it. Because the exercise which are six I think it is three up lying, three standing and I was thinking, ‘How do you progress from this; OK just do it for more, you know, more times make a note on each, on the bottom of the page,’ sort of. This day I did five, six the next day and so on, but it becomes boring when you’re still doing the same ones but much, much longer. How lovely it would have been to have had new ones to do.

Was there a video showing the exercises as well or?

No, I don’t think so no, no. Had a booklet mm.

And did you use that booklet at all or because you knew from the first time?

Well no, I did use the booklet. It may change, things might be different but I did use the booklet and I read it quite a few times because I thought I was doing some things wrong which seems that I weren’t. It all seems quite good now.

So did you find the booklet helpful?

Yeah, yeah. I found the website more helpful to be honest with you. If they’d have put those exercises on the website then I would, I think, looked at it more often.

So you would have liked to have the option to look at the exercises as well on video?

Yeah, it would be good to watch someone doing them as well, not just sort of, this is what you do, bend your legs andyeah it would be good to have a video to watch.

So were there times when you were wondering, ‘Am I doing this right?’

Only coming downstairs, I had a problem coming down the stairs. I could go up but I couldn’t come down, not properly and thatI was getting a bit worried about that. I was thinking, ‘Well is it because it’s not glued in?’ I mean it’s a stupid thing to think but if it’s not glued in, is it bouncing up and down; it seemed strange, it was a strange feeling.

So a bit of information even in the booklet about going up and down the stairs at home would be helpful?

Yeah, yeah. Yeah I could stand on the bottom step and do that but coming back down thirteen stairs was a bit more daunting.

I was surprised that, although the physios came to walk us, but I was surprised they didn’t take us through the exercises. We got the leaflet but they didn’t actually go through them whereas they did the first time round, yeah.

So that would have been helpful would it?

I think so. I think just to know you’re doing them correctly you know, yeah.

So that was given in leaflet; would you have found a video of the exercises helpful, so if you were given either a website or a DVD to put in would that have helped?

Yes, because you can see it happening then can’t you and you can see what’s correct and what isn’t, yeah.

So you’ve got your little booklet and do you feel OK doing the exercises? Some people mentioned they weren’t always sure if they were doing it right or they would have liked to see a physio.

Yes, yes that’s the thing. Sometimes you think, ‘Am I doing it’ I mean theres one where you lie on your side and lift the leg that’s gonethat you’ve had done up and down and then it says something about, then turn over and lift it the other way and I’m not quite sure what it means. I think I’m doing it right but I don’t know. Because the picture in the booklet only shows you the first bit; it doesn’t show you how you do the second bit so, yes, a video of the exercises would have been very good, yeah.

Is there anything else that would have been helpful at all?

Not that I can think of, no.

I was given a booklet of exercises, although I don’t recall any actual discussion of the exercises. So, but as I mentioned earlier, I went to see a physiotherapist fairly soon after and then the private physiotherapist.

And they very much said, you know, which exercises I should be doing at this stage, which ones, you know, progressing to later. Which was helpful. And I did do the exercises pretty religiously. And I was icing my knee very regularly after, certainly after, any time I did the exercises I would ice it afterwards. And so that, so the whole focus seemed to be on, you know, me doing exercises and icing the knee and… But that went quite well, yes.

So there were exercises in the booklet, which you started doing. But what made you feel that you would like to see a physio?

Well, I felt I needed more guidance on how to do them, when to progress, and when to progress on to other exercises. So, and also, you know, the fact of having to report to someone. Which I think is very important. And I mean as it turned out, the NHS physio, who I saw just once, she actually went in for, the second appointment in fact we, never happened with her. Because she went in to have knee surgery herself. She had warned me she was going to, might be called. And she was called.

But I mean it was encouraging, I mean I guess this was a week or so after surgery, for her to be saying, You’re doing really well. And the same with the physiotherapist I saw subsequently. It was that positive encouragement, you know, at times when one is becoming discouraged. Because, you know, it did feel like it was two steps forward, one step back. And I think I’d been warned that that was the case. So, you know, I’d start to improve and then I would do too much. Like I would go and try and do a bit of gardening or, you know, far too early, and then the next day would pay the price. And, but it was, so I’d start to feel a bit downhearted. But it was the physio saying, Actually no, you know, this is how it, how progress goes. You’re really on, well on course. Which I thought was very important.

The main question that I’ve had all the way through is, Can I kneel on them afterwards? Can I kneel on my knees afterwards? And, to be honest, no ones given me a definite yes or no. I think probably the surgeon got the closest in. And he said, Well, medically speaking and I think this is how it was put to me that, Medically speaking, there is no reason why you shouldn’t. But And the but’ is everybody is an individual. It will affect different people in different ways. How much you need to kneel down. How much you don’t need to kneel down. Whether it will cause you pain. Whether it won’t. It’s got, it’s an individual thing.

And that’s something that I’ve got to sort out for myself as and when I feel well enough and confident enough to kneel down on them. And obviously not on a hard floor. On a nice cushion or on a rubber pad, which is what I carry now anyway. But obviously, you know, being a little bit more careful to kneel on something soft. But again it’s something that I’ve got to try for myself when I feel ready.

That’s the bit that really worried me. The fact that, because of my profe-, of my occupation, if I can’t kneel down, I can’t work. And theres people telling me, Oh, no, you can’t kneel down on them. Oh, no, no, it’d be too painful. And that sort of thing was putting me off all the time. That’s the sort of thing was making me think, Well, do I really want to go through with it or do I stay on the pills? At least while I’m on the pills I can still kneel down.

And even now I’ve got one knee done and I’m still thinking to myself, Well. That’s still at the back of my mind. Okay, I’ve still got one knee that I can kneel down on at the moment. If I go straight from having the left knee done, which has been done, and then go straight in and have the right one done, I’m not going to know until it’s too late. So do I put the right one off or do I go ahead?

And that is what’s on my mind at the moment. Do I go back to work and struggle with one knee that I can kneel down on? Because the pain is not that much from there at the moment. Or do I throw caution to the wind and get both of them done and hope that I can kneel down on them afterwards? That’s the decision I’ve got to make.

Up to 50 per cent, will find that kneeling is uncomfortable following joint replacement. But whether it’s uncomfortable or not, patients will not be doing themselves any harm by kneeling. So it isn’t true to say that you can’t kneel following joint replacement. But it’s very much up to each individual patient to see how they feel. But if you can do that and it’s not painful, and particularly if your work demands it, then we would encourage you to kneel.

So in the case of someone kneeling on the ground, maybe with a knee pad, they should

Yes. There are ways to support patients who have to kneel. And knee pads and other appliances that you can use to protect you in that are really helpful.