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Author Topic: Problems after total knee replacement - declared will not walk again  (Read 2784 times)

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Offline 2LeftFeet

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Hi all

Please be nice to me, I'm new here!

I'm hoping to get a bit of advice, but by the nature of the situation, this will be a long post.  I shall try to keep it as straightforward as possible.

My Father in Law (FIL) is in his early 80s.  Osteoarthritis of the knees.  He had the right knee replaced a few years back.  Operation carried out under epidural anaesthesia.  Although he was rather confused and disorientated after the op, his rehabilitation was successful and after some ongoing physio at home, he made a full (if slow) recovery. 

The left knee has also been a problem and he underwent a range of assessments as to whether he was physically and mentally able to undergo total replacement of this knee.  I should point out that he's in his early 80s, and prone to hypochondria.  Added to that, he appears to be in the early stages of some form of dementia, although there has not been a diagnosis or anything concrete to work with.  Anyway, all those concerned were happy for the op to go ahead and he wanted it done himself as he was in a lot of pain from the knee and only able to walk a few steps with the aid of 2 sticks.

22nd November 2010, he went into hospital (do I say which one?!?) to have the left knee replaced, again under epidural.  The operation seemed to be successful, although he was extremely confused and disorientated.  He was quite forgetful and unsure where he was.

On 4th December, the hospital phoned his wife to say that he’d fallen from his bed (or possibly the chair) and had cut his arm.  It transpires that later that same day, he fell again, apparently whilst trying to get to the bathroom.  The nurses had told him to push the buzzer to get someone to help him, but he had forgotten this.  He landed on the knee which had just been replaced.  Quite a lot of blood and some patching up required.  No further operation deemed necessary and as far as we can ascertain, this second fall was not recorded in his notes.  The consultant’s registrar saw the knee a couple of days later and wasn’t overly concerned.

He was transferred to our local hospital, into their rehab ward, on 21st December.  More suitable for him, more physio time, and a ward aimed to help people who needed to progress some more before going home.  Sounded perfect.  He didn’t get on particularly well there – again, very confused, with clear dementia symptoms and unable to do much physio. We weren’t sure whether he was genuinely struggling, or just being a bit of an awkward old thing!  By this stage, he was unable to get out of bed, or back into bed, needing 2 people and a rotastand or lifting belt to transfer him, and was unable to stand.

His follow up appointment with the consultant was booked in early January, and he was transferred to the nominated hospital by ambulance.  X-rays were taken and the consultant’s registrar came to see him, took one look at the knee then went to get the consultant.  They identified a major problem – the lateral (?) ligaments on the outside of the knee (onto which he’d fallen) had ruptured and the patella had become displaced.  The consultant recommended follow-up surgery to either graft a new ligament in place, or fuse the knee if that wasn’t possible.  He said he’d do the surgery himself, and that it was very interesting as he’d never had to do a ligament graft in a patient with a replacement joint.

The second operation took place on 19th January 2011, at a different hospital.  Again, apparently successful – they did the ligament graft.  Unfortunately, my FIL was not coping well with the whole thing very well.  He’d been urinary incontinent since shortly after the first op and was just as confused and disorientated.  He had a knee brace, which he was to wear for much of the time for the first 3-4 weeks, before trying to bend the knee.  Once he could take the brace off, the knee looked a bit better, and he did have some movement in it.

On 15th February, he went back to the local rehab ward where he failed to make much progress, and by this stage, was becoming weaker by the day.  He’d spent so much time immobile and in bed that the rest of his muscles were becoming severely weakened – he struggled to pull himself up to sit up in bed as his arms and core muscles were so weak by now.  The physio declared he was to wear the leg brace constantly (we had no idea why).  He still needed 2 people to transfer him from bed to chair etc, was still urinary incontinent, and still disorientated.  He was in a room on his own due to having disturbed nights (despite the zopiclone he was being given).  There was a lack of mental stimulation and a lack of physical rehab.  It felt like they’d lost interest in him and thought he was unlikely to make any progress.  Not helped by his mental decline meaning he couldn’t remember what the physio had told him to do for his exercises etc.  A discharge date was arranged for later in March, and along with it, the necessary visits to the house (a bungalow) to decided what equipment was needed (bed, commode, rotastand etc) as well as arranging carers to visit 3 times a day.

There was another follow-up appointment on 9th March.  Again, transfer from the rehab ward by ambulance.  More x-rays.  The radiographer couldn’t understand why the brace had been put on upside down!!!  The consultant was elsewhere so my FIL saw his registrar.  The registrar couldn’t understand why he was still wearing the brace and took it away.  He said my FIL couldn’t go home and that he needed intensive physio.  The rehab ward disagreed, saying he had no authority with them, that they only did physio once a day, and that the discharge would take place as planned.

On 21st March, 4 months after going in for a routine op, with a predicted stay of 10 days, my FIL came home.  In an ambulance.  Incontinent.  Confused.  Unable to stand or walk.  Carers come to the house 3 times a day (and are brilliant).  He is settling in back at home and his mental state is improving with having familiar things around him.  He is less agitated.  He doesn’t understand that he can’t walk.  In a moment of clarity, he asked “well, I walked into hospital, so why can’t I walk now?”  Good question.

A home visit from the GP was requested, and refused.  She reviewed his meds over the phone and said she’d arrange some physio.  The physio came on Monday, saying she was the same one as had seen him in the rehab ward (really?  Surprising, especially since she said she’d seen him 3 times a day and the ward told us the physio went round once a day.)  She declared he would not walk again so there was no point in her coming back, but she would arrange a wheelchair for him.  Quite what he’s meant to do with that, I don’t know, he can barely lift a teacup, his arms are so weak now.

This has been a sad and immensely frustrating experience.  We feel there have been significant shortcomings in the standard of care he received, from being allowed to fall twice in one day, to not recording the fall onto the knee, to it taking a month for anyone to work out there was a serious problem which necessitated the second op.  Now it feels like he’s been hung out to dry.  You won’t walk again.  That’s it.  Carers. Wheelchairs.  No explanations. 


Why have I posted this?  I would like some opinion as to where to go from here.  Half of me thinks there’s grounds for a negligence case, although the family has no funds for expensive legal advice.  There will be a formal complaint made (first letter to PALS is being drafted).  Have any of you had any kind of experience of this kind of thing? 

Any advice or opinion would be most gratefully received.  If you’ve made it to the end of this hugely long post, please accept my apologies and congratulations.

Many thanks
2LF

Offline Lottiefox

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Re: Problems after total knee replacement - declared will not walk again
« Reply #1 on: April 07, 2011, 12:55:25 PM »
Hi 2LF

Goodness what a catalogue of failures. Before I go any further can I ask if you are UK based? Your poor FIL. At least he is now home and probably safer than he seemed to be in hospital. But understandably, being told you won't walk again is a terrible thing to hear. Services simply fail our older population many many times. If you are UK based let me know.

Take care

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline 2LeftFeet

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Re: Problems after total knee replacement - declared will not walk again
« Reply #2 on: April 07, 2011, 01:13:40 PM »
Hi Lottie

Thanks for your reply  :)

Yes, I should have pointed out that we're in the UK (England)

I should also have said that FIL doesn't live on his own - his wife is there too.  She's 81 and quite frail.  Their daughter (my Sister in Law) lives there as well, though works during the day. 

It feels like the bad outcome from the op(s) is being compounded by a complete disinterest from the GP. 

I wonder if it's worth getting a second opinion?  But I don't know how that would help...  I do feel quite strongly that a complaint needs to be made, simply to prevent another family experiencing a similar thing in the future.

Thanks
2LF


Offline Lottiefox

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Re: Problems after total knee replacement - declared will not walk again
« Reply #3 on: April 07, 2011, 01:45:38 PM »
Hi again

I guessed you were UK based from your history. I would probably approach it by initially making sure that your dissatisfaction is formally logged with the Trusts that treated him so you have a formal record that you are not happy with the service and outcomes. Definitely catalogue the falls, lack of recording, lack of follow up on the knee and so on. Depending on what reply you get you may wish to seek a legal viewpoint and a reputable clinical negligence lawyer won't charge you for an overview and many will work on a no win no fee basis. I have worked within neurotrauma and clin neg many years ago so if you need suggestions I can message you. I am NOT advocating complaining for complainings sake at all (before anyone else here calls me an ambulance chaser), but failures are only improved by people bringing them to attention and any compensation ever offered is usually what is needed to get a proper quality of life back to the individual.

In terms of where your FIL goes, I wonder if it might be worth seeking a private Physio appointment initially to see what they think are the current limitations and what might be done. If you could find a specialist physio with TKR knowledge and experience in working with complex cases then they could provide an objective assessment and treatment plan.  IF it truly is that walking is out at the moment, you need to go back to the orthopaedic drawing board and Yes, a second opinion may be helpful. The GP sounds terminally unhelpful. Is there potential to request a different GP gets involved? Anyone who knws your FIL well and could build some trust back up?

Not sure if any of this helps, but its just my thoughts....

Good luck,

Lottie

Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Redwing

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Re: Problems after total knee replacement - declared will not walk again
« Reply #4 on: April 10, 2011, 07:26:12 PM »
Hi 2 leftFeet

What a sad story and my sympathies are with you and your family.  I cannot advise on legalities or negligence but I do have some experience of dementia, not my own (thank goodness) but my mother in law.  She has Alzheimers, the slow progressing type, and also osteoarthritis.  After she was diagnosed with Alz and her OA was getting progressively worse, hips in her case, we made enquiries about hip replacements and practically the first thing the  Memory Clinic consultant and GP said to my husband was that it wasn't recommended in dementia patients to have major surgery because they often don't 'come back' fully from the anaesthetics.  No one thought it a good idea to have joint replacements in her case.

Sorry not to be able to offer any advice really but just pointing out what was told to us.
2001: first referral to OS for osteoarthritis in knees after about 5 years of OA pain.  Told I was too young for knee replacement.
July 2009 Bilateral arthroscopy
Jan 2010 TKR-right knee

Offline 2LeftFeet

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Re: Problems after total knee replacement - declared will not walk again
« Reply #5 on: April 11, 2011, 03:20:04 PM »
Hi Lottie and Redwing

Thanks for your replies.

The current plan is to file a formal complaint and take it from there.  Not sure how much appetite the parents-in-law have for getting involved in anything legal.  I think all they want is recognition that this did not go according to plan.  An apology would be nice but I don't think we're expecting any miracles here! 

The suggestion of a private physio assessment is a good one.  We'll look into that.

Re different GPs.  They have recently moved to this practice.  The GP herself made all the right noises before FIL was discharged, but so far has failed to deliver.  Doesn't help that she's part time.  MIL is going to see the head Doc tonight, although having seen him once myself, I'm not holding out much hope as he seemed to me to be of the old-school condescending type. 

Redwing: thanks for sharing your personal experience.  Although there has never been a formal diagnosis of any kind of dementia, there have been periods of assessments, scans etc, and a tacit suggestion that "things will get worse, not better".  Again, I wonder if this is the medical profession not wanting to commit to anything on the basis that the patient (or my MIL) are not able to understand a diagnosis.  It's frustrating because they (in-laws) are quite old fashioned in their attitudes.  They will not question what a GP says (the Doctors are God generation) and yet are too independent to agree to having one of the 'youngsters' of the family present for consultations with a GP.  Don't worry, we will pull rank on this one!!

There was a set of assessments done before the decision was taken about whether or not to operate.  We were amazed that they decided it was do-able, even with doing the op under epidural to avoid giving a grneral.  Your comment about dementia patients not fully 'coming back' after major surgery is telling  :(

The only good news is that in himself, FIL is becoming more settled, being at home again, and seems to rather enjoy having a host of people fussing over him several times a day.  Quite what effect it will have on my MIL's frail health is another matter...  I do hope there is some chance of him walking a few steps at some point, although deep down, I think it's unlikely.  We still have the final appointment with the consultant to look forward to.  That will be interesting, as will the outcome of the complaint.  I hope this doesn't happen to anyone else's family.

Any other advice, comments, opinions etc most gratefully received.
2LF

Offline mountainknees

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Re: Problems after total knee replacement - declared will not walk again
« Reply #6 on: April 11, 2011, 05:00:01 PM »
I am so very sorry for the problems your father in law is having, and you seem very dedicated to him.  I know that in the United States there would be a long line of lawyers outside your door waiting for the chance to sue then hospital that allowed him to fall, and many others. I do not know how that works in the U.K.
However and again I do not know how possible this is in the u.K., I myself am forced to use a power wheelchair.  It is battery powered and can turn on a dine.  It takes virtually no effort of operate since it is controlled by one joystick with two fingers.
I have had to use mine for the last two years,  In my case my chair is fitted with an elevated leg rest since it is less painful to keep my leg straight out.  I do not know the criteria of your health services to get one for your father in law in the u.k., but in the U.S.A., all it took was a letter from my physician saying that I could not walk and my arms were too weak from two rotator cuff shoulder surgeries to use a standard wheelchair.
 If you cound manage to get one for him to use it would mean he could get around by himself and his wife would not have to exert herself to wheel him. He is in my prayers, Goid Speed, Mountainknees

Offline Chainsaw_gran

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Re: Problems after total knee replacement - declared will not walk again
« Reply #7 on: April 12, 2011, 10:38:01 PM »
I felt very sad but not surprised on reading your blog.  NHS!!!    I made a formal complaint on 3 issues recently, to the ambulance service. I received a formal reply denying all counts. It seems they recorded what they should have done, not what they did. I did not reply; it seemed pontless. In retrospect, I wish I had gone through PALS as there is much more liaison between parties.
March 2011. Elmslie trillat/TTT. Autologous Collogen Induced Chondrogenesis to patella n Trochlear.















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