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David

Age at interview: 57
Brief Outline: David started getting knee pain around 2008. The pain continued even after he changed jobs and drove less. X-rays showed that he had osteoarthritis. He had a partial knee replacement in 2014.
Background: David is a mechanic. Ethnic background / nationality: White British.

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Around 2008 David started getting pain in his knee. At that time he was a lorry driver and spent three to four hours a day sitting in the same position, which made his knee very stiff and painful. He persevered with the pain for a couple of years and became a mechanic in 2012. Although he had changed jobs, his knee continued to cause him problems so he decided to see his GP. As his knee was swollen, his GP sent him for an x-ray, which confirmed that he had arthritis. He was then referred to a specialist hospital for further advice. 

David first saw the surgeon in November 2013 to discuss his treatment options. It was agreed that a partial knee replacement would be the best treatment because he was still young and would need to work in the future. David then went for his pre-op assessment in March 2014 and had a series of tests. He remembers health professionals checking his blood, urine, blood pressure, height and weight. He also had an ECG and swabs taken to check for MRSA. He thought the professionals were very good and remembers being given a lot of information. A physiotherapist showed him a series of 3D information videos explaining the procedure and he found them very informative. However, he would have preferred more written information that he could take home with him. 

As the waiting list for an operation was six months, David was advised to ring reception every other day to check for cancellations. He was fortunate enough to get a cancellation and had his operation two months later, in May 2014. David remembers being the first patient on the surgeon’s list and said that he didn’t feel very nervous because he had had operations in the past. Having looked at the x-ray, the surgeon felt confident that David would only need a partial knee replacement. David was seen by the anesthetist and all of his vital signs were checked. A local anesthetic was injected into his knee following the operation to keep it numb for three to four hours, and he was later given morphine to control the pain. 

When the physiotherapist was satisfied that David could walk up and down stairs using his crutches, he was discharged from hospital the following day. He remembers being told to avoid bending his knee until the stitches had been removed. He was also given an exercise leaflet, painkillers and 14 days’ supply of injections (which are used to thin the blood and prevent blood clots). 

David stayed with his parents in their bungalow for the first couple of weeks, which he said made his recovery much easier. He did his exercises in the mornings and rested in the afternoons, applying ice to his knee whenever it was swollen. David noticed that his knee was improving every day for the first six weeks. He believes that the more he moved his knee, the less pain he had, which helped him feel more confident. 

David stopped using his crutches four weeks after surgery and started driving again five weeks after the operation. At the time of interview, he hadn’t got full movement of his knee but had been told that a full recovery may take between six to twelve months. Due to a confusion over dates, David had not yet had his follow up appointment but was hoping to be reassured that the operation was successful and that his knee was healing as it should be.
 
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David got information from doctors, nurses, the physiotherapist and pharmacist. The pre-operative assessment was ‘very good’ and everything was explained.

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We talked to the surgeon. He went through it and then I signed a form to say that if when they get in there, there is a problem and I need the full knee, then it’s okay to go ahead. They told me about what the recovery time might be, depending on how it goes. And that was quite good. I spoke to the physio and they explained all the systems. So you have the operation in the morning and you’ll be up in the afternoon, just to get you upright. And then the following day they’ll get you on the stairs and things like that...

So you saw an anaesthetist, the consultant, nurses, physio. How did you feel about the healthcare and the information that they gave you? 

Very good. They were very, they explained everything. Like the pharmacist confirmed and explained all the drugs I’d be taking; went through all my history to make sure I wasn’t allergic to anything or there was any problems with any of those. The physio went through it all, explained what was going to be done after the operation, and progress with crutches and down stairs and things. The surgeon went through the operation, which was not too much of a problem. It’s just what I said, it’s quite a, generally it’s about an hour, hour and a quarter, something like that. It’s one they do on a regular basis; did all the ECG and all the bits and pieces, just to make sure that there wasn’t going to be a problem when he operated. Yes, it was very good.
 
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The TEPI videos were informative but David would have liked a leaflet about the operation as well. He rarely uses the internet. Leaflets are easy to read and reread.

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When did they show you the videos? 

When I was talking to the physio, yes. 

Did she go through it with you or did she leave? 

She left me to it, yes. 

And you watched. And what did you think when you saw them? 

They were quite informative actually...

Would you have liked any written information that you could have taken home? 

Possibly, yes, just to give me that peace of mind, because you put your trust in the surgeon. He knows what he’s doing but it would be nice just to know a little bit more. There are people in the village I’ve spoken to who’ve had similar operations and I got the gist of it. But it would have been nice to actually see what was happening, a little bit more about it. 

So something similar to what you saw on the video? 

Yes, yes. 

But on leaflets that you could read? 

Yes, leaflets or something that you could just keep reading. Yes, because with a video, you look at it and it’s gone. You look at it and you’re trying to look at the pictures and also take in what’s being said. If you look at a leaflet, you actually look at it and then study it. You read it two or three times and pick it up a little bit better possibly...

And you mentioned that it might have been good to have the leaflets that you could pick up whenever you feel like it. 

Yes, so that you can actually digest the information properly. Because if you’re not on the Internet and you’ve seen the video once, it doesn’t all go in. You want to be able to go back to it. So if you’ve got it in a leaflet, at least you’ve got something and you can say, “Oh, yes, I’ll just” or “oh, I didn’t quite understand that. Yes, I understand it now.” Yes. 
 
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David wanted to know if he should be progressing faster or if he was overdoing it. A physio appointment 3 weeks after surgery would have been reassuring.

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Is that booklet just about the exercises or the whole operation?

Just about the exercises.

So the physio showed you what exercises to do? 

Not really, no. She went through the book with me and said, “Well, this is what you’ve got to do. Do it as often as you can but don’t overdo it. And then as you feel more confident, progress with a few more exercises, a bit more weight on it or whatever you feel is best.” 

Was the explanation enough to know what to do or could it have been better? 

It’s difficult to say really. You just know in your own mind how much you think you can do. But then you’re thinking, “Well, should I be doing a bit more? Could I do a bit more?” You just want a little bit of reassurance on occasions. It’s difficult to say. That’s what I was saying. If you’re an older person, maybe you would think, “Well, maybe I shouldn’t be doing that” and then it will take you longer to progress. And then if it was the other way, you could do too much and then end up back in hospital again. 

So it’s hard to know how much is right for you to do? 

Yes, yes. 

What would have helped? Would going back to see the physio sooner help? 

Maybe, it [the booklet] gives you one to three weeks, and then three weeks to six weeks. So maybe at the end of the third week, just going back and saying, “Right, this is what I can do. Is it enough? Should it be a bit more?” There is a phone number in the back if you are a bit uncertain, you can make an appointment to go and see them. But a lot of people might think, “Well, I don’t want to cause a problem” or “They’re busy people.” And maybe not call them. So, yes. 

So the information was there, but it would be more reassuring to go back after three weeks? 

Three weeks. Just to say, “Well, this is what I’ve been doing.” You can ask them, “The book says now go on to this; am I actually in a position to go on to doing that? And is this how it’s done?” Yes, just that little bit of reassurance I think. I don’t know, maybe it’s just me...

So the leaflet tells you what exercises to do, but what you want is something more personalised? 

Yes. 

In your case you’re doing this. Is that enough for you? 

Yes. “Should I be further advanced?” or, “Am I further advanced than I should be?” Or, “Am I overdoing it?” or, “Is it just because I’m younger and I’m healing quicker?” 
 
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David couldn’t tell how well he was progressing. Seeing a physio would have been reassuring. He felt wary of phoning the hospital.

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So the physio showed you what exercises to do? 

Not really, no. She went through the book with me and said, “Well, this is what you’ve got to do. Do it as often as you can but don’t overdo it. And then as you feel more confident, progress with a few more exercises, a bit more weight on it or whatever you feel is best.” 

Was the explanation enough to know what to do or could it have been better? 

It’s difficult to say really. You just know in your own mind how much you think you can do. But then you’re thinking, “Well, should I be doing a bit more? Could I do a bit more?” You just want a little bit of reassurance on occasions. It’s difficult to say. That’s what I was saying. If you’re an older person, maybe you would think, “Well, maybe I shouldn’t be doing that” and then it will take you longer to progress. And then if it was the other way, you could do too much and then end up back in hospital again. 

So it’s hard to know how much is right for you to do? 

Yes, yes. 

What would have helped? Would going back to see the physio sooner help? 

Maybe, it [exercise booklet] gives you one to three weeks, and then three weeks to six weeks. So maybe at the end of the third week, just going back and saying, “Right, this is what I can do. Is it enough? Should it be a bit more?” There is a phone number in the back. If you are a bit uncertain, you can make an appointment to go and see them. But a lot of people might think, “Well, I don’t want to cause a problem” or “They’re busy people.” And maybe not call them. So, yes. 

So the information was there, but it would be more reassuring to go back after three weeks? 

Three weeks. Just to say, “Well, this is what I’ve been doing.” You can ask them, “The book says now go on to this; am I actually in a position to go on to doing that? And is this how it’s done?” Yes, just that little bit of reassurance I think. I don’t know, maybe it’s just me.
 
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David would prefer to contact the surgeon if he has concerns about his knee to find out whether he needs a hospital appointment or to see the GP.

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So you go back for the follow-up. What happens after that appointment?

I don’t know. I will find out when I go for the appointment.

What would you like to happen?

Well, I don’t know. If the surgeon says, “Right, everything’s as it should be. Unless you fall over and bang it or something, you should be okay” then that’s it I suppose. If there is a problem I expect he’ll say, “Go and see your GP” and then be referred again. But it’s difficult really, yes. If it’s all okay, that’ll be what, months / three months? So the bone’s sort of healed around the new part. So it should be okay. If he says it’s all okay, then you take his word and carry on doing what his suggestions are and gradually build it up again.

So after that, if everything’s all right, then if there are any problems then you would just go to your GP? Does that sound okay or would you like more reassurance than that?

I don’t know because the problem with going to see your GP is trying to get an appointment. And then if there is a problem, then getting another appointment for the hospital, which could then be three, four, five, six weeks down the line. Whereas if you could ring the surgeon and say, “Look, I’ve got a problem.” Or ring the hospital and say, “I’ve got this problem with the knee. Do I need to come and see you or can I go and see my GP? Which is the best way of doing it?” Explain what the problem is and they say, “Well, you need an X-ray” or whatever or, “Just go and see your GP and get some painkillers.” Then that might be different, I don’t know.
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