Four men limp into my clinic room one after the other.
Not particularly unusual. But what they had in common inspired me to starting writing about hip and knee pain.
It was a particularly uninspiring grey autumn afternoon...
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JohnJohn was the first new patient of the afternoon.
A 52-year-old ‘young’ man with a badly osteoarthritic knee.Â
Depending on your age, you may not consider 52 to be young.
But 52, in my clinic, is very young to be thinking about joint replacement.Â
John described how his knee pain had got worse over the last few years.
It was now getting in the way of his work as a long-distance lorry driver.
Getting in and out of his cab was getting more difficult.
Walking up and down any kind of slope '
hurt like hell'. And the knee often felt like it would give way.
I examined John’s leg and we talked through the x-ray films of his knee.
He'd lost all of his joint space on the inside. And the outside of the knee was also damaged.
His knee was too far gone to consider ‘keyhole’ surgery. Too far gone to consider half a knee joint replacement. And too far gone to consider anything but a total knee joint replacement.
The average age for joint replacement is 68 or 69 years.
John was 52 years old.
Mr JonesÂ
The second new patient that afternoon was Mr Jones, a 51-year-old man with bone on bone hip osteoarthritis (or OA).
Mr Jones’ pain was getting in the way of everyday life. Waking him up at night. Preventing him from walking more than a few hundred yards on the flat.
I examined his back, hip and knee and talked him through his x-ray films. The only surgical option open to him was hip replacement.
GeorgeGeorge came in next. Also 51 years old.
He had severe hip pain and his hip joint was completely destroyed.
I took a sharp intake of breath when I saw his x-ray film.
A sharp intake of breath, and a
‘Crikey, look at that’.George’s story and the discussion that followed was similar to the patients before him. The only option was hip replacement, or ‘do nothing’.
Surgically at least.
It was a bit unusual for the fourth new patient to also be male.
More female than male patients turn up for hip or knee joint replacement.
It was more unusual still for that person to also be under 55 years of age...
IainBoth of Iain’s knees were badly osteoarthritic. The same pattern of osteoarthritis on the inside of both knees.
Knee osteoarthritis is more common on the inside of the knee. And Iain was typical. But the deformity was worse. Especially at such a young age.
If his knee wasn’t quite as worn and his pain had been different- more catching in nature, the sort of pain that takes your breath away with an
‘OOOOoooffffff’- we might have been able to talk about keyhole surgery.
But his pain was an ongoing ache.
A constant ‘toothache-y’ gnawing pain.
He was borderline suitable, almost too far gone, for half knee joint replacement…
BUT...That misses the point...Iain was very young to be considering
one, let alone
two joint replacements.
So, I’d seen four male patients that afternoon.
John, Mr Jones, George and Iain.All were under 55 years.
All hobbled into clinic.
One after the other.
All wanted something doing.
Something, not unreasonably, to get out of pain.
All had completely osteoarthritic joints.
BUT...It wasn’t their gender or young age that inspired me to start writing...
The Elephant in the RoomÂ
Every doctor’s referral letter into another clinic describes the main problem.
It also details other chronic diseases, current medication, and important tests.
A recent scan of the heart, perhaps. An echocardiogram, for example might describe the percentage output of blood from the heart with every beat.
That level of detail is great.
BUT...When it comes to hip & knee pain, there is another piece of stand out information. Infomation that strikingly highlights the underlying cause of many people’s problems.
John, Mr Jones, George and Iain each weighedÂ
OVER 120kg.That’s over 19 stone in ‘old money’, or
260 pounds if you’re reading this in North America.
Together, those 4 men weighed as much as 8 men should.
WOW!!THAT. Right there. Is the clear reason why each of these men had destroyed their joint(s). Destroyed their joint in their early 50s. Decades before they should have had problems.
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Newsletter #007Â described how joint cartilage likes, even needs, load.
Cartilage
DOES like to be loaded...
BUT... ...NOT too much!
