Knee Replacement

[LIMA OR ALPHA JUNK]

UK commercial pilot, Class 1 medical.

I need a partial/full knee replacement. Can’t find the reference in the CAA pages. Anyone able to tell me the minimum length of time, post op, that the CAA require me to have off before I can exercise the privileges of my licence again ?

Any information gratefully received.

[A and C]

All in I was off work for about three months from the Opp to the return of my medical certificate.

Its important to get the knee moving ASAP so if you can get yourself into a hydrotherapy pool it will make recovery less arduous.

I also had an American licence and was advised to carry a letter stating that I had been prescribed morphine based drugs under medical supervision in case I got drug tested by the FAA. Apparently evidence of these drugs hangs about in the body for quite sometime.

[LIMA OR ALPHA JUNK]

Thanks for the reply. Appreciate your time.

[BoeingBoy]

I thought it worth reviving this thread as I've just gone through a Total Knee Replacement (TKR) and thought my experiences might help others facing the prospect of one.

Firstly, my arthritis came on overnight due to an old road crash injury some forty eight years ago wearing the cartilage on the inner side of my left knee away prematurely. I had no problems prior to that. After spending three months waiting to see if it was just a sprain I was diagnosed with severe arthritis and told I needed a new knee. As the outer side and knee cap were in good condition I looked into a partial but in the end was told the crash had actually misaligned the knee so a total replacement was the best option. I elected to have mine done at a well known Orthopaedic Research Hospital near Oswestry.

Whilst not looking forward to the procedure at all as it was my first major surgical procedure I have to say I made the right choice as the team at the hospital were simply the best. From reception to operating theatre the whole atmosphere was positive and fun. So much so that they try to encourage people to stay awake during the operation to assist recovery time post op. I didn't fancy that, much preferring to go out on a general but in the end I stayed awake with no anaesthetic and watched the UK Formula One on a tablet and listened to some music. In the end I watched the operation in a reflection of the theatre glass wall and wound up putting it on Facebook.....as you do! The whole process was completely painless and lasted about forty five minutes.

The first thing to note though is that no one tells you about the first pre-epidural anaesthetic injection. In all the banter and fun that was going on in the preparation room it didn't register on me that one of the assistants was standing in front of me with his hands on my shoulders as I sat on the bed. As I tried to propel myself through the wall on the first insertion he braced me and kept me in place. I'm pleased to say that the others followed a circular pattern around the back and didn't register so much as each area of numbness took hold. As for the actual epidural, I didn't even know it had been done. I was told to lie back and allow my lower half to go numb which it does in a sort of 'warm and fuzzy' kind of way. Another injection went into the knee but I could not feel that at all.

As I said, the operation is totally painless. The only sensations that did register was a skeletal vibration a couple of times as the cutting tool was used. More odd than disturbing. The other was the hammering of the components into the joint sockets. Again, not painful but a weird sensation, something like being a rag doll maybe?

Post operation pain killers take care of the next three days but I will not play down the fact that recovery is very sore and uncomfortable. There was no 'direct' or 'sharp' pain, more a sense of severe trauma around the knee which was constant. Hospitals vary buy mine applied inflatable socks around the lower limbs to prevent clots. Some people don't like them but I thought they were quite comforting, rather like having a massage, and managed to sleep well with them on. You can expect to have lots of medication served 24 hours a day. God knows why one set of tablets had to be taken at midnight though!

Getting up and about usually happens the same day however I didn't get up until the next day due to physiotherapist staff rosters. It was not difficult and as I'd kept as much muscle form as possible with exercise pre-op I found I could go straight to crutches and walk about fifty yards. Within three days I could do a hundred and climb stairs. The hospital will look for the ability to fully extend the leg straight and achieve at least a 90 degree bend before discharge although these are not finite limits.

Recovery at home will ideally require a helper but it's not essential. You will need to take it slowly and carefully on stairs. The dressing (which resembled a giant congealed caterpillar) allowed showering straight away. It was replaced with a lighter dressing after two weeks and removed totally about ten days after that. I now have a rather sporting eight inch scar vertically aligned over the knee. It's a good idea to keep it moisturised to assist healing and reduce the scarring.

There are a range of exercises that you will need to do each day and to ignore those is very much to invite complications. There is no alternative but to do as much as you can to gain mobility and strength. I was off the crutches at two weeks and using a stick progressively less until six. At four weeks I could climb in and out of a PA28 and started driving an automatic car. I finally got my EASA Class 2 back at eight weeks, although to be honest had I been in a rush I could probably have managed it in six.

It's now been three months and today I put the stick away for use on the stairs for the last time. The knee is still a little swollen but painless. It clatters and clicks a lot more than the old one and whilst the degree of bend will never equal the right one I'm at 120 degrees. I'm back to walking the dogs a couple of miles a day and cycling as well to assist mobility. I can kneel on it easily but fully squatting is out due to the design of the joint. It will be at least a year until everything is deemed to have settled and in some cases up to two years is normal.

One other thing that wasn't covered in the briefings though was insomnia. Everyone varies but in my case it was at least six weeks before I got any semblance of a good nights sleep. I was beginning to think I was on a military interrogation training course where sleep deprivation was taken to the limits. It's not directly due to pain, but more the leg needing to be moved every couple of hours. In some cases even every ten minutes before it would try to seize up. That was a tough part of the whole process. Eventually though things will improve.

So would I encourage anyone to go for a TKR? In my case it's been a positive move as by the time I had the operation I'd been suffering badly for over eighteen months but that was due to another medical issue. What people don't bargain for is the damage the knee does to the rest of the body. The lower back and opposite hip complain bitterly in the end about the imbalance and the resultant pain from them can almost equal the arthritis. Another thing that people don't bargain for is the depression from seeing your previously active life style deteriorate until you are almost immobile. It's a real problem so don't leave things too long. Having said that, if you can still lead an active life with a degree of discomfort don't rush into the operation. Whilst knees are now more likely to last 25 years than the previous 15 quoted the new knee is really only going to be about 75% as good as your old one.

In the UK you can elect to have your operation anywhere you choose so don't be pushed off to the nearest NHS knackers yard. Do your research and choose where, and who, you think you'd feel happy going to. The travelling time might be a nuisance but it's only for three nights and if you get the result you want it's worth it.

Hope I've been some help.

[A and C]

Like BB I have had a TKR and thankfully seem to have had far less discomfort, I ditched the pain relief drugs quite quickly to the surprise of the medical staff but this probably reflects the pain levels prior to the procedure.

Getting the Knee moving ASAP is key to a good recovery and to this end hydrotherapy is very good as you can walk in the hydrotherapy pool in the normal way while your body weight is largely supported by the water.

My procedure was done twelve years back and I was back to flying with a class one medical after three months , my company wanted me to demonstrate controlling the aircraft at MTOW with an engine failure at V1 and then fly a visual circuit to a landing without using rudder trim as this covered the worst posable scenario they could think of. Once the CAA had the all clear they re-issued my medical.

It took about a year for me to get very nearly the full range of movement back in my Knee and it was about nine months before I could comfortably ride my motorcycle, that was all twelve years back and now the only drawback is I get the full search from security each time I go to work.

[RatherBeFlying]

My sister is a doctor and she had been struggling with an arthritic knee for a decade, with a son in a wheelchair. It wasn't long after the op that her pain level was below pre-op.

She now wishes she had it done several years sooner. As BB rightly points out a bad knee buggers the rest of the skeleton. Decreased activity drags down your health in many ways.

So get your bad knee fixed.

[BoeingBoy]

Yes, the operation is frankly secondary to the rehab. I'm pleased to say I've been totally discharged from further physio after 10 weeks but not without a lot of daily exercise and effort.