Jane Wilson-Howarth

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My knee - a biography

Thursday, 17 March 2016
Way back in the Dark Ages when I was at medical school in Southampton I was engaged in the lady-like pursuit of tug of war. I’d donned climbing boots to ensure good purchase on the grass of Glen Eyre Hall and joined in - giving that rope my all. The other team started to win us over. I twisted to dig in deeper. There was a horrible snap in my right knee and I fell to the ground in great pain. My moronic teammates shouted at me to get up. I was in agony, under their feet. I dragged myself clear. I can’t remember who won now but the teams dispersed and I was still on the ground. I couldn’t put any weight on my leg and the knee was swelling fast. I hopped back to my room.

I’d ruptured my right anterior cruciate ligament and was on crutches for a while, but life went on and I was due to fly out to Kathmandu for a month of trekking with S. This proved to be the perfect rehab programme and I didn’t think much more about the injury. The knee stayed stable for nearly 20 years, my quads kept toned by lots of mountain walking during the six years we lived in Nepal. Then a while after leaving the Himalayas and settling back in the flatlands of East Anglia I had a series of twisting episodes (two on a tennis court, one running for a ball over tussocky ground) where the knee gave way, I found myself on the ground again in pain, and then on crutches for a few days.

It was time to let an orthopaedic surgeon have a look. I had an area of bare bone on the surface of the thigh bone which should have been dressed in nice hard smooth slippery cartilage. The surgeon spoke of the knee replacement I’d need in the future. He seemed a bit reluctant to do much in a woman of my advancing age (even though he didn't exactly say this, of course) but agreed to reconstruct the cruciate ligament, which improved my knee greatly. I continued my pretty active life with plenty of cycling and some rowing but slowly the pain crept back.

STEM CELL TREATMENT
Increasingly this stopped me doing things so I went to discuss my options with another orthopaedic surgeon: Mr Bajwa at the Spire in Cambridge. He said stem cell treatment came with 80% chance of improving my symptoms and a 5% chance of making things worse. I decided to go for it, thinking if this delays a knee replacement then that's got to be a good outcome. In the lead up to the op, I did a week or so of 'prehab' exercises strengthening my quads and this proved a good investment of effort.

The procedure involved a long anaesthetic – I believe 90 mins was mentioned – when bone marrow is sucked out of the knee-end of the femur, spun down in a centrifuge to remove cells and 25ml of the resulting serum injected back into the knee joint. While this was being prepared, the surgeon tidied up the knee arthroscopically and traumatised the area of bare bone so that the stem cells would recognise the area that needed to be colonised. And as the stem cells have the potential to turn into any kind of tissue they were expected to repopulate my bare bone with nice hard slidy hyaline cartilage. I was encouraged to take glucosamine supplements to aid repair (although I'm not sure there is any evidence it helps).

THE FIRST MONTH POST OP
I stomped around – partially weight-bearing – on crutches for a month post op. with very little pain or swelling. The two wounds - one on each side of the knee - were tiny as you can see from the photos below. I wondered how necessary a whole month off work would be, but it gave me time to focus on rehab exercises.
 

SIX WEEKS ONWARDS
The rehab scheme went very well with swimming (breast-stroke is forbidden), cycling and the physiotherapist's programme, and from about six weeks during the day I have been wearing a substantial leg brace reminiscent of Robocop. This presented some difficulties in the wardrobe department as tights can't be worn underneath and snug trousers don't fit over the top. It is winter and I ride my bike to work and on my GP visits, etc. Brrrr....

I’m expected to wear this sexy accessory for six months minimum, but it is flexible and I am able to do most of the slightly deranged things I like to do – with the exception of rowing. It did though cause some consternation at Security at Stansted Airport. One challenge with it is that I can't adjust or remove it without dropping my trousers so it was good that the nice security people allowed me to retire to a cubicle for that.

The innards of the brace stick firmly to the skin so need washing and drying: a hair-dryer is recommended but I don't own one. Rolling the fabic parts in a towel helps speed the drying process. The brace can rub and irritate. I've certainly had some contact dermatitis and even broken skin. However it is very effective at protecting the knee and takes a lot of the load off. Because of that it is difficult to know yet (at four months) how successful the procedure has been. Even so I thought that sharing my progress might be of interest to others who are considering this procedure, especially others of a certain age who don't like acting their age. I’ll post more notes on progress as it happens….
 

Nearly 18 months post op I have come to the conclusion that my stem cell treatment has made very little impact on my knee. There was perhaps some improvement initially but I suspect that this was due to rest, good physiotherapy and being able to protect the knee with the brace. Certainly the knee has been painful again this winter and it doesn't feel as if I have grown any new cartilage. What I do need to do is remember to wear the brace whenever I'm doing any serious walking.
Posted: 17/03/2016 10:41:35 by Global Administrator | with 0 comments



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