At the age of 72, actor Christopher Biggins says he has never done so much exercise as he has over the past five months — and he isn’t entirely joking.
He walks at least half an hours per day, does aqua-aerobics every other week, and does a daily hour of physio exercises.
Yet earlier this year his knees — his left in particular — had become so stiff and painful that he needed the help of sticks to get about and was ‘wincing’ in pain.
‘I also had to rely on an electric tilting chair to propel me upwards — I struggled to get out of other chairs, which was quite frustrating,’ says Christopher, who lives in East London with civil partner Neil Sinclair, 58, a former air steward.
Earlier this year his knees — his left in particular — had become so stiff and painful that he needed the help of sticks to get about and was ‘wincing’ in pain
The problem was osteoarthritis — so-called wear-and-tear arthritis — which affects around eight million people in the UK. It occurs when the cushioning cartilage at the ends of bones wears away, causing the bones and joints to rub together.
Christopher’s knee replacement surgery was what proved to be so transformative. It involved removing his left knee joint due to disease and replacing it with a metal and plastic one.
But just as crucial as the surgeon’s skill has been the rehabilitation exercises he has stuck at since.
Christopher, who had a knee replacement on May 1st, chose to pay to spend a full month in a private rehabilitation centre following the surgery.
‘Everyone told me that post-op exercise is vital to build up the muscle to support the new knee,’ he says. ‘But I knew I would need the discipline of someone telling me to do the work, as I’m not a natural exerciser.’
The problem was osteoarthritis — so-called wear-and-tear arthritis — which affects around eight million people in the UK. It occurs when the cushioning cartilage which wraps around the bones’ ends wears away, leading to the bones rubbing together at the joints.
Having been on the waiting list for the operation since the end of 2019 (it wasn’t just Covid delays, he also needed heart surgery to repair a diseased valve last October), he also felt it would be ‘a shame to wait this long for a new knee for it not to work’.
‘In hospital I was essentially just left in the bed,’ he says. ‘But at the rehabilitation centre, the Lynden Hill Clinic near Reading, I had an hour of physiotherapy a day; they were getting me to try stairs within days of arriving and they iced the knee four or five times a day to get the post-operative swelling down.
‘It sounds intense, but it worked. I’m now going up and down the stairs like greased lightning!’
He’s also had hydrotherapy — exercises performed in water.
‘My NHS consultant referred me for that,’ says Christopher. ‘It took a while to get the appointment, but it’s a good way to get the knee moving without putting too much pressure on it.’
The sum is that, whereas he struggled to climb the stairs of his two-storey home in February, Christopher is now strong enough to play the energetic role of Dame Trot at Jack And The Beanstalk at Dartford’s Orchard Theatre in Dartford in Kent in December.
However, not everyone finds joint replacement so successful. In the UK, approximately 108,000 people had knee replacement surgery before the pandemic.
It is normal for knee surgery patients to experience pain and discomfort for six months. But some research, such as a paper in the journal EFORT Open Reviews in 2018, found 20 per cent still suffer pain for longer — and other research has found 10 per cent of the 102,000 patients a year who have a hip replacement do, too.
Experts say there are many reasons this might happen, but one factor that is common is that patients fail to understand that the rehabilitation process (repetitive physical therapy exercises and a gradual increase of movement) is crucial for the success of the surgery.
‘Total hip and knee replacement operations are among the most successful surgical procedures, offering excellent relief from pain, often meaning the end to living with agonising osteoarthritis,’ says Professor John Skinner, a consultant orthopaedic surgeon at the Royal National Orthopaedic Hospital in Stanmore, Middlesex.
‘However, receiving good post-operative rehabilitation therapy can be crucial to a successful outcome.’
Christopher is now healthy enough to perform an energetic role as Dame Trot in Jack And The Beanstalk, a pantomime at the Orchard Theatre Dartford in Kent in December
Research shows the sooner you begin rehabilitation and physiotherapy exercises after any major operation — within hours rather than days — the better your chances of returning to normal daily activities.
Tim Allardyce, a physiotherapist at Surrey Physio, adds: ‘There is plenty of research to show the longer someone is bedbound, the more muscle atrophy [wasting] or loss of muscle mass they experience — meaning their muscles are weaker and their joints are stiffer and more painful.
‘Gentle exercise reduces inflammation by dispersing the fluid that collects around the joints, which causes swelling — making it easier to move.’
Rehabilitation also gradually improves the new joint’s range of movement using graded exercises and, in the long term, builds up strength in the surrounding muscles.
The National Institute for Health and Care Excellence, NICE, has issued guidelines to encourage hip and knee replacement patients to follow the enhanced healing program. This is a plan that physiotherapists have created to help them get walking and moving in the first 12-18 hours after the operation and to return home in the next four days.
Patients are assessed by a physiotherapist in hospital and given gentle exercises to repeat to ensure they are capable of performing basic everyday movements — such as walking down a corridor, going up and down stairs and getting in and out of a chair — before they go home. In Christopher’s experience, this amounted to a visit from the physiotherapists the day after his surgery and being given a leaflet ‘about the exercises I should be doing and when’, he says.
Experts believe that rehabilitation is undervalued due to the transformative effects it can provide.
‘Rehab services in the UK are really stretched,’ says Dr Benjamin Ellis, a consultant rheumatologist at Imperial College Healthcare NHS Trust in London. ‘If we really want to give people the best possible chance to recover from surgery or injuries, then we need to invest in these services more. There’s no reason that some of this could not be offered, properly supervised, at local gyms, for instance.’
Other factors than rehabilitation can also influence the strength and speed of recovery following a joint replacement.
‘We know that being in chronic pain can cause the brain to rewire itself,’ adds Dr Ellis, who is also senior clinical policy adviser with the charity Versus Arthritis. ‘These changes are usually reversed after surgery in most people. But in some, the pain mechanism app-ears to get stuck in the “on” position, meaning they continue to have pain even though the affected joint has been replaced and is no longer triggering pain.’
Good Health previously reported that many people have difficulty getting surgery.
‘Around 40 per cent of hospitals are still not doing elective hip and knee replacement operations to the same extent they were before Covid,’ says Professor Skinner. ‘Many patients all over the country have waited a year for knee and hip operations, and some two years.
‘The pressures of cancer and heart surgery have been a priority, and while that may be right, we must not forget that orthopaedic patients are in daily pain, often disabled, and need to regain a quality of life urgently, too. Joint replacement operations can transform lives.’
Christopher is living proof of that.
‘I have been going to the theatre, restaurants and meeting friends,’ he says. ‘I have even driven the car, which I had not been able to do for some time before.
‘I don’t think I have ever been as active as I am right now and being able to walk up and down the stairs or to the shops without that awful pain is fantastic.
‘My advice to anyone having a knee replacement is you can’t just sit at home and put up your feet in front of the TV — you have to work at recovery after your operation. If you don’t, you are doomed.’
JUDITH KEELING.