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 is walking for at least half an hour a day, going to aqua-aerobics once a week and does an hour of daily 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 that wraps round the end of bones wears away, leading the bones to rub together where they meet in the joint.
What has proved so transformative for Christopher was a knee replacement operation, which involved cutting out his diseased left knee joint and replacing it with a plastic and metal one.
But just as crucial as the surgeon’s skill has been the rehabilitation exercises he has stuck at since.
Christopher, who had his knee replacement on the NHS in May, opted to pay to spend a month at a private rehabilitation centre after 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 that wraps round the end of bones wears away, leading the bones to rub together where they meet in the joint
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 total is that whereas, back in February, he was struggling to get up the stairs of his two-storey home, Christopher is now fit enough to put in an energetic turn as Dame Trot in the pantomime Jack And The Beanstalk at the Orchard Theatre in Dartford, Kent, in December.
Yet not everyone finds their joint replacement is such a success. Pre-pandemic, around 108,000 people a year in the UK underwent knee replacement surgery.
It is normal to have pain and discomfort for about six months after knee surgery. 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.
While there can be various reasons for this, experts say one common factor is that some patients fail to grasp that the rehab process (repetitive physiotherapy exercises and a gradual increase in movement), although lengthy and gruelling, is vital for the surgery to succeed.
‘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 fit enough to put in an energetic turn as Dame Trot in the pantomime Jack And The Beanstalk at the Orchard Theatre in Dartford, 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.
Under NHS guidelines issued last year by the National Institute for Health and Care Excellence (NICE), most hip and knee replacement patients are encouraged to follow the enhanced recovery programme, a plan drawn up by physiotherapists that aims to get them walking and moving 12 to 18 hours after their operation and home within 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.
Indeed, given the transformative results that rehabilitation can offer, some experts believe these services are undervalued.
‘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.’
There are other factors, besides rehabilitation, that influence the strength of recovery after 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.’
As Good Health has previously reported, the issue for many is getting surgery in the first place.
‘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 testimony to 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.’
n Additional reporting: JUDITH KEELING.