Knee Arthroscopy in Algeria
On 11th September 2006, Allmuth Bourenane read my knee arthroscopy story and contacted me. She was also wondering about having an arthroscopy overseas due to the long NHS waiting list. She has since had a knee operation in Algeria and has written about it to share her story for the benefit of others.
Please do read this story - there are some valuable lessons here if you are going for an arthroscopy…
Allmuth’s Story
The accident
11 September 2006
Three weeks ago on holiday in Algeria, I jumped off a rock (3 foot high) onto the beach and hurt my knee. It was agony and felt like it was set in concrete and I can’t bend it. I paid to see a doctor in Algeria (privately) and 3 days later I had an Echography (£10), an MRI scan (£80) and saw a sports injury professor (£5) who told me that I will need to have Arthroscopic surgery. He said "if you stay for one week, I can fix your knee". I didn't have the surgery as I had to travel back to the UK the next day.
I've seen my GP and asked to be referred for a second opinion but even when paying for a private appointment, I need to wait 6 weeks. Heaven knows how long it would take on the NHS. I'm thinking of going back to have the operation in Algeria. I do kung fu & kickboxing and I'm very worried that I will have to give them up because of this new injury. I injured my knee once before – in October 2004 in a competition in the UK. After that injury, I saw a specialist and was told to go home, no exercise and take Paracetamol. In the end I had 10 private osteopath sessions (£30 for ½ hour) and was better within 5 months (although the damage had not been severe).
If I choose the British system, I will either have to pay a fortune to have private healthcare or I will have to wait perhaps 6 months for free treatment on the NHS. I'm a bit worried after reading Jakes story, not about the operation but the recovery. He seems to have had a few problems. By waiting for months, my knee will become weaker and weaker and the recovery will take longer and longer. I'm very worried that I will have to give up my fu & kickboxing, but even worse I also have problems driving now and I need to be able to drive to get to work. I hope to decide what to do this week.
Decision to operate in Algeria
20 September 2006
I have been surfing the Internet for info for the past weeks to find out as much as possible about my problem. I have no illusions, I know that I might not be able to carry on with my sport after the OP as I'm not a spring chicken anymore. My main goal is to walk properly again. Last night I had a call from our contact in Algeria. He's found a top surgeon who is specialised in knee surgery and he has agreed to do mine.
When I get there he will do a consultation / formalities and the following day the Operation as an outpatient. I have to stay 10 days as he will have to see me twice afterwards. He also reminded me again that I shouldn't do any exercise now and I must rest the leg as much as possible. But as a mother, wife, fulltime engineer and sportsperson, I'm too active to sit around all the time. You would have to put me in full body plaster!
At the moment, I'm constantly wearing a big Neoprene knee strap and I'm walking with one crutch (2 for longer distances) to keep some weight off my knee. I have to wear the strap at night too because I once accidentally bent my leg in my sleep and it almost hurt as much as when the accident happened.
As far as I can see I haven't lost much muscle yet. I try to rest the leg. I have a stool to prop it up on when I am at work and housework takes a bit longer. I have tried to do a few exercises but my knee keeps swelling up afterwards, so I stopped. I don't want to do more damage. A bit of walking has to be enough exercise for now.
If everything goes to plan I should be going to Algeria on the 3rd October.
I was also going to see the specialist here in the UK but I have now cancelled the appointment. It takes to long before I see him and I think it’s a waist of money (£100) as I have now decided to go to Algeria for the operation.
The knee operation
6 October 2006
I’m now in Algeria.
The clinic did all the pre-op tests on the 7th and the operation was on the 10th. I had the choice between an epidural or general anaesthetic. I opted for the general as the epidural involved a huge needle (I hate needles).
When I came round they told me: good news we have repaired the damage, bad news we had to open the knee and more bad news you are not allowed to travel for a minimum of 3 weeks. As I had an open ticket, I was able to change the return from the 15th October to the 5th November.
They wanted to do the surgery using Arthroscopy but realised there was too much damage and it was better to do open knee surgery. I had severe damage to the cruciate ligaments behind the kneecap. I had to have cruciate ligament reconstruction (I now have 2 screws in the knee) and I had to stay overnight in hospital. The worst was that I wasn't allowed to get up as I was on a drip and had a drain in my knee. I have never used a bed-pan before and having 2 nurses standing next to the bed waiting didn't help. I can't go when I have spectators!
My leg hurts a lot, thank god for the painkillers.
My leg was put in a huge brace (ankle to hip) with 4 steel bars to keep it straight and I have to use crutches. I have to wear this brace for 45 days (until 25th November) only taking it off to do the physiotherapy and to have a shower. I started the physio 4 days after the operation and the physio told me he would be bending the leg within 3 weeks to 90 degrees. It was very painful but he did it.
My operation report stated ACL and "rotular tendon graft". I have since learned more about the ACL but "rotular tendon graft" must have a specific medical name too, as I can't find anything under that description. ACL is normally done by keyhole surgery (Arthroscopy) so I assume it was the "rotular tendon graft" that required the knee to be opened. An ACL repair was explained as:
A complete or partial tear of the ACL usually occurs when your knee is twisted beyond its normal range of motion or from a direct frontal blow to the femur. This is the most common ligament tear especially during athletic activities such as skiing, soccer and football. It is one of the most common knee injuries in female athletes. After an ACL injury the knee can easily buckle as the tibia shifts forward.
I can tell you that the private service in Algeria was fantastic. In hospital they where very nice and explained everything very well.
When I left hospital I stayed with my parents-in-law. For the next 5 days I had a nurse coming to the house to give me 2 injections in the morning and 1 in the evening. For a further 5 days, she came in the morning to give me 1 injection. I never had so many injections in my life - I don't think they like tablets in Algeria much but I had to take a lot of them too! Another person came every 3 days to change the bandage and the physiotherapist came to the house every 2 to 3 days.
My leg still hurts a lot. I couldn't put it down for long.
I didn't leave the house for the first 2 weeks as the medication made me quite dizzy, but after that I took regular short walks. The surgeon came to the house twice to check my progress. He was very happy and flattered that as a German living in England I had decided to come to Algeria to have my knee fixed. I'm not allowed to do any sport for the next 6-8 months but he assured me that I will make a full recovery and that by end of 2007 I will be fighting again. He has given me his e-mail and telephone number, as he would like to know how I'm progressing and to give me advice if needed. He is very down to earth and friendly, unlike some doctors who can be unapproachable.
On his second visit he brought his wife with him, she's a plastic surgeon. It was funny; she likes checking out his work, especially on woman and told me that for an orthopaedic surgeon he had done me a nice scar. It's 3.5″ long and going diagonal across the kneecap. It was stitched in a way that there is no visible stitching and should fade away nicely.
Operation recovery
5 November 2006
So far, my recovery is going well although my progress since returning to the UK has slowed because I am still waiting to see the NHS physio. I have had a few private sessions with my osteopath so I'm not getting too far behind. Travelling back to the UK aggravated the knee and I still have a lot of bruising on the back of my leg.
I have to do exercises every day and I'm working hard to strengthen the muscles. I have so far lost 1 inch on the upper thigh and I'm trying not to lose anymore.
I'm now back at work (getting a lift every morning from the boss) as there is only so much daytime TV I can stomach. At least I can do something productive here; at home I'm still handicapped with the brace and the crutches. It is very annoying when you can't carry anything and the crutches are always in the way. But I manage and it's only another week until I can get rid of them.
I spoke to the surgeon 2 days ago and he was unimpressed with the physiotherapy I am receiving from the NHS. I am topping up the NHS physio with private physio sessions, which cost £30 a session. I wished I could have stayed longer in Algeria as treatment was far cheaper. However, while it is cheap to me, the same amount of money is unaffordable to most Algerians - the average income is only £100 a month.
The operation, brace, medication and all the aftercare with nurse, changing bandages and physiotherapy came to less than £800. My return flight cost £350.
Altogether I am very happy I had the operation in Algeria and I would not hesitate to go there again. It did help me that we had 6 doctors in our immediate family, each with links to other doctors.
The surgeon was Dr. Ahmed Zemmouri and the hospital is:
CLINIC DIAR SAADA
General Practitioner, General Surgery, Ophthalmology, Gynaecology
100 Chemin Abdelkader El-Mouradia
Alger, Algeria
Phone: 021.69.87.11-021.69.87.44
Fax: 021.69.87.61(English spoken and understood)
Please note that the price I paid might not reflect the true cost because if you know somebody you nearly always get a special rate.
29 November 2006
Last Friday evening (24th November), after talking to the surgeon, I took the brace off. I relayed to him that the physiotherapist in the UK wanted to wean me of the brace slowly, but he said 45 days is enough for the knee to heal completely (he usually gives his patients only 30 days, he gave me the maximum just to make sure). He said I could use one crutch for a few days, but no more brace.
Every time I came out of the brace my knee was so stiff that I could barely bend to 50 degrees. He said, as I'm behind with bending, I should now have aggressive physio.
Well the physiotherapist had a shock when I walked in on Monday without brace and crutches. I have ruined her program.
Over the last weekend I have worked hard and I could bend to 88 degrees. For now, the physiotherapist is just giving me more balancing and stepping exercises. My husband has brought me some bike pedals, which I'm using 2-3 times a day. As the NHS physio is not enough, I am still booking extra appointments with my osteopath.
Recovery continues slowly
11 December 2006
I am still having problems bending my knee to 90 degrees and I can't shift the inflammation above the knee. I went swimming for the first time on Saturday; well sort of swimming. It felt good in the water but I was in a lot of pain afterwards. And I still can’t drive, as I’m not able to do an emergency stop.
The NHS physiotherapist is not doing much, just working on getting the muscles back. The only bending I do is at the private sessions with the osteopath and with my husband every night.
I'm really trying, but its just not working. It feel wrong, I’m sure there is something wrong!
So I'm going back to Algeria on 22 December to see the surgeon and to get some proper physiotherapy. The surgeon said that he would check the knee, arrange a week of intensive physio for me and give me a program to take to the NHS physiotherapist when I return to the UK.
22 December 2006
As I told you I flew out to Algeria on the 22.December 2006 for one week. In the morning of the same day I finally had my appointment with the British specialist. I had been waiting to see him since my return to the UK beginning of November.
I thought the specialist I had seen 2 years ago was bad, but this one was even worse. When he came into the room the first thing he said was:
"You had your operation in Algeria?"
I said yes and I explained to him why. He didn’t look happy.
His examination, well he didn’t even touch my leg, consisted of:
“How far you can bend it?”
I couldn’t even bend 90 degrees.
“Can you straighten it ?”
No, not fully, again I tried and managed to about 10 degrees. He then used 2 fingers to squeeze my upper thigh and said:
"You have no muscles. What do you want me to do? You want me to keep treating you?"
I said: "Yes!" His reply was:
"I see you in 6 weeks"
I was so shocked by this consultation I didn’t even know what to say. I was really angry about the way he talked to me.
That afternoon I flew out to Algeria and I had physio the next day.
The physio was not impressed when I told him what exercises I had been given in the UK and he told me that I was really behind with my recovery. He first cooled down the knee, then used Ultrasound (in the UK they told me that they couldn’t use it because of the screws), then massaged the thigh (in the UK they told me the muscles should work without being softened) and got the kneecap working. He then put me on my front and strapped me down to the table and bend my leg toward my back. Before he even got to 90deg I screamed the place down.
He was shocked that I had so much pain. The same happened the next day and I even tried to hit him this time because the pain was so bad.
The following day I had an appointment with the surgeon. He also was shocked that I couldn’t bend or straighten the leg enough and that I had so much pain. I explained about the physio in the UK and he wasn’t impressed either. He send me for X-rays and after seeing them he said that from the position of the screws there should be no problem but he strongly suggested to do an Arthroscopy to check internal.
Second arthroscopy
27 December 2006
So on the 27 December I underwent an Arthroscopy under full anaesthetic. I wanted to have an epidural as the surgeon wanted to show me the repair on screen, but as soon the anasthesist came with the needle I nearly passed out, so he said that there was no way he could do that to me.
Let me tell you that the anasthesist only came to work for my operation. He had injured his neck and was wearing a collar and was actually on sick leave. But as he was my anasthesist at the first OP and I trusted him, and he knew how scared I was, he insisted to be there.
After the operation the surgeon told me that the repair was perfect and he wished he could have shown me on screen but that I had developed adhesions due to the lack of appropriate physio.
Due to the UK physio not physically bending my leg and not enough physio, some of the tendons and muscles had fused to the bone above the knee and that’s why I had so much pain now.
He had freed up as much as he could but he strongly suggested that I stay longer than the week that I had planned and that I undergo an aggressive physio program now to free the rest and get back on track.
I was in hospital for 8am, had the operation at 11.30am and I left at 4pm using one crutch (only for one day) with a painfree knee and started physio the following day.
Physio consisted again of cooling down the knee, then Ultrasound, then massage of the upper tight muscles and getting the kneecap working. Then he put me on my back and strapped my leg to 90deg and suspended weights (first 1kg going up to 15kg towards the end of my time in Algeria) on my foot to pull it down. It was less painful then before but it still brought tears to my eyes. Straightening the leg was equally painful. Afterwards I had to sit up on the edge of the bench and lift weights with the leg starting with 5kg going up to 9kg towards the end my time in Algeria. Then I had to spend 5 to 10 minutes on a wobbly board.
Each session took between 1 ¼ hour to 2 hours and for the next 2 months I had physio 5 to 6 times a week. As I was still in a lot of pain after a week the surgeon put me on morphine for the next 4 weeks. It helped to take the edge of the worst pain, but I still tried to hit the physio another few times. I felt bad about that but he said I wasn’t the first one who tried that. Anyway he was just doing his job.
I can only very highly recommend this physio terapist:
Hakim Oussedik
Masseur Kinesitherapeute
Rue des Sports Bt A
Les Annassers
Alger
Algiers
Every couple of weeks I had a check-up by the surgeon and he was very happy with my progress. By the end of my treatment I was able to straighten the leg 0 deg and bend to 140 deg without pain.
In total the private Arthroscopy cost me about £250 and the private physio another £250 (that’s for the 8 weeks). I calculated that if I had the same amount of private physio in the UK it would have cost me around £800 a week and I wouldn’t have been able to afford that.
The surgeon gave me a report to take back, stating that due to complications because of "inadequate physio" he had to perform the Arthroscopy.
23 February 2007
I’m now back in the UK and I’m doing my physio with the help of my husband daily at home.
26 February 2007
I did go back to the NHS physio department and showed them the report. Their response was:
- the surgeon must have buggert up the first operation
- there is no proven benefit in the physio treatment I had in Algeria
- I should have worked harder on the exercises they had given me
- my husband should have not tried to help me with the physio, like bending my leg
- if I had not been happy with the physio program I should have gone private in the first place
Well, as stated, my knee is working perfect now and I just have to build up the muscle, but I said that I will stop treatment there and ask her for the address where I could log a complaint. Not about the physio in person but about the physio treatment they give.
I have also seen my GP and told him this story. He was shocked and very sorry about the way I was treated here in the UK.
I know that there are bad and good doctors/physio everywhere and I was unlucky to meet some of them. I’m now waiting to see the specialist here on the 9th of March. Lets see how he is going to treat me this time.
9 March 2007
I have now seen the specialist, I’m not sure if it was the same guy. Well, I know it was the same guy, but what a change! He was actually friendly.
He read the report without any comment and he conducted a detailed examination resulting in him saying that he was very happy with what the surgeon and physio had done in Algeria.
He just said that it would take about another 3 months to regain the lost muscle mass.
I didn’t know what to say. I had gone in there ready to give him a piece of my mind for the way he had conducted the first appointment, but this U-turn of attitude took me by surprise.
Maybe the physio or the GP had told him that I was thinking of logging a complaint
I’m still very angry about the way he treated me at the first appointment and I’m still thinking about a complaint against both the physio and him. I’ll have to think about it, I feel a bit drained.
It’s the principle. He should have been happy that I went private and didn’t rely on the NHS and it doesn’t matter where I go private as long it is done correctly. And he did admit that they had done a good job in Algeria.
I did what was best for me. What good is it when I can’t walk properly or drive to work.
The 8 weeks away have not been easy and would have been unnecessary if I had received the right treatment. I stayed with my husbands family and everyone was very nice and looked very well after me, but I missed my son and husband very much. I also felt really bad that I had to let people down at work.
I’m now going swimming twice a week and walking a lot to strengthen the leg. Also still do bending exercises every night to keep the knee flexible.
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