It's the 3am pain that's finished me, not the walking. Is losing your sleep a good enough reason to ask about a replacement?

Writing this at nearly eleven at night because I know roughly what's coming at three and I've stopped pretending otherwise.

Here's my problem with my own case. On paper I'm doing well. I still lead the group walks, flat routes, poles, and on a good day I'll do four miles and be fine. If a surgeon asks me how far I can walk I'll give him an answer that makes me sound like I'm coping.

What he won't see is that I've been sleeping in the spare room since March, that I've got a pillow arrangement that takes ten minutes to build, and that most nights the knee wakes me somewhere between two and four and I read until it settles. My husband has started leaving the landing light on for me. I'm tired in a way I can't explain to people, and it's the tiredness that's making me think about surgery, not the knee.

Does that count? I feel like turning up and saying "I can walk four miles but I can't sleep" is going to get me sent home.

It counts. I don't know anything but I know that much. Being awake at three every night would break anyone, and the knee is the reason, so it's the knee's problem not a sleep problem.

Sue, night pain was the exact thing that got me taken seriously, and I nearly didn't mention it because I thought it was beside the point.

I did the same as you, gave a good account of my walking, listed what I could still do, presented myself as coping. My daughter came with me to the second appointment and said the thing I wouldn't, which was that I hadn't slept a full night since the previous summer. The conversation changed in that room. Not because he pitied me, but because it told him something about the joint he wasn't getting from my brave answers.

The spare room and the pillow architecture, I had all of that too. Two pillows lengthways and one under the calf. I could build it in the dark by the end.

Yes, it counts, and I would put it more strongly than that: pain that consistently wakes you is one of the more informative things you can tell a surgeon, and it is routinely under-reported in clinic.

The reason is that daytime pain is heavily confounded by what you choose to do. Someone who has quietly reorganised their whole life around a knee, flat routes, poles, no standing about, can arrive with a walking distance that sounds reassuring, because they have engineered their day so the knee never has to do the thing that hurts. Night pain is much harder to adapt your way around. Pain at rest, pain that wakes you, and pain that persists once you are still are all part of how the severity of a joint is judged, alongside function, response to previous treatment and the imaging. So the sentence you are worried sounds trivial, that you walk well but cannot sleep, is genuinely useful clinical information rather than a complaint.

Some practical framing rather than advice, because your own team has to make the call on your knee. Be specific instead of general: how many nights a week it wakes you, roughly what time, how long you are awake, what you have already tried, whether the position matters and whether you have moved rooms. Six months of broken sleep described in those terms lands very differently from "it's bad at night". If you keep a note for a fortnight before the appointment, you have something better than memory to hand over, and memory is unreliable at exactly the moment you need it. It is also worth saying explicitly what the tiredness has cost, because the effect of chronic poor sleep on mood, on pain tolerance and on what you can face doing is substantial and it is part of the picture.

What I would not do is let the good walking distance argue you out of the appointment. The site's guide to the signs that point toward a knee replacement is built around function and pain rather than the X-ray alone, and night pain sits squarely in it. Whether it is time for your knee needs an examination, your imaging and your history in one room, which is precisely what the appointment is for.

The bit about engineering your day is uncomfortably accurate. I gave a surgeon a walking distance once that was technically true and completely misleading, because I'd have needed the rest of the afternoon sitting down afterwards and I didn't mention that part.

Sue, for what it's worth the night pain is what tipped me into pushing for a second opinion after being told my scan wasn't bad enough. It's the one symptom I could describe without sounding like I was exaggerating, because the number of hours is the number of hours.

Mine is booked for August. Whatever happens, going in with the sleep written down is the thing I'd do again.

Referral is in. GP appointment took nine minutes and about six of them were me reading out the fortnight of notes, which I would not have had if this thread hadn't told me to keep them.

Five or six nights a week, usually between two and four, awake for an hour and a bit, spare room since March. Written down like that even I could hear it, and I've been living in it. She didn't hesitate.

No idea what the surgeon will say and I'm not assuming anything. But I've stopped treating the sleep as a separate thing I ought to be tougher about, which is the change this thread actually made.