Amputation Left Above-Knee Amputation, 22 April 2025

[WFD]

Week 2 Update -

My range of motion has improved slightly, to 80° cold, measured in the morning before I start my exercises.

My surgical knee is typically 1-2°F warmer than the other first thing in the morning. After exercises, etc., it will often spike to more than a 12°F difference if I don't keep icing on a schedule. A hot knee is often taken to be the sign of the runaway inflammation that causes scar tissue growth so it is important to keep the knee temperature down. Icing 20 on / 40 off will usually keep the difference below 4°F during the day.

It is too early to tell, but it seems as if the swelling might be starting to decrease. That would be great, as the swelling is what is keeping me from developing greater RoM.

For this week, the plan is the same except for:

1) No longer confined to the second floor. I can have meals with the rest of the family and play with the dogs.
2) No longer using a cane to walk (I could walk fine from day zero, but used crutches and a cane to limit stress on the knee.)
3) I will use a cane on stairs, this week at least, to limit stress on the knee.
4) I will add the exercise bike at zero resistance to each 'cycle' of exercises. I will start at 30 seconds and gradually increase it as long as there is no increase in swelling or knee temperature.
5) I will resume upper body weightlifting this week as long as it likewise doesn't bother my knee.

 

[sistersinhim]

That much increase in your knee's temperature is telling you that it's not happy with what you are doing to it. You don't want to keep getting hot like that. A hot, dry knee is more likely to develop adhesion than a warm moist knee will. Gentle movements are all you need to do to rehab that knee. Remember you're not in training, you're in healing!

 

[hemaknee]

Good evening WFD! Thank you for your posting and information. I just heard back from the doctor I will need a LOA/MUA. Surgery is set for Friday. I asked about the CPM machine, which he is not in favor of. It makes me nervous to see how meticulous you have been on your measuring and calculations in your recovery. I'm afraid I won't be as diligent. Would you be willing to share some type of chart or weekly agenda? How do you measure your knee ROM and temperature?

Thanks for any suggestions,
Hemaknee

 

[WFD]

Hi @hemaknee ,

Regarding the CPM machine - studies show that in the long run it does not give better results for normal TKR patients. Other studies do seem to show a benefit for patients prone to arthrofibrosis, and it does seem to help me - I have pretty severe arthrofibrosis. They are expensive to rent (I ended up buying my own on eBay) and very time consuming - as much as eight hours a day or even more in some cases. The time consumed is a real pain if you actually want to do anything else with your waking hours.

Do you have an exercise bike that you can set to zero resistance? That can give you motion like a CPM machine does, and it is faster. My CPM machine takes about two minutes for each cycle of flexion and contraction, and I have it set to go as fast as it can. In a two hour session that is 60 cycles or repetitions. On an exercise bike at say 30 RPM (which is slow for a bicycle) it only takes two minutes to get 60 repetitions.

For both CPM machines and bicycles, my personal opinion is that they should be sources of motion and not used as stretching machines. The reason is the large number of repetitions involved. If you do 20 minutes on the bike at 30 RPM then you accumulate 600 repetitions of flexion and extension. Would anyone think it advisable to do 600 heel slides in a single session? I sure wouldn't. Given that, my personal opinion is that CPM machines and bicycles should be used to subject the joint to non-stressful motion to prevent scar tissue growth and to move fluid out of the joint.

An example of that is provided by user 'laurie' over at KneeGuru. She had severe arthrofibrosis, treated at the Steadman Clinic in Vail. In her particular case Dr. Steadman had her sleeping in the CPM, which was set for 30-70°, when she had 0-132° RoM. Obviously this is done to provide motion without stressful stretching.

I've attached a blank copy of the chart I use to record my daily measurements, in PDF form, since I don't know if you have Excel.

I also include a picture of the form with the tape measure I use to measure the knee circumference and the IR thermometer I use to measure knee temperature (which I see is on sale on Amazon at the moment for $22.99). If you use an IR thermometer it is important to hold it at a consistent distance from the knee (I use about 12") and to always hit the same spot on the knee (I use dead center on the kneecap).

Happy to answer any other questions you have.

As far as the exercises I do, I've described them above in my thread, but please keep in mind that what works for me may not be appropriate for you. I have a checklist I use to keep me on track with the exercises but I find I have to change them from day to day depending on how my knee feels.

 

[WFD]

...oh, and keep in mind that many here on Bonesmart advocate not measuring things like RoM, to keep from obsessing over it. As an engineer, I'm all about obsessing over the details, but that's just the way I am.

 

[sistersinhim]

Most of us consider function more important than numbers. If what we can do now is much better than what it was before our replacement, then it's successful.

 

[WFD]

End of week 3 Update -

My range of motion has improved slightly again, to 85° cold, measured in the morning before I start my exercises. Swelling and knee temperature have not changed this week.

On most days I am able to complete only three (sometimes two) of the exercise cycles I laid out, before discomfort increases such that it would be unproductive to continue.

This past week I was able to resume upper body lifting without any apparent stress on the knee. I also started including the exercise bike at zero resistance at the end of each cycle, starting at 30 seconds and increasing 5 seconds per day, with likewise no apparent issues.

I had an appointment with my surgeon's PA on Monday. With no improvement in swelling we decided to try one course of a Medrol dosepak, which is a six day course of oral steroids, to try and drive the inflammation and swelling down. I started yesterday, and we will see how it goes this week.

My goal is to get the full 100° flexion that my surgeon achieved during the surgery without triggering the growth of scar tissue, and then maintain this until I am out of the scar tissue danger zone and can start more vigorous stretching to stretch the muscles and connective tissue that shortened due to the limited range of motion I had for the last two years.

This week I will

1) Continue to use a cane on stairs although I don't have to, to limit the stress on my knee.
2) Continue to increase the duration of sessions on the exercise bike by 5 seconds per day.
3) Return to driving to appointments and such, and see how my knee tolerates it.

 

[WFD]

End of week 4 update -

Things were going well and then I had a setback.

For a couple of days I noticed that I was getting sore just below the knee, in a band stretching from side to side. Like a dope I didn't back off the exercises and very early Wednesday morning around 2 AM I woke up in excruciating pain, with sharp pain shooting down the muscle on the outside of the shin and into the ankle.

What I think happened is that I strained some tissue and caused some swelling near the head of the fibula where the peroneal nerve crosses over the bone - it was very sore right in that spot. I think the pressure on the nerve is causing the pain, which is particularly bad in my ankle. These are not zingers - my last open surgery was almost 9 months ago, and this is nothing like the zingers I've had in the past.

I'm treating it with bed rest, ice, elevation, a little bit of motion and an occasional very gentle stretch, but progress is slow. Its kind of discouraging - this surgery is my last chance to restore my knee to something like normal function, and I probably will lose two weeks or more to this problem. I can't do much in the way of stretches or exercises and so naturally I worry about the scar tissue growing again unimpeded.

 

[sistersinhim]

I'm treating it with bed rest, ice, elevation, a little bit of motion and an occasional very gentle stretch, but progress is slow.

These ate the exact things you should be doing. Don't try and rush it, you'll only extend the inflammation.

 

[Jockette]

so naturally I worry about the scar tissue growing again unimpeded.

To quote one of our retired staff members, scar tissue is not just waiting to pounce on you if you don’t exercise enough. The best way to create adhesions is to keep doing exercises on a painful, inflamed leg.

You are very wise to cut back and rest it so it can heal. You are just a month out of this recent surgery and you’ve been very wise with this recovery. I’m sure you are moving about your house and even going some places, which will give your knee all the healing mobility it needs at this early stage. Well done!

 

[WFD]

I am extremely prone to development of massive amount of scar tissue, as the results of my last three surgeries have shown. Two of my surgeons have said that I had as much scar tissue as they had ever seen.

Assuming that the “scar tissue is just waiting to pounce” is in fact my assumption and the guiding principle behind my rehabilitation, and I think my only chance to get through this successfully and have some level of normal function.

 

[hemaknee]

Hello WFD,

I'm sorry you've had a set back. That is very frustrating.

Thank you for your chart and pictures of the equipment that you use. I appreciate you sharing your progress and story.

I just had my LOA and MUA, 3 days and a week ago. The first few days I had better range and the knee tissue felt soft. I could not get full range of motion due to my quad was so sore and couldn't stretch the muscle to bend the knee.

Now, today, the range and walking feels just like it did before I went into surgery. I still can't pedal a bike. However, I do notice I can move my knee cap more. Everyday, I feel like the tissue gets harder to move around the knee cap. Is this something you experienced in the past, too?

 

[WFD]

Now, today, the range and walking feels just like it did before I went into surgery. I still can't pedal a bike. However, I do notice I can move my knee cap more. Everyday, I feel like the tissue gets harder to move around the knee cap. Is this something you experienced in the past, too?

My experience is very similar. I believe that right now my flexion is limited by swelling not scar tissue, whereas before the surgery it was scar tissue that was the limit. Mature scar tissue is something you cannot do anything about (except surgery) but I hope that the current swelling will go away, giving me more bend. Time will tell.

Part of my exercise routing includes Patellar Mobilizations, for 5 minutes up to six times a day. The idea is to keep the patella mobile so it doesn't get scarred down. Dr. Peter Millet, well known for his work with arthrofibrosis, emphasizes this as an important exercise. This surgery is the first time I have done them so I don't yet know whether it will help me. So far, the trend is not good - I'm not improving - but then the swelling is not going down either, so hopefully that is the cause and can be remedied.

 

[hemaknee]

Also, WFD,

Did you seek out an arthrofibrosis doctor? Was your surgery done by the arthrofibrosis doctor?

 

[hemaknee]

Sorry, I didn't refresh and I now I see your response. Thanks you!
I do hope the swelling goes down and it improves for you. You definitely been through a lot!

It's so hard to know what to do. There are so much information and yet, it seems, nothing seems to help. Patience is what I keep hearing. It's hard when all you want to do is just go!

Sending prayers for you!

 

[WFD]

End of week 5 update -

So the setback I had is mostly resolved. I'm not bedridden anymore, and can do some exercises, though I have had to back off some or the problem flares up.

My flexion was 80-85° before the setback, and is now running 75° or so - I'm disappointed that I am not making progress. The swelling and the heat in the surgical knee is not improving. Hopefully that will change as I put this setback further into the rearview mirror.

I'm able generally to do one cycle of my exercises per day (sometimes two) but have had to eliminate the CPM for now, as it seems to aggravate the problem more than any of the other exercises. I've also had to remove the wall slides for the same reason. I've replaced the wall slides with (for lack of a better name) a vertical stretch in which I lie on the floor with my thigh vertical, propped against a piece of furniture, and let my leg naturally hang down in flexion, with only the weight of my lower leg driving the flexion. I hold it for ten minutes and it gives me a very gentle stretch.

I have just now restarted using the exercise bike, starting over again at 30 seconds and no resistance, increasing 5 seconds per day.

I hope to restart upper body weightlifting next week (beginning of week 7) which I had started during week 3, and start using my paddling ergometer (think of an exercise machine for paddle sports) for cardio (which was supposed to start this past week, week 5). We'll see how this all goes.

 

[WFD]

Did you seek out an arthrofibrosis doctor? Was your surgery done by the arthrofibrosis doctor?

I am in the Boston area, and didn't use Peter Millet (he was in the Boston area at Harvard, and [unfortunately] somewhere around 2010 he moved to the Steadman Clinic in Vail). My most recent surgery was performed by Thomas Gill at St. Elizabeth's and he trained at the Steadman clinic in the past, and also has experience treating arthrofibrosis. We'll see how this all works out.

 

[WFD]

End of week 6 update -

It's been a tough week. Around Tuesday I threw my lower back out somehow. I've done this occasionally over the years, but staying in shape and doing the right stretching exercises always kept it under control. I suspect that over the last 20 months due to forced inactivity recovering from four surgeries I have deconditioned significantly and lost strength in the abs and lower back. That, combined with tight hip flexors due to sitting too much and insufficient stretching (stretching hip flexors is hard to do with a painful knee) is for me at least, the main ingredients for lower back problems. I'm working on it as diligently as I can, and I am making progress, though it impairs the activities I can do pretty severely.

Also, the nerve problem in my shin is being stubborn about healing.

Then, Wednesday night I developed violent chills and then a 103°F fever, and was sick the rest of the week. The fever finally broke last night and I am finally on the mend.

As that great observer of the human condition Roseanne Roseannadanna said, "It's always something!"

My very painful lower back restricted me to some very simple exercises:
1. Patellar mobilization
2. Vertical stretch
3. Elevated quad sets
4. Some simple stretches for my hip flexors
5. Planks to start to strengthen my abs again.

The vertical stretch, which I described earlier in this thread, actually makes my back feel a lot better.

The effect of doing one or two sets of these simple exercises each day, plus a lot of bed rest (from a sore back and from being sick) is that my RoM cold in the morning has increased to 90° and the swelling has gone down enough that if I squint extra hard I think I can see the outlines of my kneecap. Also my kneecap is clearly a *lot* more mobile when I do the mobilization exercises.

So, I'm making progress but everything seems to be breaking or wearing out. It seems like once I turned 60 my warranty expired. I have occasionally given my Dad a hard time for not buying the extended warranty when I was born.

 

[sistersinhim]

he effect of doing one or two sets of these simple exercises each day, plus a lot of bed rest (from a sore back and from being sick) is that my RoM cold in the morning has increased to 90° and the swelling has gone down enough that if I squint extra hard I think I can see the outlines of my kneecap.

You have experienced the BoneSmart way of healing, less aggressive exercise means less swelling and better bend.

 

[WFD]

End of week 7 update -

The illness and back problems are pretty much completely resolved. The nerve problem in my shin is not improving much and is often quite painful. If it doesn't start improving I'm going to have to make an appointment, etc., what a pain. I'm on crutches all the time to keep it from triggering and to try to get it to heal.

What with all these other issues, the knee itself has been the least of my worries. Still doing my easy exercises, and RoM first thing in the morning is still 90°. The surgeon said he achieved 100° after the LOA/MUA so my hope is that once the swelling goes down (it is starting to decrease, but v e r y s l o w l y) I will have 100°. Then, once I am past the scar tissue danger zone (3-6 months?) I can start to stretch the muscles and connective tissues that have shortened over these last several years of impaired range of motion.