Amputation Left Above-Knee Amputation, 22 April 2025
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WFD
graduate
End of 10 months - Almost week 44
Gradually getting better since my setback more than a month ago. My shin and lower back bother me only first thing in the morning and then usually at the end of the day. My knee is consistently at a low level of pain but that may never go away.
If I can keep up the improvement I am going to start adding leg strengthening exercises, maybe at the beginning of February. At that point I will be eleven months past my last surgery and you would think I could finally start strengthening. I need to start building up some leg strength so that in the spring I can start pulling my own weight around the house and also put my kayak back in the water for the first time since 2020.
Gradually getting better since my setback more than a month ago. My shin and lower back bother me only first thing in the morning and then usually at the end of the day. My knee is consistently at a low level of pain but that may never go away.
If I can keep up the improvement I am going to start adding leg strengthening exercises, maybe at the beginning of February. At that point I will be eleven months past my last surgery and you would think I could finally start strengthening. I need to start building up some leg strength so that in the spring I can start pulling my own weight around the house and also put my kayak back in the water for the first time since 2020.
JusticeRider
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WFD, I’m so glad you’ve been able to come back after your setback! Those are so trying mentally and emotionally. It’s hard to know what’s too much until it’s too late. I live in fear of another setback like I had at 4 weeks. It sounds like you are figuring out what works for your body and doing everything you possibly can to help your recovery along. I hope you don’t have to live with pain, but if you do I hope it’s at a very low level that doesn’t impact your quality of life much or at all. You certainly have a good attitude and are an inspiration to those of us who have had a slow and/or difficult recovery. Please do continue to keep us updated! Wishing you the very best @WFD
WFD
graduate
Thanks, @JusticeRider .
WFD
graduate
All,
Some time ago I mentioned that Dr. Frank Noyes, of the Noyes Knee Institute, had written an e-book on knee arthrofibrosis that was available for sale on Amazon. I mentioned also that I had found a free version available for download on his website, but that later it disappeared.
Well, I found it again by accident during a Google search for something else. If you are interested you can find it at
I had originally bought it on Amazon and recommend it highly. It has for example the best description I have seen of CRPS.
Some time ago I mentioned that Dr. Frank Noyes, of the Noyes Knee Institute, had written an e-book on knee arthrofibrosis that was available for sale on Amazon. I mentioned also that I had found a free version available for download on his website, but that later it disappeared.
Well, I found it again by accident during a Google search for something else. If you are interested you can find it at
I had originally bought it on Amazon and recommend it highly. It has for example the best description I have seen of CRPS.
Thank you for the article, WFD! Some very good information is in there.
@WFD ..... normally we don't permit links that take our members offsite, but in this case we opted to allow the link to Dr. Noyes's e-book to remain. Even though it is not a new publication, you are right that it has excellent informaiton and I've included this link in our BoneSmart Library thread on Arthrofibrosis. Thank you for reminding me about this helpful publication.
WFD
graduate
Almost End of Month 11 - Week 48
The back problem is completely gone now, and the shin pain is at a very low level. My range of motion fluctuates between 90 and 95°.
As I mentioned in someone else's thread, I found an article titled 'Anterior Knee Pain' on Dr. Gorczynski's website YourOrthoMD. In it he says among other things that patients who went through TKR surgery often suffer from anterior knee pain caused by weak hip flexors, hip abductors, and external rotators. He says that
This can result in abnormal gait mechanics, abnormal rotation of the femur when weight bearing, and abnormal patellofemoral mechanics.
As soon as I read that, the lightbulb went on over my head (or as we say in coastal New England, 'the light dawned on Marblehead').
I found that I was walking with my surgical leg rotated to the inside, and when I pushed off with that foot, it was rolling to the outside, causing my shin pain and was probably also (one of?) the cause(s) of my knee pain.
I started focusing on my gait, making sure to rotate my foot externally and got some immediate relief in the ankle and shin area. The pain has sharply decreased in the weeks since, and is now at maybe 10% what it was.
Dr. Gorczynski gives some exercises to strengthen the appropriate muscles, and I have added those to my routine, along with some others.
I have decided that it is time to start focusing on strengthening the leg muscles. It has been eleven months since my arthroscopic surgery (almost 2.5 years since my TKR) and the muscles in my surgical leg have atrophied to an alarming degree. A few months before my TKR, in the summer of 2020 I could back squat 275 lbs for five reps to below parallel, and now I find that my surgical leg is not strong enough to step up onto a 4" block with just bodyweight, unless I use momentum or body english. I think this lack of strength is the root cause (now) of much of my knee pain.
So in addition to my upper body weight workout and paddling workouts, I have added exercises for:
Hip flexion
Hip abduction
Glute raises
Lateral step-ups
Step-downs
Calf raises
The goal is to bring my surgical leg strength up to match that of my good leg, and then start doing squats, first with bodyweight and then eventually with added weight. Deadlifts too.
The back problem is completely gone now, and the shin pain is at a very low level. My range of motion fluctuates between 90 and 95°.
As I mentioned in someone else's thread, I found an article titled 'Anterior Knee Pain' on Dr. Gorczynski's website YourOrthoMD. In it he says among other things that patients who went through TKR surgery often suffer from anterior knee pain caused by weak hip flexors, hip abductors, and external rotators. He says that
This can result in abnormal gait mechanics, abnormal rotation of the femur when weight bearing, and abnormal patellofemoral mechanics.
As soon as I read that, the lightbulb went on over my head (or as we say in coastal New England, 'the light dawned on Marblehead').
I found that I was walking with my surgical leg rotated to the inside, and when I pushed off with that foot, it was rolling to the outside, causing my shin pain and was probably also (one of?) the cause(s) of my knee pain.
I started focusing on my gait, making sure to rotate my foot externally and got some immediate relief in the ankle and shin area. The pain has sharply decreased in the weeks since, and is now at maybe 10% what it was.
Dr. Gorczynski gives some exercises to strengthen the appropriate muscles, and I have added those to my routine, along with some others.
I have decided that it is time to start focusing on strengthening the leg muscles. It has been eleven months since my arthroscopic surgery (almost 2.5 years since my TKR) and the muscles in my surgical leg have atrophied to an alarming degree. A few months before my TKR, in the summer of 2020 I could back squat 275 lbs for five reps to below parallel, and now I find that my surgical leg is not strong enough to step up onto a 4" block with just bodyweight, unless I use momentum or body english. I think this lack of strength is the root cause (now) of much of my knee pain.
So in addition to my upper body weight workout and paddling workouts, I have added exercises for:
Hip flexion
Hip abduction
Glute raises
Lateral step-ups
Step-downs
Calf raises
The goal is to bring my surgical leg strength up to match that of my good leg, and then start doing squats, first with bodyweight and then eventually with added weight. Deadlifts too.
JusticeRider
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@WFD it’s great to see an update from you! I’m so glad your back pain is gone and that your shin and ankle are feeling better. You’ve been through a lot and your determination shines through. I know it will pay off and all your hard work will be rewarded. You’re already doing so much better and are an inspiration to the rest of us.
The article you mentioned sounds very helpful. I’m going to check it out. Especially interested in those exercises. I know what you mean about the muscle atrophy! It’s been 2.5 years since my injury and subsequent hip and knee surgeries, and my left thigh is so much thinner than my right. I hope I can get the muscle back.
I’ll be interested to hear how your new workout routine goes for you, WFD. Thanks for keeping us updated!
The article you mentioned sounds very helpful. I’m going to check it out. Especially interested in those exercises. I know what you mean about the muscle atrophy! It’s been 2.5 years since my injury and subsequent hip and knee surgeries, and my left thigh is so much thinner than my right. I hope I can get the muscle back.
I’ll be interested to hear how your new workout routine goes for you, WFD. Thanks for keeping us updated!
WFD
graduate
Almost end of month 12 - Week 52
Halfway through the month I contracted norovirus and was flat on my back for a few days. During these days of enforced rest, my knee and shin became much more painful, even though the swelling in my knee went down by about 1/2 cm in circumference. I am definitely at a point where too much rest is bad and makes the pain worse. That is usually not a problem, keeping from overdoing things is the problem, where anything over 2,500-3,000 steps per day is troublesome.
I noticed during the month that the pain on the lateral side of my knee was getting worse and was moreover spreading vertically. Prompted by comments others made about the IT band (I've had IT band issues in the past) I started foam rolling it and got some immediate relief. The pain in the rest of the knee as well as shin and ankle still remains however. The funny thing is that over the years I've personally found foam rolling to be completely useless except for this one thing - it excels at dealing with IT band issues. For everything else I've found conventional stretching to be far superior.
I continue with the strengthening exercises and am making progress, though I lost a week from being sick. Hopefully the weakness and muscle atrophy is at the root of my pain and as it improves, the pain will decrease.
As a result of the discussion on Bonesmart about ultrasound, I've ordered a machine from Amazon and will try that out to see if I can get some relief.
I am one year out from an arthroscopic surgery and on the good side, have 10°-20° more RoM, but at the expense of nearly continuous pain and stiffness. At this point the soft tissues must be fully healed - the pain must come from other causes, such as muscle weakness or scar tissue. The best I can do is to keep plugging away and hope to get some relief over time as I try different things.
Halfway through the month I contracted norovirus and was flat on my back for a few days. During these days of enforced rest, my knee and shin became much more painful, even though the swelling in my knee went down by about 1/2 cm in circumference. I am definitely at a point where too much rest is bad and makes the pain worse. That is usually not a problem, keeping from overdoing things is the problem, where anything over 2,500-3,000 steps per day is troublesome.
I noticed during the month that the pain on the lateral side of my knee was getting worse and was moreover spreading vertically. Prompted by comments others made about the IT band (I've had IT band issues in the past) I started foam rolling it and got some immediate relief. The pain in the rest of the knee as well as shin and ankle still remains however. The funny thing is that over the years I've personally found foam rolling to be completely useless except for this one thing - it excels at dealing with IT band issues. For everything else I've found conventional stretching to be far superior.
I continue with the strengthening exercises and am making progress, though I lost a week from being sick. Hopefully the weakness and muscle atrophy is at the root of my pain and as it improves, the pain will decrease.
As a result of the discussion on Bonesmart about ultrasound, I've ordered a machine from Amazon and will try that out to see if I can get some relief.
I am one year out from an arthroscopic surgery and on the good side, have 10°-20° more RoM, but at the expense of nearly continuous pain and stiffness. At this point the soft tissues must be fully healed - the pain must come from other causes, such as muscle weakness or scar tissue. The best I can do is to keep plugging away and hope to get some relief over time as I try different things.
JusticeRider
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WFD, I’m so sorry you’re still experiencing pain, and I hope the ultrasound helps you! Please do let us know. I was wondering, do you feel the arthroscopic surgery that you had was worth it? If you had it to do over would you choose to do it again? Thanks for sharing your story WFD. I enjoy reading and keeping up with your progress and I’m always cheering you on.
WFD
graduate
I don't know. After my revision, my RoM was only 70-75° and this was causing back pain as I couldn't take a normal step without the poor RoM yanking on my pelvis and tilting it forward with every step, making my back hurt. But I had none of the pain in my shin and little in my knee.
Arthroscopic surgery was the only option other than doing nothing. Another open surgery would have made things much worse.
In hindsight, I should have had the arthroscopic LOA after my first TKR did not work out, and stopped there. The two additional open surgeries I had (the open LOA and full revision) only damaged and angered the soft tissues without giving me any more RoM. I think that is the real root cause of my problems - too much trauma from too many open surgeries.
Thanks for your support.
JusticeRider
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Thanks for your reply and honesty…it’s good for others to know. You are very determined and I hope you see continued improvement, even if it is slow. Maybe the ultrasound will be a game changer 
WFD
graduate
So I am having another setback, and wanted to see if what I am experiencing might sound familiar to someone and maybe generate some good advice. It is a weird but consistent set of symptoms that to the right person, may indicate what is going wrong.
About a week ago I overdid it a little, walking about 5,000 steps a day for several days. My wife was away and I had to take care of things - run errands, take care of our two dogs and several dozen chickens.
I developed pain on the outside of my knee that spreads down into the shin. The outer shin muscle (tibialis anterior) then became tight and very sore. The really interesting part is that on the opposite side of the leg I then developed strong pain in the upper calf muscle, roughly where the medial head of the gastrocnemius inserts into the knee. Strangely enough, if I massage this sore area on the calf, the pain on the outside of my knee, completely on the opposite side of my leg, gets better.
The pain is worse when I first get up in the morning (I have to use a cane or crutches) or if I've been sitting, which makes me think swelling is involved.
I read with interest @EalingGran 's post about neuroma of the infrapatellar branch of the saphenous nerve, since the saphenous nerve passes through the area of the medial head of the gastrocnemius, but that doesn't explain where the pain on the outside of the knee comes from.
This whole set of symptoms has happened to me at least 10 or 12 times and the two sets of symptoms always occur together, so I think it is a strong hint as to what is causing the problem.
Anyway, if this sounds familiar to anyone, I'd appreciate any feedback or help, before I start the process of trying to get appointments with a neurologist, etc.
It is now more than a year since my last arthroscopic surgery, and I am still using a cane or crutches part of the time, and this is not good.
About a week ago I overdid it a little, walking about 5,000 steps a day for several days. My wife was away and I had to take care of things - run errands, take care of our two dogs and several dozen chickens.
I developed pain on the outside of my knee that spreads down into the shin. The outer shin muscle (tibialis anterior) then became tight and very sore. The really interesting part is that on the opposite side of the leg I then developed strong pain in the upper calf muscle, roughly where the medial head of the gastrocnemius inserts into the knee. Strangely enough, if I massage this sore area on the calf, the pain on the outside of my knee, completely on the opposite side of my leg, gets better.
The pain is worse when I first get up in the morning (I have to use a cane or crutches) or if I've been sitting, which makes me think swelling is involved.
I read with interest @EalingGran 's post about neuroma of the infrapatellar branch of the saphenous nerve, since the saphenous nerve passes through the area of the medial head of the gastrocnemius, but that doesn't explain where the pain on the outside of the knee comes from.
This whole set of symptoms has happened to me at least 10 or 12 times and the two sets of symptoms always occur together, so I think it is a strong hint as to what is causing the problem.
Anyway, if this sounds familiar to anyone, I'd appreciate any feedback or help, before I start the process of trying to get appointments with a neurologist, etc.
It is now more than a year since my last arthroscopic surgery, and I am still using a cane or crutches part of the time, and this is not good.
I have to agree with you, and I’m sorry you‘re in such a situation. It’s one of the reasons I’ve held back from getting more second opinions, though none of them have offered any surgery, which might be a blessing. While my knee isn’t great, it’s ”only” dealing with the trauma of one (poorly done, in my opinion) surgery, and after 6 years, it’s probably healed as much as it can. It’s manageable.
However, after falling at Christmas, I was open to the idea of some exploratory surgery, but once again, not offered.
I can’t comment on your recent setback, it’s not something I’ve experienced. Hopefully it will settle down in time.
WFD
graduate
End of Month 13 - Almost 57 weeks.
The pain in my shin and knee has continued to gradually get worse, no matter what I do. Rest makes it worse, exercising too much makes it worse. I had my PCP get me a referral to a PT that I trust and went in last Tuesday for an evaluation.
After two and a half years of limited RoM and activity and having to use a cane or crutches much of the time has left me with some very weak muscles generating in turn some significant imbalances. Plus my gait is horrible. He put together a plan to strengthen the weak muscles, using one pool session and one 'dry land' session per week, plus three weekly exercise sessions to be done at home. I have a feeling that the three home sessions will become two, if the land sessions at PT are hard work.
I had my first pool session last Thursday, which involved mainly walking on an underwater treadmill to retrain my gait and later that afternoon I felt much better walking on dry land, though I could tell some muscles were very tired. Since then I've been more stiff and sore than usual, but I think that is unavoidable. If the root cause of my problems are muscle weakness, imbalance, and poor gait, then strengthening is the only way to go, and that will not be painless.
My PT cautioned me that if my knee pain is in fact caused by muscle weakness and imbalance, then it can take 'months' to fix, so I think I'm in this for a while. If by next Fall I am not better I will have to go off to the surgeon for x-rays, etc.
The pain in my shin and knee has continued to gradually get worse, no matter what I do. Rest makes it worse, exercising too much makes it worse. I had my PCP get me a referral to a PT that I trust and went in last Tuesday for an evaluation.
After two and a half years of limited RoM and activity and having to use a cane or crutches much of the time has left me with some very weak muscles generating in turn some significant imbalances. Plus my gait is horrible. He put together a plan to strengthen the weak muscles, using one pool session and one 'dry land' session per week, plus three weekly exercise sessions to be done at home. I have a feeling that the three home sessions will become two, if the land sessions at PT are hard work.
I had my first pool session last Thursday, which involved mainly walking on an underwater treadmill to retrain my gait and later that afternoon I felt much better walking on dry land, though I could tell some muscles were very tired. Since then I've been more stiff and sore than usual, but I think that is unavoidable. If the root cause of my problems are muscle weakness, imbalance, and poor gait, then strengthening is the only way to go, and that will not be painless.
My PT cautioned me that if my knee pain is in fact caused by muscle weakness and imbalance, then it can take 'months' to fix, so I think I'm in this for a while. If by next Fall I am not better I will have to go off to the surgeon for x-rays, etc.
It sounds like you have a good plan to move ahead. You know your body more than anyone else, so if you become painful you already know how to slow down. You will be fine.
@WFD Sometimes this process is a long and involved one. It does sound like your PT is moving in the right direction. Just don't let them push you. You have many months of walking differently pre-op. That does not resolve overnight. Slow and steady.
And I agree - 3X per week exercises is a bit much. Please listen to that knee.
And I agree - 3X per week exercises is a bit much. Please listen to that knee.
Taking “months to fix” - just what you don’t need to hear. I am admiring your perseverance, after two years of pain I have all but given up on keeping my legs strong and hoping that the medics can fix things. You are inspiring, truly. You have risen above it mentally.
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Agree that exercises can make you ache but I don't think it should be painful.
I am building up my glutes/ hamstrings and quads with pilates. Have started using a resistance band or 1/2 kg ankle weights. Can't remember whether you have tried pilates? I really find it so helpful because it really emphasises core strength/ balance and listening to your body.
