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Heather Mills - Amputee Forum
ann

B/k prosthetic knee problems

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Just wondering if anyone has any ideas on this.

Those on here who know me, know I am in the UK and have been a bilateral b/k for many years. My latest pair seemed initially successful but are giving a lot of knee pain on the inside of both knees and in the last few weeks I have been back to the prosthetist/technician on quite a few occassions getting the knees eased out. Initially I was told, they were much higher at the back and sides and these were trimmed and again seemed to improve things initially but then caused problems again. They agree they are tighter, though this is because the last ones were apparently not tight enough.

The pain levels kind of build up through the day, quite often worse with sitting and walking after sitting, and is mainly on the insides of both the knees as well as aching later in the day and am also experiencing hip pain which is not usual, sometimes there is some redness on the insides of the knees, I have also noticed on the longer stump that it isn't as warm at the end as it usually is when I take it off, which I have told them about. When I walk with the legs they feel quite stiff and both legs don't seem to respond as I would expect them too on continued walking outside the house,they are definitely not feeling part of me as they usually do, but I am being told there is nothing different. The feet are my usual type. A physio has picked up the hip on one side is doing different things to the other side, though has put this down to lack of muscle in the other side and given me exercises, which I know is the case, though wasn't a problem until I started wearing this new pair of prostheses.

The knees are definitely tighter, especially the right knee where I get the most discomfort, initially I couldn't slide my leg straight in the socket but the left side where the leg is more protected by a gel liner the leg seems to go in the socket more easily. The pain goes after a day or so of me switching back to previous prostheses, yet looking at the sockets I can't see a lot of difference. I have had similar to this several years ago and the legs were remade and things were ok with the knees, at that time I also had the knees x-rayed and they showed no problem, so I am pretty sure it is a prosthetic fit problem. Am wondering also if this could be an alignment problem because the pain is practically in the same place on both legs.

Just really wondering if any of you folks had experienced similar problems and how they were resolved. I am back again for an emergency appointment this afternoon so if anyone has any ideas would be pleased to hear, am getting to the point of asking for a remake, though this is a second attempt, different prosthetist and we are six months in, so getting a tad concerned.

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Ann, are the "red spots" on the inside of the knees up at the top by the trim lines, or are they further down? When you try walking after sitting for a bit, what sort of problems are you having? This latest socket of mine has been an interesting experiment in just how tight a socket can get at the knee without restricting movement or causing pain. It took them several attempts to get the knee area sorted out, but the socket is now allowing me really good flex at the knee and is also supporting the knee so I'm not getting any sort of "side-to-side" motion.

My own sockets have always been "flared" at the knee in the past, and it took some getting used to such a snug fit. But I know that when I reached the point of a "red spot" on the inside of my knee, they actually re-cast me and started again until they reached the point where the redness disappeared.

I get the impression that, at least with some suspension systems, they're doing some "experimenting" on socket fit and trim lines at the moment...my casting sessions for this latest socket have been quite unlike anything I've been through in the past. With your long history, a change in fit and trim might be even more of a stress on your body, don't you think?

You've been at this one a long time...I hope they get you sorted out soon!

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Thanks for replying Cheryl.

The red spots on the inside of the knee were well below the trim lines. The sort of pain I was having was basically a kind of pressure pain in the inside of both knees, but would spread to the whole of the knee and when I tried keep wearing it and pushing through the pain I think they were swelling. Like you say with your sockets, mine have always been flared in the past. The pressure was to the extent where when I was out I really wanted to take the legs off and as soon as I reached the car or home, that was what I was doing. Continual walking was really hard work, much more difficult than usual, they felt very heavy, and neither of the legs felt 'one' with me.

In the past if I have had problems like this I have been recast, but this is the second attempt and they didn't recast but used the previous check sockets and they were heated out in the troublesome areas, this seems to be the way they do things nowadays though I am not sure about it myself. Before I took delivery of these final sockets a couple of weeks ago I had three weeks or so at home using reinforced check sockets, I could only wear them in the house but they were supposed to pick up any problems before they made the final socket, in theory that should have worked, I had no problems with the left check socket although a few issues with the right. The final sockets were supposed to be a replica of the check sockets but they turned out a lot tighter and even the prosthetist remarked on it at the time.

At the appointment yesterday afternoon, where I saw a different prosthetist, the loading of the socket over the foot was much further forward than expected to be, so that was adjusted and also I was given some more room at the knees. After they'd been adjusted and I walked in them, the longer of the two legs felt more natural, though not the other side, it felt quite different, So I questioned whether they had done something different to the left leg and he explained that he had altered them both the same but that the longer stump would probably need less adjustment, so adjusted the other side and that extra adjustment made them feel more equal. So was advised to take them and give them a good try .... again! So far, it seems ok and the knee pain is lessening again so finger's crossed.

I don't think they are particularly 'experimenting' on my socket fit Cheryl, I know what works for me and am nowadays quick to let them know what I know works for me,the trim line was higher and definitely a more snug fit though I don't think was radically different from what I have had before and I am beginning to think this had more to do with the alignment set up perhaps than the socket.

The guy I saw yesterday did talk about a different type of socket he would like to try, though he is a locum and not there permanently,and I don't mind experimenting ... 'if' I have something I can fall back for everyday ... whilst having the fitting processes, as you know am bilateral, so not having one or other of the prosthetics to wear means not walking and that makes a very big difference to my everyday life.

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Well, I hope the latest alignment adjustments make a difference for you, Ann...and I'm very glad to hear that you're being vocal about what is and isn't working for you! I know that I've had problems which I thought were socket related but that were cleared up with alignment adjustments...it's one of those "prosthesis things" that still puzzles me.

I thought my last visit on my own new leg was going to be today...but there seems to be "one more ever-so-tiny-but-annoying glitch" to be worked out. There is either an itsy-bitsy pinhole leak somewhere in a pump hose or a sleeve...or else my pump may be failing. (The leak is generally being thought of as the most likely...but it's also been very, very hard to locate.) Honestly, if this leg didn't feel so good, even when it's not at peak efficiency, I'd be tempted to go back to a pin-lock suspension. But it DOES feel remarkably good...and I'm just hoping and praying that we'll get it all sorted out soon.

I would think that bilateral amputees would indeed face more of an impact from being without prostheses...I can at least deal well with my wheelchair because I do have one "good" leg for making transfers, standing to reach stuff, etc...I'm sure that all of that would at the very least take more "thinking through" for someone who could find themselves without one leg...or the other leg...or both legs together at any given moment. You're in my thoughts, Ann!

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