A Patient’s guide to the physiotherapy exercises and advice following distal femoral replacement/distal femoral diaphyseal replacement

The Physiotherapist will come and see you after your operation to provide you with exercises and help you get out of bed for the first time.

They will let you know how much weight you are allowed to put on your operated leg.

You can start to bend your knee straight away and the physiotherapist will teach you the exercises on the following pages.

You will usually use a frame or crutches to stand and walk.

1. Lying in bed, squeeze your buttocks firmly together, hold for five seconds then relax . Repeat ____ times every hour
   
2. Lying in bed with your legs straight, push the back of your knees down against the bed, hold for five seconds then relax . Repeat ____ times every hour 
   
3. Place a rolled towel under your knee and a band around your   forefoot . Using your arms to assist the movement, push your knee   down on to the towel so your heel lifts off the bed and your knee   straightens . Repeat _____ times 
   
4. Place a slide board or plastic sheet under your leg . Bend and  straighten your knee by sliding your foot up and down the board .  You can use a bandage to assist this movement .  Repeat _____ times 
   

The nurses will assist you in and out of bed for as long as you require assistance, but with practice and exercise you will soon be managing this yourself.

The physiotherapist will gradually help you increase the distance and independence of your walking and will assess whether a frame or elbow crutches are appropriate for you.

The physiotherapist will also be monitoring the movement in your knee to make sure you are doing the exercises and regaining the movement necessary to allow you to go home. We usually aim for you to be able to bend your knee to a right angle (90 degrees) and to fully straighten the knee.

1. With a slide board or plastic sheet under your foot, bend your knee  by sliding your heel back under the chair. Hold this position for five  seconds then relax and straighten the knee. Repeat _____ times
   
2. Pull your toes towards you whilst tensing the muscle in the front of your thigh, lift your heel off the   floor to straighten your knee as much as possible. Hold for five seconds and slowly lower.  Repeat _____ times .
   
3. Sit with your knee straight and heel resting on a stool to stretch the muscles at the back of the knee. Sit for _____ minutes
   

1. In a standing position holding on to a solid support, bend your operated leg up in front of you. Hold for 5 slow counts and slowly lower. Repeat _____ times.
    
2. In a standing position holding on to a solid support, squeeze your buttocks tightly together and gently bend both knees then straighten. Repeat _____ times.
    
3. In a standing position holding on to a solid support, keeping your knees together, bend your operated knee bringing your heel up behind you then lower. Repeat _____ times.
   

Always go up and down one step at a time. If you have a handrail, then use it and hold your other crutch in your spare hand.

Ascending stairs

Stand close to the step. Step up with your good leg first.

Then step up with your operated leg  onto the same step. Lastly, bring up your crutches 

Descending stairs

Stand close to the step. Place your crutches down first

Then place your operated leg down. Lastly, place your good leg down onto  the same step

Prior to discharge you will need to achieve the following goals:

• Move your knee from 0-90°
• Be independent and safe with your exercises
• Walk safely with the appropriate walking aid
• Climb up and down a step or stairs if appropriate for your home circumstances

On discharge from hospital you will be referred for on-going outpatient physiotherapy at your local hospital, or if you prefer you may be seen for outpatient care by the RNOHT physiotherapy team either at Stanmore or Bolsover Street.

If you require further treatment for your cancer, this will be coordinated by your clinical nurse specialist. They will keep you informed and liaise between the different treatment centres.

Following your initial check-up, you will continue to be reviewed by your doctor for many years. This is to check your leg for tumour recurrence and check the prosthesis for loosening and infection. You will undergo x-rays of your leg as well as a physical examination. As always, should you have any concerns in between these appointments please contact your clinical nurse specialist.

Please note that you need to take care if you have any acute infections such as dental infections or tonsillitis in the future – you will need antibiotic cover to protect your prosthesis.

When can I return to driving?

You will be unable to drive for at least the first six weeks post operatively. After this time, your consultant or GP will advise you on whether it is safe to return to driving. Typically, this is once you have full range of movement and adequate strength in your operated leg to perform an ‘emergency stop.’ You are not required to inform the DVLA unless the disability is long term. You may also need to inform your insurance company of your operation, as your insurance may be invalid.

Can I have a shower or bath?

There are no restrictions to bathing. The nurses will inform you when it is safe to get your wound wet. This is usually before you are discharged from hospital.

Can I sleep in any position in bed?

Yes, there are no restrictions in sleeping positions.

When can I return to work/school/college?

This will depend on your job and should be discussed with your physiotherapist and doctor on an individual basis.

When can I return to exercise?

To protect your prosthesis from loosening or fractures it is important that you avoid all contact and impact sports.

It may be possible to return to swimming, cycling, Pilates, PE or other hobbies but this should be discussed on an individual basis with your consultant or physiotherapist.

When is it safe to resume sexual relations?

Unless you find it painful, or your doctor advises you otherwise, it is safe to continue sexual relations with your partner . Generally a comfortable and safe position for both men and women is to be on their backs underneath their partner . If you wish to discuss this further, please speak to your physiotherapist.

Scars form as a result of the natural healing process of the skin . The scar may stick to underlying tissues and limit movement at that joint . Massage can help soften the scar tissue and make it flatter, paler, cooler and smoother . Massage can be commenced once all stitches are removed and the wound is closed; normally at about 6 weeks postsurgery . Use an unperfumed moisturising cream or lotion . Massage the scar and any tight/hard areas lying close to the scar for 5-10 minutes 2-3 times per day for optimum results . It may take several months to achieve a flat and movable scar . A scar can take up to 18 months to mature fully.

1. Start with small circles along the length of the scar either with your thumb or first two fingers. Use a firm even pressure.
2. Next, work horizontally across the scar- to and fro in small movements.
3. Then, work vertically along the length of the scar.