This presentation won best paper award at BAPO (British Association of Prosthetics & Orthotics) Conference in 2008. The focus is on conservative management of severe OA knee pain and deformity using the V-VAS Knee orthosis from Anatomical Concepts
3. Orthoses
• Have been successfully used
• Pressures generated to provide offloading may not be
easily tolerated
• Designs may not be easily adjusted for optimal comfort
• May not be adequate with severe deformity
4. Single Upright
Designs
3 & 4 points of
pressure
Various pad & strap
configurations
Long lever arms to
create effective bending
moment
6. V-VAS Concept
• Total contact cuff
• Unique self-aligning adjustable joint
• Adjustable when on the body
• Femur and tibia - independent adjustment
• Unique application of corrective forces
• Made with custom cast or scan
Varum - Valgum Adjustable Stress V-VAS™
14. Mr AC - 84 years
Profile
• Bilateral knee OA
• Not fit for total knee
• Past History
• Ischaemic Heart Disease
• Lung cancer and lung
resection
• Chronic Renal failure
• Anaemia
• Atypical mycobacterium
pulmonary infection
15. Clinical Management
•Hyaluronic acid and multiple steroid
intra-articular injection provided
minimal benefit
•Morphine patches for thoracic pain
•TB chemotherapy
Weight Bearing - No Brace
17. Mr AC
• Benefits
• Pain judged 60-70% improvement
• Improved walking distance limited
by respiratory problems rather
than knee pain
• Issues
• Felt brace heavy and cumbersome
• Tricky to apply until correct
application taught
• Significant weight fluctuations
influenced fitting
18. Interpretation
• Unbraced XRay - varus axis of 11 degrees
• Braced XRay - varus axis of 11 degrees
• Question
• Does brace work by preventing hinge
adduction and compression of the medial
joint?
19. Mr MD - 44 years
Profile
• 1985 left knee arthroscopy and
open medial menisectomy
• 1995 repeat arthroscopy
shows complete loss of medial
chondral surface
• 2005 right knee arthroscopy
shows bone on bone contact
• Both knees have moderate
PFJ and lateral compartment
chondral loss.
Without Brace - Stork View
20. Mr MD
Exam
• Bilateral clinical varus
Observations
–Too young for joint
>20 degrees
replacement
• Both knees lack 5 –Too severe for chondral
degrees full resurfacing
extension –Too advanced for high tibial
• Moderate effusion
osteotomy
–May be suitable for Benjamin’s
right knee only
double osteotomy
• Severe pain and
swelling right knee
21. Mr MD
Following Bracing
• Brace used 2 - 4 hours per day
• Excellent reduction in pain and
swelling of right knee
• Weight-bearing Xray
• No brace 11 deg Varus
• With brace 4 deg Varus
22. Mr ST - 66 years
Profile Past History
• Right knee & left hip
–Coronary bypass grafts (re-
stenosed)
osteoarthritis –Gout
• Ex marathon runner –Previous knee brace rejected in
2005
• Lateral menisectomy
Pain medication
1963
–Gabapentin
• Knee arthroscopy in –Paracetamol
1989 showed patella- –Tramadol
femoral and lateral
compartment wear
23. Mr ST
Observations
• Pain disrupts daily activities
• Painful and unstable knee
• Steriod injection in left hip very helpful
(December 2007)
• Steroid injection in right knee not helpful
(September 2007)
24. Mr ST
Examination
–20 degrees valgus
–Correctable to neutral
–Full extension to 120 degrees
flexion
–Xrays show bone on bone
contact in lateral compartments
and PFJ
–Mild OA medial compartments
–Bone on bone hip OA
26. Benefits
• Manageable pain relief
• Increased tolerance to corrective forces
• No contact to knee area itself
• No need for counterforce strap
• Custom fit - Off the Shelf price