Conservative Management of Severe OA Knees with the V-VAS Orthosis
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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
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Conservative Management of Severe OA Knees with the V-VAS Orthosis
- 1. Management of Severe OA Knee Customised Knee Orthosis William A Munro, Derek Jones, Martin Buchan
- 2. Treatment of OA • NSAID’S • Total knee replacement • Narcotics • Shoe wedges • Synvisc injections • Hinged knee sleeves • • Debriedment Rigid frame KO’s • KAFO’s • Uni-compartment resurfacing
- 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
- 5. Double Upright Designs 3 point pressure system Single segment adjustments Within a “fixed frame”
- 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™
- 11. Adjust Optimal T/F Angle
- 12. Successful Applications • Mild to Severe Genu Varum or Valgum • Non-Operative Tibial Plateau Fixations • Failed Tibial Plateau Reconstructions • Osteochondral Defects • Post Total-Knee Arthroplasty • Tibial and/or Femoral Spacers
- 13. Cases
- 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
- 16. Weight Bearing - No Brace Braced
- 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
- 25. Required Measurements Via Cast or Scan
- 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