|
| |
 |
|
| CASE STUDY |
|
| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 121-123 |
|
Knee brace for osteoarthritis using distraction force
Rani Kumari
Department of Prosthetics and Orthotics, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
| Date of Submission | 27-Dec-2022 |
| Date of Decision | 05-Jan-2023 |
| Date of Acceptance | 14-Jan-2023 |
| Date of Web Publication | 16-May-2023 |
Correspondence Address:
Dr. Rani Kumari
Department of Prosthetics and Orthotics, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Vadodara - 391 760, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jihs.jihs_22_22
Osteoarthritis (OA) is a common chronic condition among old age person, which affects joint motion disabling to perform daily routine tasks. This hampers their overall quality of life. In the current study, a new combination of braces design for OA was constructed combining valgus braces and unloader braces. The aim was to prove the effectiveness of the new braces on the patients with ligament laxity, muscle spasm, contraction, and mediolateral instability. In total, 28 patients were divided into three different mobility groups, i.e., respondents with mobility limited to their home environment, those with ability to walk to a nearby shop, and third group with no mobility restrictions. The patient-reported outcome measure questions in the study were prepared for the questionnaire. The results of this study illustrated pain reduction in about 54% of respondents after using a new knee brace. This provided possibly less cocontraction, which further helped reduced progression of knee OA, suitable joint support, and increased mobility.
Keywords: Braces, joints, osteoarthritis, valgus braces and unloader braces
How to cite this article:
Kumari R. Knee brace for osteoarthritis using distraction force. J Integr Health Sci 2022;10:121-3 |
| Introduction | |  |
A major challenge in joint diseases, osteoarthritis (OA), is being faced by many developing countries. OA is one of the most common chronic conditions leading to disability among aged people of 60+ years. It mainly affects individuals engaged in heavy duty work like standing for a long period and walking long distances, impacting on their daily activities. Some of the symptoms include pain, stiffness, posture changes, reduced strength, and knee stability hampering mobility.
Surgical interventions are considered only when stepped care treatment plan cannot be implemented. A conservative management of OA is required as per the guidelines of the OA Research Society International in the USA.[1] and the UK National Institute for Health and Care Excellence. It includes a mixture of aerobic and strength exercises, weight management, use of knee braces, pain medication, and education for self-management. Various types of braces are available for OA, which support rehabilitation and functioning. However, in all such braces, work only for genu valgum and genu varum, and muscle contraction and spasm, has been ignored. When the effectiveness of other braces has proven insufficient for patients with symptomatic medial tibiofemoral OA,[2] a valgus knee brace is being prescribed for them (as per the Dutch National Federation of Medical Specialists guidelines).[3] Use of these braces delays joint replacement surgery as long as possible, especially in relatively young and active patients.
Several systematic reviews have quantified the effectiveness of unloader braces in improving clinical outcomes and mechanical leverage.[4] We believe that there is a huge research gap in understanding the short- and long-term consequences of these braces on the tissues in the knee joint, including the cartilage and ligaments as a part of perception-based studies.[5] Considering these points, a new combination of braces design for OA has been constructed in the present study. This is to prove its effectiveness for the patient with ligament laxity, muscle spasm, mediolateral instability, and muscle contraction.
| Methodology | | |
Materials required for the present experiment included polypropylene sheet, Silicone spray, stockinette, measuring tape, aluminum bar, mechanical joints, soft liners, leathers, and adhesives. In total, 28 patients participated in the study segregated into different mobility groups, including respondents with mobility limited to their home environment, those who were able to walk to a nearby shop, and third group with no mobility restrictions. The mid-axis of the knee joint was marked on the modified mold in fitting parameters. Mark the joint over the mold to intersecting the two lines half inch above the mid axis of knee joint then upper and lower bar both assembles with knee joint. The limited motion ankle joint was converted into free motion ankle joint.
Upper joint bar and lower joint bar placed over the mold. In this joint we used a split stirrup as a lower joint bar. The modified joint was placed medially or laterally in between the center of the medial and lateral wall on the mold, where the axis was marked just half inch above the mid-axis of the knee joint. Bending of upper and lower bars was made in such manner that it don't interrupt at the knee joint movement.
The axis of the knee joint was again marked on the plastic mold half inch above the knee axis by keeping on to the modified mold fitting the joint on to the plastic mold. The joint on the plastic mold strapping and padding was fitted to assure that the patient was comfortable with it. In this study, patients were questioned about symptoms, functional status, and perceived health. The following questions were defined to determine the effectiveness of the knee braces:
- How has your general daily functioning changed since using your knee brace?
- How has your pain symptoms changed since using your knee brace?
- Please indicate how mobile you are with/without the knee brace?
Information about health before and after an intervention was fetched to improve the effectiveness of using a knee brace. This study compared feedback from patients about function gained with and without a semi-rigid knee brace.
No standard or target values could be used in the study, as there were no comparative studies when this research works was carried out regarding the effectiveness of these orthopedic aids. The patient-reported outcome measure (PROM) questions in the study were prepared based on the usual questionnaires used in any pain reliving knee brace, thus adhering to scientifically accepted and validated PROM questions.
| Results | | |
A total of 28 patients completed the questionnaire. Analyzing the movement pattern of the knee in the frontal plane visually, we found individual patterns. Based on the curve progression of the ab-/adduction angle, we were able to identify three different groups.
We choose three groups of people with or without knee brace; then, we find out the graphical data of knee abduction and adduction movement in the gait cycle.
- Group-1: without knee brace, so they cannot do knee abduction
- Group-2: mild knee arthritis with knee brace, they can do full knee abduction
- Group-3: severe knee arthritis with knee brace, but they can do the knee abduction less than Group-2 [Figure 1].
 | Figure 1: Effect of knee brace during walking (Group 1: Red, Group 2: Blue, and Group 3: Black)
Click here to view |
When analyzing the mean curve progressions, it can be seen that the difference between Groups 2 and 3 is small; however, Group 1 shows an entirely different movement pattern. The results show considerably improved mobility while using a knee brace in different mobility groups. In the group of respondents who were limited to their home environment, mobility decreased by 74% while using a knee brace.
In the group of respondents who were able to walk to a nearby shop, mobility increased by 60%, and the group experiencing no mobility restrictions increased from 3% without using a knee brace to 13% while using a knee brace. In addition, 54% of respondents reported a reduction in pain symptoms, and 62% of respondents reported an improvement in the overall daily functioning while using a knee brace. The results of this study particularize the reduction in pain obtained with knee braces to an improvement in self-reported pain symptoms of 54% of respondents after using a knee brace [Table 1]. Thirty percent of the respondents reported that their pain symptoms changed significantly.
| Discussion | | |
Many patients compensate for knee instability by increasing muscle activation (cocontraction) around their knee joint. This provides a stable feeling, but also has a progressive effect on knee OA due to the increased pressure on the knee joint. Wearing a stabilizing rigid knee brace ensures a reduction in muscle cocontraction and pain. With a reported pain reduction of 54%, it is possible that users wearing knee braces in this study used less cocontraction, which might indicate reduced progression of knee OA. Further research is needed to confirm this finding.
The use of pain medications was not assessed in this study, and the use of analgesics could have influenced the results. Although it is expected that only a few patients use pain medication when using knee braces, further research should include this information to investigate the overall reduction in pain.[6] In addition, 9% of patients did not experience any improvement when using a knee brace, or even experienced deterioration. While several factors such as correct knee brace fitting, overcompensation of muscles, or additional injuries could play a role in this, further research is required to understand these outcomes.[7],[8],[9]
Many professionals and organization working for management of grossly degenerated OA knee condition, ultimate solution is total knee replacement, where only drawback comes that muscle spasm due to contraction. In this knee brace for Osteoarthritic condition, Distraction using in this brace so it work like Third class lever. So patient feels comfortable while walking.[10],[11] All these components were placed in this new design of the current study, to make the brace more comfortable and effective, including distraction force phenomenon; however, it was essential to train the patient. Perception-based methods make an assessment of parameters such as, pain, function, and quality of life, marked as qualitative markers of disease progression. However, the disease condition depicts the quality of these methods and depends on mood, physical activities, and at the end on the score provided for each patient. It is also difficult to quantify the morphological and biomechanical changes in the soft tissue regions. Therefore, one should be cautious about making assumptions regarding the predictive value of long- and short-term effects based on the overall physical activity of the patient.
| Conclusion | | |
Therefore, I would like to conclude that I have used my design on the patient with a successful result. It has been proven to be very effective to the patient and has also satisfied him. The results of this large-scale PROM study show that the use of a semi-rigid knee brace appears to provide a suitable joint support, offering pain relief and freedom of movement, and should be considered a useful nonsurgical treatment method for use in patients with knee OA. This large-scale PROM study of the effectiveness of the use of semi-rigid knee braces in patients with knee OA shows that the use of a brace contributes to general daily functioning, reduces pain, and increases the possibility to perform daily activities. For patients with OA, reduced pain enables an increased mobility away from the home environment, resulting in a more active life and increased quality of life. Use of a knee brace appears to provide a suitable joint support, offering pain relief and freedom of mobility.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Reeves ND, Bowling FL. Conservative biomechanical strategies for knee osteoarthritis. Nat Rev Rheumatol 2011;7:113-22.  |
| 2. | Chang J, Chen T, Yan Y, Zhu Z, Han W, Zhao Y, et al. Associations between the morphological parameters of proximal tibiofibular joint (PTFJ) and changes in tibiofemoral joint structures in patients with knee osteoarthritis. Arthritis Res Ther 2022;24:34. |
| 3. | Alfatafta H, Onchonga D, Alfatafta M, Zhang L, Boncz I, Lohner S, et al. Effect of using knee valgus brace on pain and activity level over different time intervals among patients with medial knee OA: Systematic review. BMC Musculoskelet Disord 2021;22:687. |
| 4. | Petersen W, Ellermann A, Zantop T, Rembitzki IV, Semsch H, Liebau C, et al. Biomechanical effect of unloader braces for medial osteoarthritis of the knee: A systematic review (CRD 42015026136). Arch Orthop Trauma Surg 2016;136:649-56. |
| 5. | Khosravi M, Arazpour M, Saeedi H, Rezaei M. Design evaluation in novel orthoses for patients with medial knee osteoarthritis. J Biomed Phys Eng 2019;9:719-32. |
| 6. | Walter JP, D'Lima DD, Colwell CW Jr, Fregly BJ. Decreased knee adduction moment does not guarantee decreased medial contact force during gait. J Orthop Res 2010;28:1348-54. |
| 7. | Morgenroth DC, Medverd JR, Seyedali M, Czerniecki JM. The relationship between knee joint loading rate during walking and degenerative changes on magnetic resonance imaging. Clin Biomech (Bristol, Avon) 2014;29:664-70. |
| 8. | Vanwanseele B, Eckstein F, Smith RM, Lange AK, Foroughi N, Baker MK, et al. The relationship between knee adduction moment and cartilage and meniscus morphology in women with osteoarthritis. Osteoarthritis Cartilage 2010;18:894-901. |
| 9. | Hall M, Diamond LE, Lenton GK, Pizzolato C, Saxby DJ. Immediate effects of valgus knee bracing on tibiofemoral contact forces and knee muscle forces. Gait Posture 2019;68:55-62. |
| 10. | Brandon SC, Brown MJ, Clouthier AL, Campbell A, Richards JD, Deluzio KJ. Contributions of muscles and external forces to medial knee load reduction due to osteoarthritis braces. Knee 2019;26:564-77. |
| 11. | Aghajani-Fesharaki S, Farahmand F, Saeedi H, Abdollahy E. Design, implementation and testing of a novel prototype orthotic knee joint with two degrees of freedom in a patient with medial knee osteoarthritis. Sultan Qaboos Univ Med J 2018;18:e524-8. |
[Figure 1]
[Table 1]
|
Search Pubmed for