Abstract: Following a request from a consultant, a new brace designed for the reduction of residual flexion contracture was procured and supplied.
Introduction:
There are a number of braces available for the reduction of flexion deformities which rely on dynamic stretching1, 2,3. These offer an ambulant brace with a variable tension spring to encourage knee extension.
On the request of a consultant who had seen a newer design of brace at a conference, I was asked to provide the brace which allows the patient to control a tolerable stretch to the affected joint in set therapeutic time slots4. This allows patients to decide not only on the tolerable stretch applied to their joint, but also to plan this therapy into their working lives.
Case presentation
First patient sent for measurement for the JAS GL brace was a patient, who worked as a self-employed plumber. He underwent a total knee replacement with another, now retired orthopaedic surgeon several years previously and although had less pain in the replaced joint itself, the residual flexion contracture of approx. 10 degrees caused secondary muscular fatigue pain and hip pain.
The patient was appointed for measurement for the device per manufacturer / distributor instructions5.
After the procurement and appointing procedure the patient was seen and fitted with their brace to ensure correct fitting and patient instruction. Given that these devices rely on patient compliance to ensure correct application of the soft tissue stretch, this process is very important.
Once the patient is happy with the device and able to apply and remove, they were issued with the brace to use, along with the department’s telephone number to ensure that they are able to obtain advice during the period the device is to be used.
On supply the patient appreciated and was aware of the function of the brace.
To date this patient has not been reviewed in orthopaedics as his appointment has been changed however the referring consultant is to report back once this review has occurred
Discussions and conclusions:
Given the potential for knee flexion contractures post TKR and problems related to them6,7,8, it seems appropriate that non-operative solutions are available. The use of a simple, user directed device which need not be worn for long periods will allow those requiring reduction of flexion contracture a therapy which can be accommodated within the working day.
Author: Richard Webb
