The LIBRARY => Knee braces => Topic started by: Liverbird38 on September 16, 2011, 11:34:51 AM

Title: Will a brace help ?
Post by: Liverbird38 on September 16, 2011, 11:34:51 AM
Hi everyone
I'm 38 and in 1994 had a knee injury that went undiagnosed for 10yrs. To keep the story short, I have had 2 failed ACL reconstructions. The situation with my knee at present is as follows: I have advanced Medial Femoral Arthritis with Osteophytes due to having badly worn away Medial Meniscus, which is as a direct result of having no ACL. I no longer have a PCL either, and have degenerative changes to my patellar Tendon. Pretty much everything is a mess except my MCL LCL ligaments. My hospital have advised that the only treatment available to me is complete knee replacement surgery, but, because of my age they will not perform this until I am 60-65yrs of age. I have been advised that my best option at the moment would be to try to prevent further injury/damage to the joint by wearing a knee brace; this, I have been told, will help with joint stability and help ease the pain. I have no experience with knee braces and would really appreciate any advice you can offer. Would a knee brace really help me do you Feel ? and which one would be the best one to get ? Can they be worn over the top of normal clothing like Jeans or example ?
Thank you so much for taking the time to read my post.
Title: Re: Will a brace help ?
Post by: Kaputt_Knee on September 16, 2011, 03:09:38 PM
Firstly, braces are designed to be effective by wearing them next to the skin and fixed firmly in place. If you wear them over your clothing, they cannot be tightened sufficiently to function as they were designed to. So it looks odd and is useless. The only thing you are doing is saying  " Hey, look at me I'm wearing a brace."

Secondly, there are people here who have had TKRs in their 30s. It is a measure of your quality of life that matters rather than a date on a calendar. It would be better if you can be referred to patello-femoral specialist as there are many options available these days. If a general orthopaedic surgeon has not kept up to date with joints outside of their special interests they may not know of the newer approaches.

You also need to have the brace prescribed as the good ones are not cheap. Looking at what you have described I would be leaning to what is called an unloader brace, or at least that as part of its functionality. Good effective ones are expensive and usually custom fitted.

Go back to your GP after having had a look at some of the names of specialists in your area or in places where you are able to travel to. You can start by looking here:

Plus take a look at some of the names on the hospital web sites here:

and in your immediate area. I'm assuming from your name that you are somehow associated with Liverpool and not just a fan of the comedy from the 1960/70s, cos you are too young  ;)

You can search on TKR and age as well by searching the threads. The search function is pretty good once you get used to it. Once you have 20 posts you can directly message any people who had TKRs at an early age.

Good luck - don't let them fob you off with the you are too young excuse. Does your life have to be pain-filled and put on hold effectively for nearly 30 years? Push the quality of life and pain with your GP and see if you can get a referral to someone who thinks outside of the box labelled "Too Young"

Sue  :)
Title: Re: Will a brace help ?
Post by: Liverbird38 on September 17, 2011, 10:56:56 PM
Thank you so very much for taking the time to reply. The information you gave me was invaluable and I feel a lot better informed now. I have spoken with several surgeons regarding the TKR and not one of them will do it. I was refered to my consultants professor to get another opinion and he point blank refused too. I am in agony 24/7 and are unable to work at the moment due to the pain and side effects from my meds. I had a chat with my G.P and explained about the dire quality of life I had and although he agreed with me he would not go against the decision these other surgeons have made so I feel like i'm on my own with this. I could just cry some days as nobody will help me.  I can't sit for long without experiencing pain and can't stand or walk without pain but the hospitals just keep telling me there's nothing they can do. I will see what I can do about the brace as have an appointment at the hospital on Monday for an injection in my knee so will see what they say about sorting that out at the very least for me. Thank you again for all your help I am really grateful.
Title: Re: Will a brace help ?
Post by: dm on September 18, 2011, 04:35:21 AM
If a replacement is absolutely off the board as an option then I'd be pursuing things from a what can they do to improve the quality of life standpoint??

1. can they trim the osteophytes to improve the joint function and make it operate more smoothly, even if that will only last a few years due to bone regrowth? heck, if it works for 4-5 years in conjuction with a good fitting unloader brace to take the strain off that medial side, then that would be worth doing.

2. can they reconstruct your acl to give you some stability back? Doing the PCL too would be asking too much methinks, but if they could give you your acl back, that would go a long way to stop the tibia and femur from sliding and grinding on each other and making matters worse.

So, to me, just from what you describe, if they'd trim up the bone spurs, put an acl in there to take the slop out of things so that the bones quit sliding around so much and making the bone spur growth and cranking on the already deficient meniscus areas worse than it has to be, and put you in a custom unloader brace with some ligament instability option stuff in it too, to help with taking the stress off the damaged side and add some stability assistance, then that would go a long way to buying you some time to get to the point where they could do a TKR, plus I think an unloader brace would give you the pain relief you seek on the medial side that's being compressed w/ missing meniscus and bone spurring.

BUT you gotta convince them to do this for you, which has got to be hard when dealing with the NHS. I'm in the US, so the rules are different. If you could somehow manage to go private, then you might have other options.

One of Ossur or Townsend's unloader braces that also has some ligament instability options added may be what you need, an OS experienced with combined issues like you have would really know, also depends on what's available where you are and what you can afford. My Ossur unloader is custom and would have cost me $2500 USD if I had no insurance, but with insurance, and the way our system works, my portion of cost was about $250 about 5 years ago. I'm going to end up in a new one soon enough... I beat them up with 12-16 hr a day use.

meanwhile, you might look into multi-modal pain managment methods, if you're hurting as much as you sound like. I use things like electrical stimulation (tens) combined with ice which helps, and local anesthetic patches on the knee just below the kneecap across the front of the knee and to the inside covering the tendon in front and the inside joint line which helps dial the pain down a couple notches on the pain scale, stuff like that, to help lessen the need for stronger painkillers, which I also use at need. I switch things up, so that the stronger stuff keeps working when I really need them to.

I hope you can convince them to do something to help you at least get functional, if they're absolutely adamant that they won't just give in and do the replacement that they seem to say you need in most respects but don't meet their guidelines for because of age. To me that means they need to think harder and come up with another option besides leave you to become pill dependent and nonproductive because of the knee's current condition - what else were they gonna do - sign off on permanent disability checks for life for you because of it?
Title: Re: Will a brace help ?
Post by: Liverbird38 on September 19, 2011, 06:34:24 PM
Hi guys thank you once again for all the advice you have both given me. I can't believe how much info you have given me; wish te hospital/GP had been as helpful. Anyway, had an appointment today with OS and put forward some of the suggestions given to me and was informed that surgically, all they can offer me is a wash-out of the knee. I have spoken with my GP and are gonna change my meds to the patches so hopefully that'lll help with the side-effects form the one's i'm currently on. The OS has ordered me a brace although am not overly keen on the make as it's the Donjoy OA adjuuster and have heard nothing but negative things about this brace but i'll give it a go; anything has to be better than what 'm going through at the moment. Are going to look into getting a TENS machine too. I am overwhelmed with all the advice you have given me and it will make a difference to how i'm living with my knee problems at the moment. I feel like you have opened a few doors to me that the professionals didn't make me aware even existed so thank you so very very much.
Title: Re: Will a brace help ?
Post by: dm on October 08, 2011, 12:55:59 PM
You don't say which country you're in, which may have some impact on what is available to you for brace options. One thing you can do is to talk to the brace provider, and see if you can have some input on getting another brand, as what's prescribed may be nothing more than OS preference, and if you can convince the brace provider you'd be better off in another model, he may be able to help you out. The oadjuster is well known for having chafing issues, and if you've got skin sensitivity problems, then bring that up before they try and order you one! Ossur's Spriit might serve just as well, for example, and it doesn't apply pressure at the joint via condyle pad like the oadjuster does.

See, the thing is, Donjoy's oadjuster is an off the shelf brace, which lowers cost. Ossur's Spirit is also an off the shelf unloader, but some physicians don't know it exists, or they're just preferential to Donjoy. I'm more active, I like Ossur's products better because there's more frame to the brace, which hangs onto me better.

My advice is to talk to the brace provider about your activity level and what YOU want in a brace, the brace provider can go back to your OS and tell them that the model suggested is inappropriate for you in their opinion, and that a different model that does the same thing would work better.

Suggestion..... go to ossur's and donjoy's and townsend's web sites and read about the braces, and become a more informed customer.