To assess the outcome of Offloading Knee brace (V-VAS) in the treatment of osteoarthritis of the knee. A total of 147 patients with knee arthritis were included in this study. Eighty six patients were followed up retrospectively and 61 patients were followed up prospectively. Average follow up was about 3.4 years in retrospective group and 1.2 years in prospective group. The Oxford knee score, Pain score, Walking distance and Patient satisfaction were evaluated. Average oxford scores before the brace was 19 and after the brace was 32. The pain scores before and after the brace was 8 and 3 respectively. The walking distance had improved to 900 yards. The patient satisfaction was 78%. Thirteen of eighty six patients in the retrospective group discontinued the brace, of these two had high tibial osteotomy, six patients had total knee replacement, one had unicondylar knee replacement, one patient had dislocation of patella and two elderly patients were house-bound because of medical problems. The Off loading knee brace is effective in the management of osteoarthritis of the knee. Patient satisfaction is high when using the brace. However compliance may be an issue in some of the patients. Education and early appointment for brace re-fitting increases patient compliance. Bracing is a beneficial treatment for severe medial OA of the knee.
We carried out a retrospective review of 47 intra-articular fractures of the calcaneum treated by open reduction and internal fixation in 45 patients by a single surgeon between 1993 and 2001. The fractures were evaluated before operation by plain radiographs and a CT scan using Sanders’ classification. Osteosynthesis involved a lateral approach and the use of the AO calcaneal plate. The mean follow-up was for ten years (7 to 15). Clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS), the Creighton-Nebraska Score, the Kerr, Prothero, Atkins Score and the SF-36 Health Questionnaire. The radiological evaluation consisted of lateral and axial views of the os calcis. Arthritic changes in the subtalar joint were assessed with an internal oblique view and were graded using the Morrey and Wiedeman scale. There were 18 excellent (38.3%), 17 good (36.2%), three fair (6.3%) and nine poor (19.2%) results. Five patients had a superficial wound infection and five others eventually had a subtalar arthrodesis because of continuing pain. Restoration of Böhler’s angle was associated with a better outcome. The degree of arthritic change in the subtalar joint did not correlate with the outcome scores or Sanders’ classification. Prompt osteosynthesis should be considered for intra-articular fractures of the calcaneum in order to restore the shape of the hindfoot and Böhler’s angle.
