The V-VAS Orthosis for severe Osteoarthritis of the Knee
Whilst there are various options for treating severe, single compartment, osteoarthritis (OA) of the knee, these severe forms can be very difficult to treat successfully whether by medication, surgery or orthotically.
When patients have co-morbidities that prevent pain-relieving surgery the V-VAS (Varum Valgum Adjustable Stress) orthosis has proved to be a particularly successful conservative orthotic approach in hundreds of cases.
The V-VAS is a custom fit orthosis made with a special technique and components. An intial, standing, plaster cast is taken of the patient whilst some careful manual correction is applied to the joint with a special technique. The resulting cast is used as the model around which the V-VAS orthosis is manufactured. The resulting orthosis is extremely light and comfortable to wear but the real secret of it’s success is it’s structural joint design that allows the amount of offloading provided to the damaged joint to be carefully adjusted and controlled.
Most orthotic designs on the market cannot offload a severe OA knee case without using very high forces on the surrounding tissue which result in discomfort - and almost certainly the result is rejection of the brace.
The V-VAS uses a “Dynamic Closed Frame” that allows some unique features including easy adjustment whilst being worn by the user. The patented joint design efficiently allows the damaged joint compartment to the “off-loaded” producing pain relief and a return to activity.
Instead of using a narrow frame as seen on most designs, it uses a total contact cuff on the thigh and tibia along with an adjustable, self aligning, polycentric joint system to create four points of pressure instead of three. There is no need for a condylar pad. This results in increased comfort.
Sample Case (Mr MD - 47years OLD)
1985 left knee arthroscopy & open medial menisectomy
1995 repeat arthroscopy shows complete loss of medial chondral surface
2005 right knee arthroscopy - bone on bone contact. Both knees moderate PFJ and lateral compartment chondral loss.
Bilateral clinical varus > 20 degrees
Both knees lack 5 degrees full extension
Moderate effusion right knee only
Severe pain and swelling right knee
Too young for joint replacement
Too severe for chondral resurfacing
Too advanced for high tibial osteotomy
May be suitable for Benjamin’s double osteotomy
Interpretation of Outcomes
Brace initially used 2 - 4 hours per day
Now used during whole working day
Excellent reduction in pain and swelling of right knee
No brace 11 deg Varus
With brace 4 deg Varus
Indications for the V-VAS Orthosis
Mild to severe Genu Varum or Valgum
Non-operative Tibial Plateau fixations
Failed Tibial Plateau Reconstructions
Post total-knee arthroplasty
Tibial and/or Femoral spacers
At present we are looking to establish a training programme to roll out the V-VAS beyond our current Scottish Central Belt area.