Musculoskeletal Care of the Mature Patient

Is there an approach to treatment of symptomatic osteoarthritis of the knee for patients who aren’t ready for a knee replacement and who would prefer postponement by several years? What is to be done for the patient with altered quality of life who has been cautioned against joint replacement surgery because of systemic illness such as heart disease?

 The combination of pulsed electrical stimulation with a brace to reduce the load on the affected compartment may be the answer to reducing pain and increasing a patient’s function. The concept of pulsed electrical stimulation for treating symptomatic patients experiencing debilitation form osteoarthritis is not new, the FDA has cleared the device as an adjunctive therapy for osteoarthritis of the knee based on clinical studies in 2006 and 2007. The efficacy of an unloading knee brace has also been examined in depth. That information has been available since 1999 as an addition to standard medical treatment for osteoarthritis of the knee.

Enter the combination of an unloading brace coupled with a pulsed electrical system and there is the potential to postpone knee replacement surgery for years and to manage arthritic patients wherein a co-morbidity, systemic illness, will not allow a patient to safely undergo a knee replacement. Will it work? To answer the question a multicenter clinical study has been developed and I have been recruited to serve as one of the centers for the FDA study. Medicare is sufficiently enthusiastic about the potential success of this form of management for osteoarthritis of the knee that it will pay for the device.

Should you decide to avail yourself of this method of management for an osteoarthritic knee because you are not ready for surgery or because you have been advised that surgery carries too great a risk, after a physical examination and review of your X-ray, should you meet the study criteria, you will be measured for the device. Full informed consent will be executed at the time of the office intake. The participant’s burden is to wear the unit eight hours a day for four months. The eight hours of mandatory usage need not be continuous. Follow-up visits are not burdensome but will be required over the ensuing five years.

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