Knee Orthosis, Double Upright with Adjustable Joints (Custom Fabricated)

Name of the Procedure:

Common Names: Custom knee brace, double upright knee orthosis
Technical/Medical Term: Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated - HCPCS Code L1846

Summary

A custom-fabricated knee orthosis is a specially designed brace that supports the knee joint. It features adjustable joints to help control knee movement, providing support and stability while allowing necessary motion. This orthosis is tailored to fit the patient's leg precisely, offering effective management of various knee conditions.

Purpose

Medical Conditions Addressed:

• Instability due to ligamentous injuries
• Post-operative support
• Arthritis-related instability
• Knee hyperextension

Goals/Expected Outcomes:

• Improved knee stability
• Pain reduction
• Enhanced mobility
• Prevention of further knee damage

Indications

Symptoms or Conditions:

• Knee instability
• Pain and discomfort in the knee
• Post-surgical support requirements
• Limited knee function due to injury or arthritis

Patient Criteria:

• Individuals with ligament injuries
• Patients recovering from knee surgery
• Persons experiencing arthritis-related knee instability
• Those needing rotational control and varus/valgus adjustments

Preparation

Pre-Procedure Instructions:

• No specific fasting requirements
• Continue regular medications unless otherwise advised
• Wear loose-fitting clothing for easy measurement

Diagnostic Tests:

• Physical examination of the knee
• Imaging tests like X-rays or MRI, if required
• Gait analysis or movement assessment, if applicable

Procedure Description

1. Assessment and Measurement:

   • Performing a detailed examination of the knee's condition.
   • Taking precise measurements of the thigh, knee, and calf.

2. Custom Fabrication:

   • Using measurements to create a mold or digital scan of the knee.
   • Fabricating the orthosis using durable materials.

3. Fitting and Adjustment:

   • Ensuring proper fit and comfort.
   • Adjusting the flexion and extension joints as per the patient’s needs.
   • Adding medial-lateral and rotational control features.
   • Including varus/valgus adjustments if necessary.

Tools and Equipment:

• Measurement tools (tape measure, calipers)
• Fabrication materials (polymer, metal uprights, adjustable joints)

Anesthesia or Sedation:

• Not required for this procedure

Duration

• The entire process, from assessment to fitting, may take several hours spread over multiple visits.

Setting

• Orthotics and Prosthetics clinic, may also be part of outpatient services in a hospital

Personnel

• Orthopedist or orthopedic surgeon
• Certified orthotist
• Assistive nursing staff, if needed

Risks and Complications

Common Risks:

• Minor discomfort during fitting
• Skin irritation or pressure sores from prolonged use

Rare Complications:

• Poor fit leading to ineffective support
• Allergic reaction to materials used

Management:

• Regular follow-up appointments for adjustments
• Immediate reporting of discomfort or skin issues

Benefits

• Significant improvement in knee stability
• Pain reduction within days to weeks
• Enhanced functional ability and mobility
• Tailored support specific to patient’s condition

Recovery

Post-Procedure Care:

• Regular wearing as instructed by the orthotist
• Maintaining skin hygiene under the brace
• Periodic adjustments for wear and comfort

Recovery Time:

• Generally immediate functional benefit
• Full adjustment to using the orthosis may take a few weeks

Restrictions:

• Follow activity level recommendations by healthcare provider
• Attend follow-up visits as scheduled

Alternatives

Other Treatment Options:

• Off-the-shelf knee braces
• Physical therapy
• Medications for pain and inflammation
• Surgical interventions (in severe cases)

Pros and Cons:

• Custom orthosis offers tailored fit but is more expensive and time-consuming
• Off-the-shelf braces are cheaper and quicker but may offer less effective support

Patient Experience

During the Procedure:

• Minimal discomfort during measurement and fitting

After the Procedure:

• Initial period of adjustment, potential minor discomfort
• Improved stability and comfort after the adjustment period

Pain Management:

• Over-the-counter pain relievers for minor discomfort
• Consultation for any significant pain issues