“The patient sets the agenda”

Cartilage damage or even degeneratively advancing osteoarthritis? Stage 2, 3, or even 4? For Dr. med. Martin Schiweck from Aachen Orthopedics Clinic in Germany, the patient’s problems and goals are the most important aspects when taking a case history to ensure finding the best treatment solution.

Bauerfeind life: What is your usual approach to cases of osteoarthritis of the knee?

Dr. Martin Schiweck: Essential questions about a patient’s medical history include: how long has the patient had problems? How far can the patient walk? What has been done so far? Some kind of imaging is also mandatory. An MRI can be very helpful if the condition is not advanced yet. This allows us to see the menisci, cartilage, ligaments and the response on the bone marrow. Perhaps surgery is not the best choice.

What could be the alternative?

Dr. Schiweck: A conservative approach – for as long as possible, according to the guidelines of the DGOU. For this, I need to know the patient’s intentions. Do they definitely want to exercise? Or does the patient not have time for surgery because of upcoming work commitments? The patient sets the agenda. With potential osteotomy candidates, for example, we can also achieve an axial situation that alleviates symptoms with a relieving hard frame orthosis, such as SecuTec OA. Perhaps that will initially satisfy the customer. We can usually find this out during a brace test. Orthoses offer many options. We can combine them with pain therapy. To do this, we will consult with primary care doctors or cardiologists. The important thing is that the patient remains active. Patients with osteochondritis dissecans will receive a relieving orthosis from us, such as SecuTec OA, if corrective osteotomy is not required to begin with.

Can a person run a marathon with osteoarthritis of the knee?

Dr. Schiweck: A friend of mine, same age as me, 45, whose medial cartilage has been completely destroyed thus exposing the bone, tried a half marathon. I didn’t recommend it , but I prescribed him the new GenuTrain OA. He also ran with a raised outer edge on his shoes. He said that he got on well. But that’s an extreme example. Still , it shows how performance can differ, despite the diagnosis, and how effective certain medical products can be, especially when they’re combined.

Which other experiences have you had with GenuTrain OA?

Dr. Schiweck: Together with a medical supply retailer in Aachen, we carried out a wearing test. I’ve so far had feedback from five patients. They all want to keep wearing them. In general , you can’t go wrong with this close-fitting orthosis with varus or valgus adjustment , unless the patient has some sort of skin disorder.

Do you also prescribe supports?

Dr. Schiweck: Supports, such as GenuTrain or GenuTrain A3, are well accepted by patients. Owing to their proprioceptive stimulation, I find them very useful in secondary prevention, for example for young football players following lateral meniscal suturing. If the prevention of osteoarthritis of the knee is helpful , it’ll be after these knee injuries in young people.

Image: Michael Bause