“You can’t do that with just any orthosis“

The pronounced axis misalignment of Gerald Thieme’s leg presents a challenge for gonarthrosis orthosis therapy. Ralf Müller from the saXcare medical supply retailer in Chemnitz, Germany, is amazed by the range of treatment options offered by the new SecuTec OA.

Bermuda shorts are an extremely practical item of clothing in many respects on this hot summer day. Instead of standing at the assembly line of the VW engine plant in Chemnitz today, Gerald Thieme is sitting in shorts in the treatment room at saXcare in the Schönherrfabrik center in Chemnitz. We’re here to talk to him and master orthopedic technician Ralf Müller about the pain-relieving SecuTec OA knee orthosis. The medical supply retailer saXcare gave Thieme a custom-made orthosis for use as a patient and also provided him with a series-produced orthosis for a wearing test , whereby the two can complement one another…

Uncommon medical conditions

saXcare’s orthopedic technology center for made-to-measure products is located in a glass tower at a historical industrial site that formerly housed a loom factory. Ralf Müller is responsible for customized orthotics and prosthetics at the center. “These specialized products are generally used to treat people with uncommon medical conditions, who account for around 20 percent of our customers,” he explains. “However, that doesn’t mean we can only set aside 20 percent of our time for them.” Such patients have a legitimate need to use non-standard products that nevertheless offer optimal care. Although it takes a great deal of effort to meet this need, the experts at the center enjoy putting their extensive craftsmanship abilities to work for this. “Every customer has the right to put our technical skills to the test ,” says Müller. “For us, this is a source of motivation, and we also consider supplying fine products to be a matter of honor.”

Cruciate ligament tears and axial deviations

The misalignment of Gerald Thieme’s left leg is uncommon and immediately noticeable: his left thigh and calf display a pronounced arch. Whereas the axis of his right leg is almost completely straight , the left axis is sharply curved, leading to a bandy leg with a deviation of 15 degrees. The scars on the knee are from reconstructive surgery on his anterior cruciate ligament. The football injury Thieme suffered a long time ago that led to the surgery also likely played a role in the development of the misalignment. What’s more, Thieme continued to play football up until recently. After all , a varus deformity can be helpful when it comes to outmaneuvering a defender. However, his axial deviation was certainly of no benefit after his football matches, on the assembly line at work, in the garden, or while riding his motorcycle – the latter being the 59-year-old’s greatest passion.

Pronounced varus deformity leads to medial gonarthrosis

An extreme varus deformity is generally accompanied by medial gonarthrosis. Although Gerald Thieme wore a GenuTrain support , he found he could no longer ignore the increasing pain he was experiencing. The wear on his cartilage in the medial knee compartment was too far advanced (grade II to III), so his doctor prescribed him a custom-made orthosis. The cast carbon orthosis produced from a plaster impression by saXcare was designed to provide relief to the damaged knee by correcting the misalignment. Thieme needed valgus pressure to provide medial relief for his varus gonarthrosis. “It’s important to use a reasonable approach here because patients often won’t accept pain caused by overcorrection,” Müller explains. “The orthosis must not be allowed to exert constraining forces or pressure in sensitive areas. In one case, I actually observed how a patient’s tibialis anterior muscles became paralyzed.”

SecuTec OA surprises the experts with test

Before the SecuTec OA market launch, a call was sent out to gonarthrosis patients asking if they would be willing to take part in a wearing test. Thieme’s condition made him a perfect candidate – the question was whether the orthosis could be made to fit him properly. After Thieme spoke with his physician, the decision was made to have saXcare also fit the near-production prototype of the new SecuTec OA for Thieme to use in the test. The “airier” industrial orthosis was a new experience for Thieme – but not for saXcare: “We were already familiar with SecuTec Genu, which has a similar design and is used to treat instability of the knee,” Müller explains. “Still , we were surprised by the quality of SecuTec OA and the possibilities it offers.”

Joints move congruent to the adjustment

The production orthosis has been available since May. On the day Thieme had it fitted, he and Müller were able to experience the possibilities it offers in greater detail. The VW mechanic sat down in front of the orthopedic mechanic, who pulled the anatomically contoured orthosis over Thieme’s left knee and adjusted it in line with his leg axis. Müller then took two bending hooks, which he used to bend the aluminum ends of the thigh frame slightly outward, thus creating space to accommodate Thieme’s large thigh muscles. “You can’t do that with just any orthosis; you need to have firm material that’s not brittle, or else it will break,” says Müller, who then points to the centerpiece of the orthosis: “The joint axes have to move congruent to the adjustment during the crimping process – that’s the true art of fitting here. This ensures that the anatomical pivot point doesn’t shift and that the rolling and sliding function of the knee joint is maintained.”

“I hardly notice the orthosis anymore when I wear it. It’s light and doesn’t show under clothing.”Gerald Thieme

Movable calf shell ensures secure positionin

Gerald Thieme looks down. He’s familiar with this view by now after having worn the orthosis for several months. “I hardly notice it anymore when I wear it ,” he says. “It’s light and doesn’t show under clothing. I can sit better with it and it also helps me a lot when I’m standing on the line in the plant.” The orthosis feels light because there are no constraining forces and no pressure caused by overcorrection. With SecuTec OA, pressure is distributed gently along the lower leg over a large contact surface that can be made even more form-fitting through the use of adjustable condylar pads. The final adjustment that enables the relieving effect is made using an Allen key. Here, Müller can correct the leg axis in the varus/valgus setting by adjusting the hinges on the lower leg frame. The extreme deformity is counteracted by valgus pressure. The movable calf shell also provides support here: “It’s a type of design benefit that no other orthosis can offer,” Müller explains. The shell has a self-regulating inclination angle that enables it to adapt comfortably to the shape of the calf and also ensures a secure fit.

Custom-made and series-produced orthoses

Everyone who took part in the SecuTec OA test , including physicians, had a similar reaction to the product – amazement that a series-produced orthosis can also correct a severe misalignment , like a custom-made orthosis does. “In Mr. Thieme’s case, however, we’re working at the limits of what’s feasible, in part due to his muscle structure,” says Müller. Gerald Thieme in any case is very happy: “I feel stable when I walk and the orthosis feels secure – it’s my favorite piece of clothing in Bermuda shorts weather and it fits better under my motorcycle pants as well.”

Images: Frank Steinhorst (3), Bauerfeind