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JAS Knee Flexion Splint/Brace

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AlaskanTKR

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Jun 2, 2008
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Palmer, Alaska
Anyone have experience with this thing? The dr. prescribed it and the pt ordered it - should be here mid of next week - last step before manipulation. PT said it takes 3 or 4 sessions of 30 minutes per day and you slowly "crank" in every 5 minutes over the 30 min period. PT is very positive about this choice. Thinks we will get better ROM as opposed to Manipulation at this time.

Any comments welcome!
Marianne
 
Kevin has had his JAS for six weeks or so. He had a left TKR on May 16 and a manipulation in early July. He was stuck at around 95 degrees. He uses his a couple of times a day in both flexion and extension positions. He tightens it once at the beginning to the point of "mild discomfort" and does not adjust it again. As of September 5th, he had made it to 105 degrees flexion but is still several degrees short on his extension. PT was discontinued on the 5th as they think the JAS is helping as much as anything. Be careful not to overdo it with the JAS! This can cause you to LOSE range of motion.

Good luck!
 
Kevin's Wife -
Thanks for the info - I already asked the pt if the insurance would make PT stop and they said no - Good to know that he is making progress. I have stuck at an ugly 90 degrees for a long enough time for the OS to be concerned. Also good to know that it can also be used after a manipulation - which may still be in the future. I would kill for 105 but will wait my turn. The OS thinks when all is done 130 is reasonable so I have a long way to go.

I will be careful to not overdo - I cannot afford to loose any more rom.

Hope Kevin continues to heal - Thanks
Marianne
 
Re: JAS Knee Flexing Splint/Brace

Marianne,

I understand the Jas but why didn't your Doc. not want you to use a CPM. The CPM will take care of both the extension and flexing.

God Bless,
Rick
 
Kevin had a CPM for weeks, but it didn't do nearly as much as the JAS. In fact, he used the CPM and the JAS both for the first two weeks, but then they opted to stop the CPM completely and focus on the JAS. The JAS puts a constant pressure on the joint, stretching the muscles. The CPM works great initially to keep scar tissue to a minimum. Unfortunately, it doesn't for everyone.

Kevin was barely 90 degrees before manipulation, 115 immediately after, and then regressed back under 100 for a long period of time. Even today, at 105, he can't pedal a bicycle a complete revolution. It looks like there was far too much previous damage from the initial accident in 1992 and the following nine surgeries prior to the TKR. But the pain is less today and he still has the leg. For that, we're extremely thankful.
 
I too had a cpm for 6 weeks after the tkr. I used it religously at least 6 hours a day - either 2 3s or 3 2s. During the first week in the hospital it ran like 6 hours 2 times a day and the next 3 weeks it was at least 6 per day - some days more. After going back to work I would come home and try my best to get the next 6 hours in the cpm. Weekends were easier - I eventually got to 90 at the 6 week mark and the OS and CPM people felt I would probably not get much more from its use at 90. Plus with increased work schedule 6 hours wasn't practical on top of pt and rest and elevation and ice. so...... here we are.

The OS described pretty much what Kevin's wife describes. Thats why I am sort of excited to try this JAS before the manipulation. The OS says most people come out of manipulation with a good ROM and often regress. More than likely I would since I have an issue with swelling. This knee has had 5 scopes and a torn medial collateral ligament prior to the tkr so things have been "busy" in there. After scopes I always swell considerably but have never ever had a problem with rom. Sounds like Kevein experienced exactly what my OS described. I hope he can get back to the 115. I so know the feeling of being stuck. Out of curiosity - what does Kevin's surgeon think about how he is progressing. Both the OS and the pts I see are so positive and just keep telling me to work through as much of the pain as possible - take the drugs - (and this from an os who cuts me off usually after week 3 of a scope!)and to remember that each person heals differently!

Thanks for all your input. I am so swollen from the treadmill again - Yikes -Icing all day today has really helped!

Marianne
 
I think surgeons are trained to push the positive because we spend so much time focused on the negative. When we don't achieve what they claim we can, they address the current situation and then state, "This is normal. You'll see a great improvement soon!"

After reading all of the issues that others have suffered, I bet each person can safely state, "I'm glad I didn't have that issue." There is always someone who has something worse, and we must learn to celebrate every bit of forward progress, no matter how small.
 
Marianne/Kevin's wife,

Help me here a little. I have read about the JAS and I have a CPM. Now the JAS can be set to what ever ROM you can take and just leave it. The CPM can be set between a range or if you like it can be set just like the JAS. So to me the CPM is a little more advanced. Sorry!

Rick
 
Ok - my info is not first hand yet so I can only relate what the PT and OS told me. It seems similiar in that it is a passive stretch like the cpm. The difference is that it is static - you set it for a 5 minute stretch then at the end of 5 minutes you crank it a bit to add to the stretch then let it stretch for another 5 minutes. If you can crank it - even a little - you crank it for another 5 minutes, etc - if all is good in the world you do this 6 times over the 30 minutes period. Its sort of like what they have been doing with me on the total gym - but only I am in control and the idea is to crank it only as much as you can tolerate with a good stretch maybe to a pain level of only 2 or 3.
The cpm is continuous passive motion where it is a more repetetive stretch. It worked for a while for me but once I hit 85 it just petered out. I tried using it in a similiar way to the way this thing is supposed to work but - not sure if it was the angle or what - it just didn't work. I m hoping this thing works. It seems to be like a follow up to the cpm for those of us who have more scar tissue issues or swelling issues that won't quit.
The more I think about it - the moreit is like what the pt does when he bends my knee prior to being measured - I hang off the table an he slowly pushes against the knee. With the JAS I can reproduce his action 3 times per day for 30 minute periods in addition to seeing him 3 times per week. Heel slides on the floor and wall would be similiar but due to the swelling and scar tissue they have been difficult - in addition my husband is not home to help. When he was home the wall slides seem to help - He would gently apply pressure - unfortunately my 9 year old could not reproduce the same exercise. He works away for 2 weeks and is home for 1.

I will let you know how things go.
Thanks for your input Rick and Kevin's Wife - it helps to hear from others!
Marianne
 
Marianne,

Thanks for the information on the JAS, I did some more searching and found this. Now I am a little more educated and understand your need for the JAS. I hope it gets you ROM moving in the right direction.

How does a JAS devices differ from CPMs (Continuous Passive Motion devices)?
"CPM devices are motorized and are used for several hours per day early post-surgery in order to prevent loss of joint motion. CPM has been shown to prevent adhesion formation, reduce swelling, and improve healing of joint tissues after trauma or surgery. CPM devices are not designed to restore motion of a joint that is surrounded by stiff tissue. As opposed to CPM, JAS devices are manually driven rather than motorized, are used for 30-minute treatment sessions, and restore motion in a joint that is already stiff. They provide prolonged end range stretch to shortened tissues in order to produce a permanent change in length".

God Bless
Rick
 
First hand experience relating to extension. Needs to be done within 2-3 weeks of surgery or the knee sets into place. Longer they wait to use the less the likelyhood of it improving. Generally speaking manipulation is not an opion in many cases of poor extension as they are worried that they will break a bone during manipulation.

I am at six months on bi-lateral TKR and it is being used on right knee with no noticeable improvements after 4-5 weeks. Left knee is fantastic.

Second Doc wants me to use for up to 6 months 3 xs per day 30 minutes at a time as you described in first post on this thread.

If done too late it their last chnace before having to redo the knee. Issue in extension is caused by the knee prothesis being too close together thus restricting ROM. This is generally caused by not grinding enough off thigh or shin or the prothesis being out of spec to begin with.

If they re-operate it appears they did something wrong and they are deathly afraid of a mal-practice lawsuit. 2nd Doc feels I have to learn to live with a leg that will not straighten and causes severe pain at night preventing sleep. They are just as bad as the police with their Blue Wall of Silence, I call this the White Wall of Silence.

Original OS mentioned that there is a problem of tightness with Smith&Nephew journey prothesis but of course clammed-up when I asked for details.
Hopefully yours will work out fine.
 
I am just over six weeks and I am not doing so hot with the rom ao I think that I will be calling the OS tomorow and asking him if this is a relivent option?
 
Rick - Well said! Thank you for the words I couldn't find! I have high hopes for this thing because of the swelling that might accompany a manipulation. I am keeping my fingers crossed. Biggest problem now is getting it - It will be sent Fedex from JAS directly to the PT - but the PT office is 45 minutes away from the OS and everything is being done by phone and Fax. They are hoping to have it Wed, Both PT and OS would like it in place b4 the Thursday apt woth the OS.

Dave - Luckily extension isn't my issue - it is all rom We have the extention just about perfect - just a little more to go - but the OS shoved on it and he felt confident that at least that is no problem. The situation you are in sounds sooooo painful to deal with. I guess I should be glad mine is flexion not extention. At least I have the option of manipulation if necessary. I generally only have real pain during the measuring and bending for ROM at pt. The exercises are all tolerable with occassional owies. Tonight I have a bit of pain in a place I haven't had it b4. It like actually really hurts. It only started 30 minutes ago and I can't figure out what is causing it. Oh well - I am sure this to shall pass.

Shoust - Good Luck! I hope they can get you some relief. If I ever get this thing and get it in gear I will update ya!

Marianne
 
Marianne, those little pains come and go. I think after going through this, all of us get a little hyper sensitive about the knee.
Yesterday, I cut the heck out of my left hand while sharpening a lawn mower blade. I jumped back and hit my new knee on the edge of a wooden box. Like an idiot, I'm bent over rubbing and checking my knee while my hand is bleeding.
Both knee and hand survived.
Keep working that knee and loving those kids like you do...
 
Doug -

Holy cow! Did you get the hand looked at? Blades give me the willies (Husband had a chain saw accident one winter while cutting wood 10 mile sout of town). Yikes. I hope you are doing ok. I know what you mean about things coming and going - Last pm we needed to do "poop patrol" in the yard. The hubby seemed to forget that job while he was home. My malamutes leave cow pies behind. After 20 minutes of trudging around in the gravel that is now my back yard I was ready to cry - in fact I think I did. My knee was HUGE. Crawled into bed - ran the cryo-cuff all night and guess what - this am all was as normal as normal gets these days. Same with the treadmill this pm - Huge and red for about an hour after ward - but then the ice and ahhhhhhh. ALl is good with the world.

Hope the hand is ok - and the knee is holding on there. Still waiting on the JAS - Next day air into Alaska seems to be more like 3 day priority. Oh well -

Marianne
 
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