Featured Technology: OssKin Evoke Knee Brace

September 17, 2020

Chris Toelle, LCO, Hanger Clinic East Zone Orthotics Specialist

Historically, it has been difficult to capture the complex motions of the human knee joint using a knee orthosis joint. Traditional knee brace joints move in a single plane, whereas newer, more modern designs, like the 3D printed Evoke knee orthosis by OssKin, more closely mimic the natural movement of the knee, helping to better protect, align, and reduce pain.

Knee orthoses can be used as a low-risk, cost-effective method to treat osteoarthritis (OA) knee pain, injury, or degenerative diseases on a short-term or long-term basis. In addition to reducing pain, the external support of the orthosis provides added stability and mobility, and helps prevent deformity, potentially leading to improved quality of life and increased independence.

Pain Reduction – Pain in the knee – on the medial side, lateral side, and the front of the knee – can be reduced by the use of an appropriate orthosis. Most clinicians recognize that pain relief with a knee orthosis works by reminding the patient to avoid extreme, abrupt, stressful movements, and promote rest for affected anatomic structures.

Knee Stability – The use of a knee orthosis has been shown to increase balance and stability in gait when knee pain is reduced or eliminated and knee joint range of motion is restored (Vassilios G. Vardaxix, 1997). This is achieved by limiting unwanted knee motion and supporting proper knee motion.

Mobility – Improved mobility is often seen with a knee orthosis used in the intervention of OA, trauma, sports injury, and derangement of knee.

Deformity – Patients who engage in high-impact activities such as running or contact sports are more prone to develop deformities in their knees than those who are less active. This “more-active” group may not qualify for invasive surgeries due to age or other contra-indications. Knee orthoses may be an effective treatment option to support balance, stability and mobility.

Types of Knee Orthoses: Prefabricated vs. Custom

When a knee orthosis is determined to be appropriate, patients are directed to an orthotist by their physician, by prescription to evaluate whether a prefabricated or custom knee orthosis will be the best plan of treatment. Prefabricated orthoses are ready-made devices that fit a wide range of diagnoses and anatomically diverse presentations. In many cases, prefabricated knee braces will not fit or function optimally, and a custom device may be indicated. Custom-made knee orthoses are molded or scanned to the patient’s anatomy and are often considered preferable and more effective. They often provide a better fit, alignment, and structural support, helping patients achieve positive outcomes for varying treatment needs.

Introducing the Evoke™, a 3D Printed Custom Knee Brace

With a total-contact, custom-made knee device like the Evoke, a 3D printed knee orthosis by OssKin, clinicians have a powerful orthotic tool to treat OA pain, instability, and imbalance, while preventing deformity.

Exclusively provided at Hanger Clinic, the Evoke leverages an asymmetrical hinge system, known as the Asymotion™ hinge system. It uses advanced 3D printing to help relieve pain and restore the natural motion of the knee.

Symmetrical vs. Asymmetrical Hinge Systems

Other knee brace hinge systems (known commonly as symmetrical hinge systems, polycentric, or 4-bar linkage) significantly pre-load the knee and allow the joint to stray out of its natural motion. Although moderate pain reduction may occur, these hinge systems do not focus on restoring natural range of motion or re-alignment of the knee.

The Asymotion asymmetrical hinge system and its effects on gait biomechanics in patients with OA were evaluated in an independent clinical study by the University of Montreal Research Department Medicus Orthopedic Laboratory in 2013 (Laboratory, 2013). The researchers compared gait biomechanics of people with knee OA, with and without the use of the Evoke knee orthosis. Results of those using the brace showed:

Improved walking speed
Increased knee flexion and extension of knee
Decreased hip adduction
Increased external rotation of tibia vs. thigh
Increased in external rotation of foot vs. leg with brace
Reduced the migration of the knee brace dropping down leg while worn
Improved wearing comfort and compliance

Meet Evoke User, Dr. David Sugar

Dr. David Sugar was not only born with bad knees, he suffered many sports injuries over the years. As he got older, things went from bad to worse, to the point where he had a knee replacement on his right knee in his mid-40s. Fast forward 8 years, and it was Dr. Sugar’s left knee that was now plaguing him. He had become “bone on bone” and was in extreme pain all the time.

In his occupation as an orthopedic surgeon, Dr. Sugar is often on his feet for many hours at a time. For the sake of his patients, he knew he needed to be in tip top shape, which is why he reluctantly gave in and scheduled replacement surgery for his left knee. He didn’t want to do it – all the down time that comes along with such a huge operation was daunting to think about.

Before he went through with the knee replacement surgery, he decided to speak to the team at Hanger Clinic to see if there was anything they could recommend to help relieve the pain. He ultimately decided to give an unloader knee brace a try. As an orthopaedic surgeon, he had prescribed these for many of his patients over the years, and quite frequently, people were not happy because of how they fit and the awkwardness of wearing a brace all the time. But, this time was different.

Dr. Sugar’s Hanger Clinic team recommended the newest generation unloader brace called the Evoke. It was much lighter and had a much smaller profile than traditional styles. He was able to wear it all day, every day without it sliding down. He is now able to work all day, exercise, play golf, and hike without any pain or discomfort. In fact, he successfully climbed two mountains in the Pacific Northwest without any problems. The thought of having a knee replacement is now in the past, because he has no pain and is as active as he wants to be. In fact, there are days he wonders if he ever felt pain in his knee, because it feels so great now.

I cannot thank the great people at Hanger Clinic enough for not only what they have done for all of my patients but what they have done for me. They have given me back the life I had before.
Dr. David Sugar, Hanger Clinic Patient

Clinical Test Results

A recent clinical test measured (Laboratory, 2013) some of the positive effects using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). WOMAC consists of 24 items divided into three domains that measure the effectiveness of a particular device – in this case, the Evoke OA knee brace.

The 3 domains are:

Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing

Stiffness (2 Items): after walking and later in the day

Physical Function (17 items): stair use, rising form sitting, standing, bending, walking ,getting in / out of car, shopping, putting on/taking off socks, rising form bed, lying in bed, getting in/out of bath, sitting, getting on/off of toilet, heavy household duties, and light household duties

The WOMAC test was conducted on hundreds of subjects over 12 months with patients wearing the Evoke OA brace between 3 and 6 weeks. The results showed a significant decrease in pain and stiffness. Patients also felt fewer limitations when wearing the Evoke brace.

Where to Find the Evoke Knee Brace

The Evoke knee orthosis is offered exclusively at Hanger Clinic locations throughout the United States. Hanger Clinic orthotists are highly trained in the treatment of OA knee pain and can help determine the correct type of orthosis based on individual patient needs, with the goal of delivering the best possible outcomes.

Manufacturer: OssKin

^{This post was developed by Chris Toelle, LCO, in collaboration with Eric Weber, CPO, National Orthotics Specialist for Hanger Clinic.}