Should you consider trying an offloading knee brace in the management of knee osteoarthritis?
Author: Ossur (UK) Ltd.
Date: Aug 2017
Eight million people in the UK suffer with the condition, with knee osteoarthritis rising in younger people due to increased sports/activity, previous knee injury or general wear and tear in your joints.
Conservative treatment is now a pathway which is recognised by OARSI and is a treatment which is discussed between the surgeon and patient throughout the treatment pathway. Historically braces were not something widely prescribed because of their aesthetics, however with technological advancements braces are now seen as a credible alternative to surgery for the patient and from a surgeon’s perspective, given the clinical evidence available. All patients should consider knee bracing as an option before surgery and doctors should offer non-invasive treatments and alternatives.
NICE Guidelines Osteoarthritis Treatment Pathway
What is an offloading knee brace?
An offloading knee is used where there is a need to shift the load from one side of the knee to the other, thereby alleviating pain and, in the case of osteoarthritis, slow down the degradation of cartilage which can ultimately lead to a knee replacement being required.
There are a few treatment options for managing osteoarthritis depending on the individual and the severity of the condition. The key to managing the condition is early diagnosis so that the right treatment programme can be put in place to ensure that quality of life is not compromised and ultimately delay the need for surgery.
Conservative treatment considers non-invasive techniques such as exercise, healthy eating and the use of a knee brace. Where osteoarthritis is concerned a treatment option of exercise and increased activity doesn’t sound feasible, though exercise releases endorphins which act as natural painkillers in the body and combining this with healthy eating can reduce your weight and the overall load exerted on the knee itself. The use of a knee brace as part of a conservative treatment option offers a pain relieving option (therefore reducing your intake of painkillers) to help facilitate your increase in activity.
How can the Unloader® One help manage osteoarthritis?
The Unloader One is a clinically proven knee brace to help manage the following conditions:
- Unicompartmental osteoarthritis
- Articular Cartilage Defect Repair
- Avascular Necrosis
- Tibial Plateau Fracture
It works by offering suspension and unloading leverage through a 3-Points of Leverage system in conjunction with a manually adjustability unloading system, since the amounting of unloading required will vary throughout the day and with the activities undertaken.
The brace has also been the focus of research undertaken from Arthritis Research UK, a leading charity investing in the latest treatments and technologies to help manage arthritis.
Research & Case Studies
The Unloader One is used widely within the NHS and within private clinics, with numerous research studies undertaken to understand the its effectiveness in a wide range of patients with results showing a reduction in pain, improved function and less reliance on pain medication.
Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis
Paul YF Lee,1,2,3 Thomas G Winfield,4 Shaun RS Harris,4 Emerald Storey,1,3 Amit Chandratreya1,2
Prior to this study research on the use of unloading knee braces had never exceeded a duration of 5 years, with 8 years of prospective data gathered from a total of 63 patients who had been presented with unicompartmental osteoarthritis.
The study was undertaken to assess the effectiveness of unloading knee braces compared to surgical pathways, with the primary focus in assessing patient pain scores. Patients were provided with surveys to collate EQ-5D (EuroQol five dimensions) taken prior to wearing the brace and then thereafter, cost and quality-adjusted life years (QALYs) compared to those who had received a total knee replacement (when considering an 8 month waiting duration and 8 years of results).
This study recently published in the BMJ indicates that an offloading knee brace is a cost-effective method as a bridging therapy and its long-term use can delay and reduce surgical intervention for patients with unicompartmental knee osteoarthritis. After wearing a brace for up to two years, 40% of patients in the study didn’t require surgery at all.
Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee
Pollo FE1, Otis JC, Backus SI, Warren RF, Wickiewicz TL.
In this study the patients who took part were all suffering from medial compartmental osteoarthritis, with the main focus in assessing the benefits of using a valgus brace compared to the use of surgery, with the brace reducing the load exerted on the affected side of the knee and with it reducing pain and increasing mobility.
In total 11 patients were part of this study, with the compressive load of the affected compartment calculated in conjunction with the effects of joint alignment and the strap tension on load sharing.
In drawing conclusions they found that overall patients saw a reduction in pain and with it were able to increase their activity levels which suggested that the use of a valgus (or offloading) knee brace could be beneficial to patients with the same or similar conditions.
Osteoarthritis is a degenerative condition and will only get worse, therefore early diagnosis can promote effective treatment. In considering knee replacements they are designed to last 15-20 years, therefore with the average age of those being diagnosed decreasing the average lifespan increasing many patients may have to undergo a replacement of the replacement which is not ideal (especially given recovery can be up to 6 months). This leaves many patients being too young for surgery and therefore other options need to be assessed, for which a knee brace now remains a clinically proven alternative.
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Last revised: 21 August 2017
Next review: 21 February 2018