Volume 41, Number 2, Pages 187–194?
Journal of Rehabilitation Research & Development
Load-shifting brace treatment for osteoarthritis of the knee: A minimum
2 1/2-year follow-up study
Nicholas J. Giori, MD, PhD
Surgical Service and Rehabilitation Research and Development Center, Department of Veterans Affairs (VA) Palo Alto
Health Care System, Palo Alto, CA; Department of Orthopedic Surgery and Sports Medicine, Stanford University,
Abstract—Objectives in treating primarily unicompartmental
knee arthritis with a load-shifting brace are pain relief, compli-
ance, brace durability, and complication-free treatment over
multiple years. This was a single institution retrospective chart
review, radiograph review, and telephone survey of patients
treated from 1997 to 1999 with a load-shifting knee brace.
Forty-six patients (49 knees) with a minimum 2 1/2-year fol-
low-up (average 3.3 years) were reviewed. Kaplan-Meier sur-
vivorship analysis revealed that load-shifting brace use had a
survival of 76% at 1 year, 69% at 2 years, and 61% at 3 years.
Younger patients had a higher likelihood of longer brace use
than older patients. One patient had ipsilateral leg swelling and
a pulmonary embolus after initiating bracing. Eliminating the
high numbers of early failures would be desirable. One should
be aware of the potential complication of venous thrombosis
Key words: brace, knee, osteoarthritis, survivorship.
Osteoarthritis of the knee involving primarily one
compartment is commonly encountered in the orthopedic
clinic. Treatment options include conservative manage-
ment with medications, bracing, osteotomy, unicompart-
mental arthroplasty, and total knee arthroplasty.
Conservative management with medications or strength-
ening is commonly done for mildly affected patients,
while severely affected patients in an older age group
who are less physically active can be effectively treated
with unicompartmental arthroplasty or total knee arthro-
plasty. Younger, active patients who do not respond to
conservative measures, or patients with other medical
problems that prohibit surgery, may be treated in a load-
A load-shifting brace for osteoarthritis involving pri-
marily one compartment of the knee incorporates a rigid
frame, a hinge mechanism, and straps to apply a bending
moment to the knee. The brace applies either a valgus or
varus moment to the knee, unloading either the medial or
lateral compartment. It is custom-fitted to the patient and
can cost from US$1,500 to $2,000.
Studies of patients treated with a load-shifting brace
have demonstrated pain relief, functional improvement,
gait improvement, improvement in knee scores, and
improvement in the adduction moment across the knee
[1–3]. Fluoroscopic analysis of these patients during
walking has also revealed separation of the condyles on
the unloaded side during heal-strike phase of gait .
Abbreviations: BMI = body mass index, CI = confidence
interval, SD = standard deviation.
The work published in this manuscript was unfunded at
the time of manuscript preparation.
Address all correspondence to Nicholas J. Giori, MD, PhD;
Surgical Service (112), VA Palo Alto Health Care System, Palo
Alto, CA 94304; 650-493-5000, ext. 64765; fax: 650-852-
3430; email: email@example.com.
I thank Philip Lavori, PhD, for his help in the statisti-
cal analysis of this manuscript. I also thank Emilia Green-
Riviere, RNP, and George Bennett for their contributions.
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Submitted for publication January 6, 2003. Accepted in
revised form September 6, 2003.