Load-shifting brace treatment for osteoarthritis of the knee: A minimum 2 1/2-year follow-up study

Surgical Service (112), VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.
The Journal of Rehabilitation Research and Development (Impact Factor: 1.43). 04/2004; 41(2):187-94. DOI: 10.1682/JRRD.2004.02.0187
Source: PubMed


Objectives in treating primarily unicompartmental knee arthritis with a load-shifting brace are pain relief, compliance, 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 follow-up (average 3.3 years) were reviewed. Kaplan-Meier survivorship 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 and thromboembolism.

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    • "A 12-week study of multimodal therapy that encouraged knee OA patients with a body mass index >28 kg/m2 to lose at least 5% of body weight reported that only 14% of patients achieved this goal.16 Similarly, lateral wedge insoles and knee bracing provide no demonstrable clinical benefit on knee pain or disease progression, which may be partially attributable to poor compliance and patient discomfort.32–38 "
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    ABSTRACT: Conservative management of medial compartment knee osteoarthritis (OA) is a misleading term used to describe the application of medical, orthotic, and/or rehabilitative therapies exclusive of surgical interventions. The implication of this nomenclature is that these therapies offer satisfactory symptom relief, alter disease progression, and have limited side effects. Unfortunately, conservative therapeutic options possesses few, if any, characteristics of an ideal treatment, namely one that significantly alleviates pain, improves knee function, and reduces medial compartmental loading without adverse side effects. As uncompensated mechanical loading is a primary culprit in the development and progression of knee OA, we propose that the therapeutic perspective of conservative treatment should shift from pharmacological treatments, which have no influence on joint loading, minimal potential to alter joint function, substantial associated risks, and significant financial costs, towards minimally invasive load absorbing therapeutic interventions. A safe and effective minimally invasive medical device specifically engineered for symptomatic relief of medial knee OA by limiting joint contact forces has the potential to reduce the clinical and economic knee OA burden. This review characterizes the current standard of care recommendations for conservative management of medial compartment knee OA with respect to treatment efficacy, risk profile, and economic burden.
    Full-text · Article · Feb 2013 · Orthopedic Reviews
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    • "Similarly, strategies that aim to bring the frontal ground-reaction force vector closer to the knee joint centre-for example by bringing the body centre of mass closer to the knee-may also be beneficial in reducing the KAM. Although valgus knee braces are effective at improving knee alignment and reducing knee load [27,28], and thus seem a logical treatment choice, knee braces are often associated with adverse effects [29] and reduced compliance in patients with knee OA, limiting their clinical applicability [30]. In contrast, exercise is recommended by all clinical guidelines for knee OA [31,32], is associated with relatively few adverse effects [33,34] and has the potential to reduce the KAM [26]. "
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    ABSTRACT: Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people, giving rise to pain and loss of function. Many people experience progressive worsening of the disease over time, particularly those with varus malalignment and increased medial knee joint load. Therefore, interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression. Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load. A neuromuscular exercise program, emphasising optimal alignment of the trunk and lower limb joints relative to one another, as well as quality of movement performance, while dynamically and functionally strengthening the lower limb muscles, may be able to reduce medial knee load. Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature. This randomised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading, pain and function in individuals with medial knee joint osteoarthritis. We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program. 100 people with medial knee pain, radiographic medial compartment osteoarthritis and varus malalignment will be recruited and randomly allocated to one of two 12-week exercise programs: quadriceps strengthening or neuromuscular exercise. Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home. The primary outcomes are medial knee load during walking (the peak external knee adduction moment from 3D gait analysis), pain, and self-reported physical function measured at baseline and immediately following the program. Secondary outcomes include the external knee adduction moment angular impulse, electromyographic muscle activation patterns, knee and hip muscle strength, balance, functional ability, and quality-of-life. The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load, pain and physical function in people with medial knee osteoarthritis and varus malalignment. Australian New Zealand Clinical Trials Registry reference: ACTRN12610000660088.
    Full-text · Article · Dec 2011 · BMC Musculoskeletal Disorders
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    • "Unloader-brace (11) Adductor moment, compressions loads, walk analysis, pain and function 4 Giori 2004 [22] Not controlled n = 49, medial (43) or lateral (6) femoro-tibial OA Unloader-brace (49) Global assessment, complications 4 Richards et al., 2005 [20] "
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    ABSTRACT: To develop clinical practice guidelines concerning the use of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis. The French Physical Medicine and Rehabilitation Society (SOFMER) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by multidisciplinary expert panel, was used. Few high-level studies of bracing for knee osteoarthritis were found. No evidence exists for the effectiveness of rest orthosis. Evidence for knee sleeves suggests that they decrease pain in knee osteoarthritis, and their use is associated with subjective improvement. These actions do not appear to depend on a local thermal effect. The effectiveness of knee sleeves for disability is not demonstrated for knee osteoarthritis. Short- and mid-term follow-up indicates that valgus knee bracing decreases pain and disability in medial knee osteoarthritis, appears to be more effective than knee sleeves, and improves quality of life, knee proprioception, quadriceps strength, and gait symmetry, and decreases compressive loads in the medial femoro-tibial compartment. However, results of response to valgus knee bracing remain inconsistent; discomfort and side effects can result. Thrombophlebitis of the lower limbs has been reported with the braces. Braces, whatever kind, are infrequently prescribed in clinical practice for osteoarthritis of the lower limbs. Modest evidence exists for the effectiveness of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis, with only low level recommendations for its use. Braces are prescribed infrequently in French clinical practice for osteoarthritis of the knee. Randomized clinical trials concerning bracing in knee osteoarthritis are still necessary.
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