Previously, we reported a prospective study of 30 patients with unicompartmental osteoarthritis of the knee treated nonoperatively with an unloader brace and average follow-up of 2.7 years. Although the initial study suggested short-term benefit according to pain and function measures, the objective of the current study was to evaluate these same patients via telephone questionnaire to determine the status of their brace use and any surgical procedures on the affected limb. Because we noted that even at 2.7 years, some patients opted for surgical management despite good response to bracing, our hypothesis was that these patients would not opt for long-term brace wear. Twenty-four of 30 patients were available for reporting based on telephone interview; in addition, we talked with family members of 5 patients who had died. When evaluated at 2.7 years, 41% of the 30 patients were still using the brace, 35% had discontinued brace use, and 24% had undergone arthroplasty. When contacted for the follow-up survey at an average of 11.2 years, 17 (58.6%) of the 29 patients had undergone arthroplasty. The mean interval between initial evaluation and arthroplasty was 3.9 years. In addition, 7 patients had undergone arthroscopic surgery. Importantly, none of the patients were still wearing the brace. The use of an unloader brace is effective in providing short-term pain relief and improved function; however, most patients subsequently opt for total knee replacement on the symptomatic knee.

Substantial postoperative stiffness requiring manipulation is a well-recognized complication of total knee replacement. This study sought to determine whether the Medial-Pivot (MP) knee (Wright Medical, Memphis, TN) or the Double-High (DH) knee (Wright Medical) is more often associated with manipulation under anesthesia (MUA) for post-total knee arthroplasty (TKA) knee stiffness. It was hypothesized that manipulation rates would be similar. Retrospective review of 755 TKA patients showed that 4.1% required MUA, which is comparable to the literature. Manipulation by MUA for DH and MP knees was generally successful, with an average overall improvement in knee flexion of nearly 30°. MP and DH knees appear to have a lower than average prevalence of post-TKA knee stiffness requiring manipulation when compared with the literature. The number of MP and DH knees requiring MUA did not appear to differ substantially.

Extension constraint knee braces alter joint alignment, dynamic balance, knee mechanics during gait, and vertical loading during gait. However, the changes in motion observed were lower than those induced by the constraining mechanism.

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