Long-term Results of an Unloader Brace in Patients With Unicompartmental Knee Osteoarthritis

Abstract

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.

Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis

“…Evidence suggests that unloading knee braces are a safe treatment option for unicompartmental arthritis, which can reduce pain and increase activity in the short term, but their effect in the long term is uncertain. 6 7 In the literature, follow-up for longer than 3 years has not been evaluated. A Cochrane review showed that there was limited high-quality evidence over 12 months to assess the overall effect of the brace and found the brace’s advantages inconclusive in short-term studies.…”

Assessment of loading history of compartments in the knee using bone SPECT/CT: A study combining alignment and 99mTc‐HDP tracer uptake/distribution patterns

“…For treatment of overload of compartments in the knee a variety of treatment options such as distal femoral or proximal tibial osteotomies, deloading braces, insoles, or patellofemoral realignment procedures aim to reduce the mechanical loading on the medial, lateral, or patellofemoral compartment of the knee joint 1–8…”

Unloader Knee Braces for Osteoarthritis: Do Patients Actually Wear Them?

“…Other studies have varied in terms of reported compliance rates with time. One followup survey of patients previously prescribed braces reported that 41% of 30 patients were using the brace at 2.7 years, where use was defined as an average of 5 hours per day for work or weightbearing activity [2]; when those patients (n = 29) were resurveyed at an average of 11.2 years followup, none were using the brace [21]. Another study, in a population of military veterans, found 76% of patients were still using the brace at least once a week after a year [10].…”

“…Another study reported improvements in pain relief in patients wearing the brace longer than 8 weeks, but despite this relief, compliance with brace use at a mean of 2.7 years was only 42% [2]. That same group of patients was recontacted in a followup study; none continued to use the brace at 11 years [21]. A Cochrane review from 2005 concluded that braces have some (albeit limited) efficacy for treatment of medial compartment osteoarthritis and little long-term use [5]; an additional study in 2006 found 42% of subjects discontinued brace use within the 12-month trial period, 88% of whom discontinued the brace within the first 6 months [6].…”