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

Abstract

Background Unloader braces are a nonsurgical approach for predominantly unicompartmental knee arthritis. Although noninvasive, braces are expensive and it is unclear whether clinical factors, if any, will predict regular brace use. Questions/purposes We asked: (1) Do patients continue to use the unloader brace more than 1 year after it is prescribed? (2) Do any clinical or radiographic factors predict continued use of the unloader brace after the first year? (3) What are the most common subjective reasons that patients give for discontinuing the brace?Methods We administered 110 surveys to all patients who were fitted for unloader knee braces for predominantly unicompartmental osteoarthritis 12 to 40 months before administration of the survey. Standardized indications and fitting protocols were used. The following parameters were tested for association with ongoing brace use: alignment, arthritis severity, compartment involved, BMI, weight, age, gender, pain and function, number of refittings, and problems with the brace. The survey response rate was 81% (89 of 110). Results Of the 89 responders, 28% reported regular brace use (twice per week, an hour at a time, or more); at 2 years, 25% used the brace regularly. No clinical or radiographic factors considered were associated with ongoing brace use. Patients reported lack of symptomatic relief, brace discomfort, poor fit, and skin irritation as reasons for discontinuing the brace. Conclusions Surgeons and patients need to balance the benefits and absence of complications of bracing against cost and the low likelihood of ongoing use 1 year or more after the prescription of the brace. Level of Evidence Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

“…Despite previous reviews that are generally supportive of valgus bracing and highlight their relatively low cost and associated risks (11,(52)(53)(54), the rates of valgus brace prescription are very low (23)(24)(25). The personal costs, complications, and poor long-term compliance associated with valgus bracing are previously noted concerns that may influence patient decisions and clinical practices (11,23,55,56). The present meta-analysis suggests that minor complications, such as constraining fit, slipping, swelling, blisters, and skin irritation are indeed relatively common (Figure 3).…”

Knee Medial Collateral Ligament and Posteromedial Corner Anatomic Repair With Internal Bracing

“…[14][15][16] These results may justify broadening of clinical indications to internal bracing of a ligament repair or reconstruction, with a goal of protecting a repaired ligament from noncompliant patient activity, secondary injury, or construct elongation and failure during early rehabilitation 17,18 or as a secondary stabilizer after return to sport, particularly when patient compliance with external orthotics may be poor. 19,20 However, future research is required to determine the results of ligament internal brace augmentation of a ligament repair or ligament autograft or allograft tissue reconstruction.…”

Managing the Pain of Knee Osteoarthritis

“…20 how compliant patients will be in wearing these braces over time. 19 A systematic review found that both short-and mid-term studies indicate that valgus unloading knee bracing decreases pain and disability in medial knee OA more effectively than knee sleeves. 44 In addition, these valgus braces improve the quality of life, knee proprioception, quadriceps strength, and gait symmetry, and decrease compressive loads in the medial knee compartment.…”

“…13 But there are several nonoperative approaches that can reduce the symptoms of OA, 14 such as activity modification, weight loss, and nonsteroidal antiinflammatory drug. Physical therapy, 15,16 shoe inserts, 17,18 knee bracing, 19,20 and knee injections 21,22 are other therapeutic options that may reduce the symptoms of OA. The main goal of all these therapeutic modalities is to reduce pain and increase the overall functioning of the patient.…”