Clinical Orthopaedics and Related Research®

, Volume 471, Issue 6, pp 1982–1991 | Cite as

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

  • Emily Squyer
  • Daniel L. Stamper
  • Deven T. Hamilton
  • Janice A. Sabin
  • Seth S. Leopold
Clinical Research



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.


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?


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).


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.


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.


  1. 1.
    Altman RD. Overview of osteoarthritis. Am J Med. 1987;83:65–69.PubMedCrossRefGoogle Scholar
  2. 2.
    Barnes CL, Cawley PW, Hederman B. Effect of CounterForce brace on symptomatic relief in a group of patients with symptomatic unicompartmental osteoarthritis: a prospective 2-year investigation. Am J Orthop (Belle Mead NJ). 2002;31:396–401.Google Scholar
  3. 3.
    Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377:2115–2126.PubMedCrossRefGoogle Scholar
  4. 4.
    Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010;18:24–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Brouwer RW, Jakma TS, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev. 2005;1:CD004020.Google Scholar
  6. 6.
    Brouwer RW, van Raaij TM, Verhaar JA, Coene LN, Bierma-Zeinstra SM. Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthritis Cartilage. 2006;14:777–783.PubMedCrossRefGoogle Scholar
  7. 7.
    Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence-based knee injections for the management of arthritis. Pain Med. 2012;13:740–753.PubMedCrossRefGoogle Scholar
  8. 8.
    Dimond EG, Kittle CF, Crockett JE. Evaluation of internal mammary artery ligation and sham procedure in angina pectoris. Circulation. 1958;18:712–713.Google Scholar
  9. 9.
    Foran JR, Sheth NP, Ward SR, Della Valle CJ, Levine BR, Sporer SM, Paprosky WG. Patient perception of physician reimbursement in elective total hip and knee arthroplasty. J Arthroplasty. 2012;27:703–709.PubMedCrossRefGoogle Scholar
  10. 10.
    Giori N. Load-shifting brace treatment for osteoarthritis of the knee: a minimum 2½ year follow-up study. J Rehabil Res Dev. 2004;41:187–194.PubMedCrossRefGoogle Scholar
  11. 11.
    Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.PubMedCrossRefGoogle Scholar
  12. 12.
    Kirkley A, Webster-Bogaert S, Litchfield R, Amendola A, MacDonald S, McCalden R, Fowler P. The effect of bracing on varus gonarthrosis. J Bone Joint Surg Am. 1999;81:539–548.PubMedGoogle Scholar
  13. 13.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRefGoogle Scholar
  14. 14.
    Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347:81–88.PubMedCrossRefGoogle Scholar
  15. 15.
    Niu J, Zhang YQ, Torner J, Nevitt M, Lewis CE, Aliabadi P, Sack B, Clancy M, Sharma L, Felson DT. Is obesity a risk factor for progressive radiographic knee osteoarthritis? Arthritis Rheum. 2009;61:329–335.PubMedCrossRefGoogle Scholar
  16. 16.
    Pollo FE, Jackson RW. Knee bracing for unicompartmental osteoarthritis. J Am Acad Orthop Surg. 2006;14:5–11.PubMedGoogle Scholar
  17. 17.
    Ramsey DK, Briem K, Axe MJ, Snyder-Mackler L. A mechanical theory for the effectiveness of bracing for medial compartment osteoarthritis of the knee. J Bone Joint Surg Am. 2007;89:2398–2407.PubMedCrossRefGoogle Scholar
  18. 18.
    Richmond J, Hunter D, Irrgang J, Jones MH, Levy B, Marx R, Snyder-Mackler L, Watters WC 3rd, Haralson RH 3rd, Turkelson CM, Wies JL, Boyer KM, Anderson S, St Andre J, Sluka P, McGowan R; American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg. 2009;17:591–600.PubMedGoogle Scholar
  19. 19.
    Rosneck J, Higuera C, Tadross N, Krebs V, Barsoum W. Managing knee osteoarthritis before and after arthroplasty. Cleve Clin J Med. 2007;74:663–671.PubMedCrossRefGoogle Scholar
  20. 20.
    Suominen S, Koskenvuo K, Sillanmäki L, Vahtera J, Korkeila K, Kivimäki M, Mattila KJ, Virtanen P, Sumanen M, Rautava P, Koskenvuo M. Non-response in a nationwide follow-up postal survey in Finland: a register-based mortality analysis of respondents and non-respondents of the Health and Social Support (HeSSup) Study. BMJ Open. 2012;2:e000657.PubMedCrossRefGoogle Scholar
  21. 21.
    Wilson B, Rankin H, Barnes CL. Long-term results of an unloader brace in patients with unicompartmental knee osteoarthritis. Orthopedics. 2011;34:e334–e337.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Emily Squyer
    • 1
  • Daniel L. Stamper
    • 1
  • Deven T. Hamilton
    • 2
  • Janice A. Sabin
    • 2
  • Seth S. Leopold
    • 1
  1. 1.Department of Orthopaedics and Sports MedicineUniversity of Washington School of MedicineSeattleUSA
  2. 2.Department of Medical Education and Biomedical InformaticsUniversity of Washington School of MedicineSeattleUSA

Personalised recommendations