FREE FULL-TEXT ARTICLE SUMMARY AND COMMENT | ARTHRITIS/RHEUMATIC DISEASE April 28, 2015
Treatment Options for Knee Osteoarthritis Are Limited Jonathan S. Coblyn, MD Reviewing Hunter DJ., Arthritis Care Res (Hoboken) 2015 Apr 67:455
Bracing is not used often, but it might benefit some patients.
Options for treating patients with osteoarthritis (OA) of the knees include analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, arthroscopy, and injections with steroids or viscosupplements. Little evidence suggests that any of these interventions provide more than short-term relief. Clearly, options other than total knee replacement are needed. When the most common type of OA, medial-compartment OA, becomes severe, it can cause varus deformity. A valgus brace, which moves stress forces from the medial to the lateral side of the knee joint (where there is more preserved cartilage), theoretically should benefit patients with OA. However, this form of therapy has not been studied in large populations and is not used often clinically. In this meta-analysis of six randomized, controlled trials, researchers evaluated valgus bracing versus placebo or control orthoses (such as neoprene sleeves) in OA patients. A small but statistically significant difference in self-reported pain and function favored valgus bracing versus placebo; a smaller difference was found for bracing versus control orthoses. About 25% of patients reported minor complications of bracing including constraining fit, slipping, swelling, blisters, and skin irritation. The authors acknowledge some of these complications were caused by lack of adequate information given to patients by providers (i.e., when and how long to wear the brace and its valgus angulation). Comment
Treating patients with knee OA remains a challenge. Virtually all options are beneficial in the short term, but, unfortunately, no intervention changes the natural history of this common malady. However, valgus bracing might be an option for some motivated patients and knowledgeable physicians. Citation(s):
Moyer RF et al. Valgus bracing for knee osteoarthritis: A meta-analysis of randomized trials. Arthritis Care Res (Hoboken) 2015 Apr; 67:493. (http://dx.doi.org/10.1002/acr.22472) Hunter DJ.Bracing for knee osteoarthritis: Translating evidence into practice. Arthritis Care Res (Hoboken) 2015 Apr; 67:455. (http://dx.doi.org/10.1002/acr.22467)