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Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

The clinical effect of an unloader brace on patients with osteoarthritis of the knee, a randomized placebo controlled trial with one year follow up

Authors: Hjörtur F. Hjartarson, Sören Toksvig-Larsen

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

Treatment of patients with knee osteoarthritis is challenging. Unloader braces have been developed with various success. Unloader One® Knee Brace is light, easily-fitted and shown to be effective by the unloading of the affected compartment. The aim of the study was to assess the clinical outcome of the brace vs. a placebo on patients with knee osteoarthritis.

Methods

Initially 150 patients were randomized to receive either the Unloader brace or a control placebo group look-alike brace where the active strips had been removed. The patients were followed up at 6,12,26 and 52 weeks with Knee Society Score (KSS) and Knee injury and Osteoarthritis Outcome Score (KOOS). The reason for dropout was recorded.

Results

A total of 149 patients were included, 74 in the study and 75 in the control group. The mean age was 59.6 vs. 60.2, BMI was 27.5 vs. 26.9, 37% vs. 44% were women in the study vs. control group. Both groups showed improvement in KSS over 52 weeks, with the study group showing higher improvement in mean scores. KSS increased from 64.3 to 84.0 for the study group and from 64.0 to 74.6 for the control group (p = 0.009). The study group improved in KSS function from 67.0 to 78.6 (p < 0.001) and KOOS for knee related symptoms increased/improved from 64.3 to 72.4 (p < 0.001). Activity of daily living increased/improved from 65.3 to 75.2 and Sports/Recreation from 24.6 to 40.2 (p > 0.001) whereas the control group did not show significant improvements in any of the scores. The dropout was higher in the control group, 40 vs. 25.

Conclusions

The brace seems to be more effective and better tolerated than the placebo.

Trial registration

The trial was retrospectively registered with ClinicalTrials.gov (NCT03454776) on March 6th 2018.
Literature
1.
go back to reference Bay-Jensen AC, Hoegh-Madsen S, Dam E, Henriksen K, Sondergaard BC, Pastoureau P, Qvist P, Karsdal MA. Which elements are involved in reversible and irreversible cartilage degradation in osteoarthritis? Rheumatol Int. 2010;30(4):435–42.CrossRef Bay-Jensen AC, Hoegh-Madsen S, Dam E, Henriksen K, Sondergaard BC, Pastoureau P, Qvist P, Karsdal MA. Which elements are involved in reversible and irreversible cartilage degradation in osteoarthritis? Rheumatol Int. 2010;30(4):435–42.CrossRef
2.
go back to reference Neogi T, Zhang Y. Epidemiology of osteoarthritis. Rheum Dis Clin N Am. 2013;39(1):1–19.CrossRef Neogi T, Zhang Y. Epidemiology of osteoarthritis. Rheum Dis Clin N Am. 2013;39(1):1–19.CrossRef
3.
4.
go back to reference Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16(2):137–62.CrossRef Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16(2):137–62.CrossRef
5.
go back to reference Petersen W, Ellermann A, Zantop T, Rembitzki IV, Semsch H, Liebau C, Best R. Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136). Arch Orthop Trauma Surg. 2016;136(5):649–56.CrossRef Petersen W, Ellermann A, Zantop T, Rembitzki IV, Semsch H, Liebau C, Best R. Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136). Arch Orthop Trauma Surg. 2016;136(5):649–56.CrossRef
6.
go back to reference Rannou F, Poiraudeau S, Beaudreuil J. Role of bracing in the management of knee osteoarthritis. Curr Opin Rheumatol. 2010;22(2):218–22.CrossRef Rannou F, Poiraudeau S, Beaudreuil J. Role of bracing in the management of knee osteoarthritis. Curr Opin Rheumatol. 2010;22(2):218–22.CrossRef
7.
go back to reference Ostrander RV, Leddon CE, Hackel JG, O'Grady CP, Roth CA. Efficacy of unloader bracing in reducing symptoms of knee osteoarthritis. Am J Orthop (Belle Mead NJ). 2016;45(5):306–11. Ostrander RV, Leddon CE, Hackel JG, O'Grady CP, Roth CA. Efficacy of unloader bracing in reducing symptoms of knee osteoarthritis. Am J Orthop (Belle Mead NJ). 2016;45(5):306–11.
8.
go back to reference 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. Osteoarthr Cartil. 2006;14(8):777–83.CrossRef 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. Osteoarthr Cartil. 2006;14(8):777–83.CrossRef
9.
go back to reference Steadman JR, Briggs KK, Pomeroy SM, Wijdicks CA. Current state of unloading braces for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016;24(1):42–50.CrossRef Steadman JR, Briggs KK, Pomeroy SM, Wijdicks CA. Current state of unloading braces for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016;24(1):42–50.CrossRef
10.
go back to reference van Raaij TM, Reijman M, Brouwer RW, Bierma-Zeinstra SM, Verhaar JA. Medial knee osteoarthritis treated by insoles or braces: a randomized trial. Clin Orthop Relat Res. 2010;468(7):1926–32.CrossRef van Raaij TM, Reijman M, Brouwer RW, Bierma-Zeinstra SM, Verhaar JA. Medial knee osteoarthritis treated by insoles or braces: a randomized trial. Clin Orthop Relat Res. 2010;468(7):1926–32.CrossRef
12.
go back to reference Kellgren JH, Lawrence JS. Radiological assessment of rheumatoid arthritis. Ann Rheum Dis. 1957;16(4):485–93.CrossRef Kellgren JH, Lawrence JS. Radiological assessment of rheumatoid arthritis. Ann Rheum Dis. 1957;16(4):485–93.CrossRef
13.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;(248):13–4. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;(248):13–4.
14.
go back to reference Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96.CrossRef Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96.CrossRef
15.
go back to reference Dupont WDPW. Power and sample size calculations: a review and computer program. Control Clin Trials. 1990;11:116–28.CrossRef Dupont WDPW. Power and sample size calculations: a review and computer program. Control Clin Trials. 1990;11:116–28.CrossRef
16.
go back to reference 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(11):2398–407.PubMedPubMedCentral 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(11):2398–407.PubMedPubMedCentral
17.
go back to reference 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(4):539–48.CrossRef 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(4):539–48.CrossRef
18.
go back to reference Sattari S, Ashraf AR. Comparison the effect of 3 point valgus stress knee support and lateral wedge insoles in medial compartment knee osteoarthritis. Iran Red Crescent Med J. 2011;13(9):624–8.CrossRef Sattari S, Ashraf AR. Comparison the effect of 3 point valgus stress knee support and lateral wedge insoles in medial compartment knee osteoarthritis. Iran Red Crescent Med J. 2011;13(9):624–8.CrossRef
19.
go back to reference Pham T, Van Der Heijde D, Lassere M, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, et al. Outcome variables for osteoarthritis clinical trials: the OMERACT-OARSI set of responder criteria. J Rheumatol. 2003;30(7):1648–54.PubMed Pham T, Van Der Heijde D, Lassere M, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, et al. Outcome variables for osteoarthritis clinical trials: the OMERACT-OARSI set of responder criteria. J Rheumatol. 2003;30(7):1648–54.PubMed
Metadata
Title
The clinical effect of an unloader brace on patients with osteoarthritis of the knee, a randomized placebo controlled trial with one year follow up
Authors
Hjörtur F. Hjartarson
Sören Toksvig-Larsen
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2256-7

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