title: Gait Using Pneumatic Brace for End-Stage Knee Osteoarthritis.
abstract: More than 20 million individuals in the United States are affected by knee osteoarthritis (OA), which can lead to altered biomechanics and excessive joint loading. The use of an unloader pneumatic brace with extension assist has been proposed as a nonoperative treatment modality that may improve gait mechanics and correct knee malalignment. We assessed the following parameters in patients who have knee OA treated with and without a brace: (1) changes in temporospatial parameters in gait; (2) knee range of motion, knee extension at heel strike, and foot placement; (3) knee joint moments and impulse; and (4) changes in dynamic stiffness and rate of change of knee flexion during midstance to terminal stance. This 2:1 prospective, randomized, single-blinded trial evaluated 36 patients (24 brace and 12 matching). OA knee patients were randomized to receive either a pneumatic unloader brace or a standard nonoperative treatment regimen as the matching cohort for a 3-month period. They underwent evaluation of gait parameters using a three-dimensional gait analysis system at their initial appointment and at 3 months follow-up. All the testing, pre- and postbracing were performed without wearing the brace to examine for retained effects. Treatment with the brace led to significant improvements versus standard treatment in various gait parameters. Patients in the brace group had improvements in walking speed, knee extension at heel strike, total range of motion, knee joint forces, and rate of knee flexion from midstance to terminal stance when compared with the matching cohort. Knee OA patients who used a pneumatic unloader brace for 3 months for at least 3 hours per day had significant improvements various gait parameters when compared with a standard nonoperative therapy cohort. Braced patients demonstrated gait-modifying affects when not wearing the brace. These results are encouraging and suggest that this device represents a promising treatment modality for knee OA that may improve gait, knee pain, and strength in knee OA patients.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Department of Orthopaedics, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Jeffrey Jai
authors.initials: JJ
authors.lastname: Cherian
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Roland
authors.initials: R
authors.lastname: Starr
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, New York.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Harwin
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhave
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000503:physiopathology / Q000628:therapy; D001696:Biomechanical Phenomena; D001915:Braces; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000628:therapy*; D016059:Range of Motion, Articular; D016037:Single-Blind Method