title: Clinical Outcomes of a Pneumatic Unloader Brace for Kellgren-Lawrence Grades 3 to 4 Osteoarthritis: A Minimum 1-Year Follow-Up Study.
abstract: The use of a pneumatic unloader brace has been shown in pilot studies to decrease pain and increase muscle strength in patients with knee osteoarthritis (OA). Therefore, we analyzed patients who had knee OA, and either received a pneumatic unloader brace and conventional treatment or conventional treatment alone. Specifically, we assessed: (1) use of pain relieving injections; (2) opioid consumption; and (3) the eventual need for total knee arthroplasty (TKA) in the above-mentioned cohort. We performed an analysis of a longitudinally maintained database of patients from a prospective, randomized, single center study. This study randomized patients who had Kellgren-Lawrence grades 3 to 4 to receive either a pneumatic unloader brace and conventional treatment or conventional treatment alone. The brace cohort comprised 11 patients with a mean age of 55 years (range, 37-70 years). The final matched cohort comprised 25 patients with a mean age of 63 years (range, 41-86 years). The minimum follow-up was 1 year. There was a lower proportion of patients who underwent an eventual TKA in the bracing cohort as compared with the nonbracing cohort (18 vs. 36%). The mean time to TKA was longer in the bracing cohort as compared with the nonbracing cohort (482 vs. 389 days). The proportion of patients who used opioids was similar in both groups (27 vs. 22%). There was a significantly lower number of patients who received injections in the bracing cohort as compared with the nonbracing cohort (46 vs. 83%,p= 0.026). The bracing cohort had received a significantly lower number of injections and a lower rate of subsequent TKA as compared with the nonbracing cohort. The mean time to TKA was also longer among the bracing cohort. These results may demonstrate the potential of this brace to reduce the need for and prolonging the time to TKA. Performing larger prospective randomized studies, with built-in compliance monitors is warranted. This brace may be a valuable adjunct to the current knee OA treatment armamentarium pending further investigation.
authors.affiliation: Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhave
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Sabahat Z
authors.initials: SZ
authors.lastname: Khan
authors.affiliation: Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Khlopas
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Osman
authors.initials: O
authors.lastname: Ali
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: Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D018771:Arthralgia / Q000628:therapy; D019645:Arthroplasty, Replacement, Knee; D001915:Braces; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D020370:Osteoarthritis, Knee / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid