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Braces and orthoses for treating osteoarthritis of the knee

Brouwer RW., van Raaij TM, Jakma TT.S.C., Verhagen AP, Verhaar JAN, Bierma-Zeinstra SMA

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Summary

Braces and orthoses for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of braces and orthoses for osteoarthritis (OA) of the knee.

The review shows that in people with OA of the knee :

wearing a knee brace compared to no brace:

increases the distance you are able to walk.
may not lead to any difference in pain, knee function, or quality of life.

wearing a laterally wedged orthosis compared to wearing a neutral wedge:

may not lead to any difference in pain, knee function or overall well-being.

wearing an elastically strapped insole compared to wearing a traditional lateral wedge after 6 months:

may improve pain and function.

We often do not have precise information about side effects and complications. Possible side effects may include pain in the back of the knee, low back pain, foot sole pain, skin irritation and poor fit.

An assessment of any changes in the x-rays of the joints over the long term was not measured in these studies.

What is osteoarthritis and what are braces and orthoses?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. OA can occur in different areas of the knee or the whole knee. Depending on the area, OA can change the alignment of joints. Braces and orthoses are devices that you wear to support your knee joint. Orthoses are insoles that fit comfortably inside your shoes. Braces are made of combinations of metal, foam, plastic, elastic material and straps. A knee brace can be fitted especially for the person wearing it.

Best estimate of what happens to people with OA who use a knee brace:

Walking distance: People were able to walk 1.8 km longer after wearing a knee brace for one year. These results are based on high quality evidence.

Best estimate of what happens to people with OA who wear foot or ankle orthoses:

Pain: People's pain was reduced by 14 more points on a scale of 0 to 100 after wearing an orthoses for 6 months. These results are based on low quality evidence.

The numbers given are our best estimate. When possible, we have also presented a range because there is a 95 percent chance that the true effect of the treatment lies somewhere between that range.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Brouwer RW, van Raaij TM, Jakma TT, Verhagen AP, Verhaar JAN, Bierma-Zeinstra SMA. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004020. DOI: 10.1002/14651858.CD004020.pub2.

This version first published online: January 24. 2005
Last assessed as up-to-date: May 31. 2007

Abstract

Background

Patients with osteoarthritis of the knee can be treated with a brace or orthosis (insole). The main purpose of these aids is to reduce pain, improve physical function and, possibly, to slow disease progression. This review was originally published in Issue 1, 2005.

Objectives

To assess the effectiveness of a brace or orthosis in the treatment of osteoarthritis of the knee.

Search strategy

Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) up to October 2002 in the original review and in this update until May 2007. Reference lists of identified trials were screened.

Selection criteria

Randomised and controlled clinical trials investigating all types of braces and orthoses for osteoarthritis of the knee.

Data collection and analysis

Three reviewers independently selected trials, extracted data and assessed trial quality. Due to the heterogeneity of the studies, pooling of outcomes was not possible.

Main results

Five studies (n=589) were included: two knee brace and three orthoses studies. In the longer follow-up studies (1 to 2 years) many patients stopped their brace or insole treatment.

The pain and function scores of a brace and a neoprene sleeve group showed greater improvement at six months compared with a control group. In a second brace study, the pain and function scores were improved in the brace group compared with the controls, but only the walking distance was significantly longer.

In one study there was a significantly less intake of NSAIDs and significantly better compliance in a lateral wedge group compared with a neutral wedge group, but there were no significant differences in function scores at 6 and 24 months.

In another insole study at 6 months follow up, the pain score was significantly improved in the strapped insole group compared with the traditional lateral wedge group (relative percentage difference (RPD=29%). The femorotibial angle was significantly improved in the strapped insole group at 6 and 24 months (RPDs at both timepoints= -1.1%). The pain and function scores were not significantly different at 24 months.

Authors' conclusions

Based on two brace and three insole studies, we conclude that there is 'silver' level evidence (www.cochranemsk.org) that a brace and a lateral wedge insole have small beneficial effect.
There is 'silver' level evidence that strapped insoles correct leg alignment. However, long-term adherence to brace and insole treatment is low. There is no evidence whether a brace is more effective than an insole.

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