Case Study: Bilateral Knee Pain Due to Osteoarthritis - Clinical Pain Advisor

Case Study: Bilateral Knee Pain Due to Osteoarthritis

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  • Figure. Anteroposterior radiograph of the knees.

A 63-year-old woman presents to the office with bilateral knee pain and a known history of osteoarthritis. Anteroposterior radiograph of the bilateral knees is obtained (Figure).  The patient was previously told that unloader bracing would be a good option for her knee arthritis.

Which statement regarding unloader bracing is true?

Osteoarthritis of the knee is one of the most common conditions seen in both primary care and orthopedic practice.1 Initial treatment is almost always conservative, which can be successful in avoiding the need for knee replacement surgery. Unloader bracing is...

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Osteoarthritis of the knee is one of the most common conditions seen in both primary care and orthopedic practice.1 Initial treatment is almost always conservative, which can be successful in avoiding the need for knee replacement surgery. Unloader bracing is a conservative treatment that has been proven to help relieve pain and improve function in patients with knee osteoarthritis.1,2 Unloader bracing is particularly useful in patients with either medial compartment arthritis and a varus deformity or lateral compartment arthritis and a valgus deformity. For the more common varus deformity, the unloader brace places a valgus correction force on the knee to remove contact pressure from the medial compartment. A 1.2-mm change in condylar separation has been shown at heel strike on radiography in a patient wearing an unloader brace.3 Patients with varus alignment and medial compartment osteoarthritis can have medial collateral ligament laxity that can be improved with a medial unloader brace. The ideal patient for bracing is a taller, relatively low-weight patient with isolated medial compartment arthritis. The brace is unlikely to fit shorter, overweight patients, which can result in poor adherence. Unloader braces should be used when patients are walking to redistribute weight-bearing stress. Unloader bracing is not effective for tricompartmental arthritis.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

1.  Mistry DA, Chandratreya A, Lee PYF. An update on unloading knee braces in the treatment of unicompartmental knee osteoarthritis from the last 10 years: a literature review. Surg J (NY). 2018;4(3):e110-e118.

2. Kirkley A, Webster-Bogaert S, Litchfield R, et al.  The effect of bracing on varus gonarthrosis. J Bone Joint Surg Am. 1999;81(4):539-548.  

3. Komistek RD, Dennis DA, Northcut EJ, Wood A, Parker AW, Traina SM. An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heel-strike of gait. J Arthroplasty. 1999;14(6):738-742.

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