How do we treat knee osteoarthritis at Complete Physio?

Specialist bracing is just one part of a multi-faceted approach to knee osteoarthritis offered at Complete Physio. At Complete we offer a one stop clinic where we can provide a range of treatments to get people out of pain and back to full function. These include:

• Advice and education – this will focus on activity modification, pacing and self-help pain relief
• Guided rehabilitation – this will include a comprehensive, progressive strengthening programme for particularly your quadriceps muscle.
• Hands on treatment – to help provide pain relief and improve your mobility
• Ultrasound guided injection therapy – this can help to provide pain relief to help you undertake more exercise and improve your step count! We provide steroid, platelet rich plasma (PRP), and hyaluronic acid (HA) injections.

The mainstay of treatment for osteoarthritis should be exercise based therapy. However, for patients really struggling with pain an ultrasound guided injection followed by a customised brace can provide rapid and long-term pain relief. At Complete we offer a one stop shop where patients can get knee injections to settle their pain and then use a brace to offload it long term and reduce the need for repeat injections.

Should I get a brace?

During your physiotherapy assessment your physio will be able to advise you if a brace will benefit your recovery. Depending on your diagnosis it may be suggested that you use a brace while completing a course of physiotherapy. This may be for a short period of time (approximately 3 months) to allow the joint to settle down or it may become a longer-term solution to control your pain and reduce the chance of painful flare-ups. Often people are reluctant to use external braces as they can be large and chunky. However, the Ossur Unloader One is a lightweight, low-profile design, which sits discreetly under clothing, but can equally be worn over tighter clothing if desired.

There is also a money back guarantee if you are not happy with the brace. The brace must not be damaged and returned within 30 days.

How does it work?

The Ossur Unloader brace uses a leverage system across three points to take pressure of the knee joint. It helps to take this pressure off during walking and exercise. It is not effective if you are sitting down or sleeping. The brace has Smartdosing dials which can increase and decrease the amount of support needed depending on the activity and individual requirement. This provides flexibility and allows you to control the pain, rather than the pain controlling you.

What is the evidence that the braces work?

Short term use has been shown to improve quality of life and pain in those who use them (Briggs et al., 2012). There is promising evidence that suggests 6 months of using a brace can half the need for surgery in patients compared to those who only wear it for 3 months.

Evidence has also indicated that using the brace for more than 2 years can close to eliminate the need for surgical intervention in 40% of patients who use the Unloader long term (Lee et al., 2017; Mistry et al., 2018). It can also be used as an effective pain reducer in those who are on a waiting list for surgery. The brace has been shown to reduce the use of pain medication by 25%, with a 35% reduction in prescription anti-inflammatories (Rannout et al., 2010).

How much does the brace cost?

The brace costs £599, this cost includes the fitting appointment with our bracing specialist physiotherapist. During this appointment they will fit the brace to you and show you how to use the smartdosing feature on the brace. If you have AXA health cover, you may be able to cover the costs of the brace, if you have been referred by a Consultant or Sport and Exercise Medicine specialist.

If you would like to discuss the role of bracing further, please email chrismyers@complete-physio.co.uk or to book an appointment call 020 7482 3875.

References:

Briggs, K.K., Matheny, L.M. and Steadman, J.R., 2012, Improvement in Quality of Life with Use of an Unloader Knee Brace in Active Patients with OA: A Prospective Cohort Study, Journal of knee Surgery, 25(05), P417-422.
Lee, P., Winfield, T.G., Harris, S.RS., Stoery, E. and Chandratreya. A., 2017, Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis, BMJ Open sport and Exercise Medicine, 2(1), P1-8.
Mistry, D.A., Chandratreya. A. and Lee, P.Y., 2018, An Update on Unloading Knee Braces in the Treatment of Unicompartmental Knee Osteoarthritis from the Last 10 Years: A Literature Review, The Surgery Journal, 4(3), P 110-118.
Rannout, F., Poiraudeau, S. and Beaudreil, J., 2010, Role of bracing in the management of knee osteoarthritis, Current Opinion in Rheumatology, 22(2), P 218-222.