Brace Helps Knee Arthritis Sufferers Avoid Surgery, Improves Quality of Life
01/19/99 Portland, Ore.
Patients who have had knee surgery to remove cartilage often experience knee pain later in life. This pain, known as unicompartmental osteoarthritis of the knee, can severely limit a patient's activities and often leads to costly knee replacement surgery.
But research at Oregon Health Sciences University and the Portland Veterans Affairs Medical Center shows a device called an unloader brace can relieve pain, improve mobility and help many patients delay or even avoid surgery.
"This is for people who aren't ready for knee surgery, but whose life is miserable because their knee hurts," said Kelly Krohn, M.D., assistant professor of medicine in the division of arthritis and rheumatic diseases at Oregon Health Sciences University. Krohn is also staff rheumatologist at the Portland Veterans Affairs Medical Center. Krohn recently presented his research findings on the unloader brace at the annual meeting of American College of Rheumatology in San Diego.
Osteoarthritis of the knee can result from damaged cartilage on one side of the knee joint. This may be the result of previous trauma or the need for surgery from injuries to the knee. The missing cartilage puts the joint out of alignment and the increased load no one side of the joint causes pain. Surgeons can often relieve the problem by taking a wedge of bone out of the other side of the joint. But such surgery is usually not a permanent fix and total knee replacement often becomes necessary. Many surgeons feel that knee replacement surgery is more difficult in patients that have undergone a wedge osteotomy in the knee previously. The valgus brace works by mechanically realigning the joint, redistributing the pressure to reduce pain. The brace, manufactured by Generation II USA of Bothell, Wa., is custom-fitted to each patient. The alignment of the device can be adjusted slightly depending on the patient's needs.
Krohn's study involved 32 patients at the Portland VA Medical Center. Almost two-thirds had had previous surgery on the knee being studied. "The results were quite striking," said Krohn. Thirty of the 32 patients reported using fewer pain medications after wearing the brace compared to before. And overall, patients reported a 30 percent improvement in their pain on a standardized scale. They also reported and increase of their activities of about 25%. This is equivalent to the best arthritis medications currently available to treat osteoarthritis of the knee. The brace also improved walking times for the patients. "Walking times improved from 10 to 15 percent depending on the distance," said Krohn. "That's a significant improvement for patients who have been struggling just to get from point A to point B."
One of the study patients was Ivan Joseph Adams, a Vietnam War veteran who now works in the medical media department at the Portland VA facility. "I'd had trouble with falling down for years," said Adams. "My knee would just give out. But as soon as I started using the brace, the falling stopped. And the pain on my knee joint is about half as much as it was before. This has been a real godsend."
Krohn said perhaps his most significant finding was how much the study patients would be willing to pay for the brace, which costs about a thousand dollars. "Twenty-six of the d32 patients said they would be willing to pay $200 out-of-pocket to keep the device. Two-thirds said they'd be wiling to pay $500," said Krohn. "And this is from a group of patients that typically doesn't have a lot of disposable income. This reflects the value that this group of patients placed on the results of wearing the brace."
Krohn hopes this research will lead to wider acceptance of the valgus device by arthritis and rheumatic disease specialists. Up until now, it has mostly been prescribed by orthopedic surgeons. "Medical specialists usually demand clinical trials before accepting a new treatment like this," said Krohn. "We think we have strong evidence now to show this device is a good alternative to medication or surgery for a select group of patients with osteoarthritis of the knee."
The research was funded by a grant to the Portland VA Research Foundation from Generation II USA, Inc.