Brace before Replace!

Many thanks for your interest Ben.

It is not a requirement that the patient has an exercise/rehabilitation programme, to be prescribed and fitted with the Unloader brace, as there are some services that are not set up to facilitate this at present. However, they have patients who are benefitting from the brace and they are working toward a full MDT service to include prescriptive exercise. That said it is definitely a recommendation and part of the patient pathway that the brace is fitted as part of any exercise programme, such as Escape Pain available within an MSK service, as this has been proven to improve patient outcomes.

As the Unloader is a clinically proven bio mechanical solution for unicompartmental OA of the knee (medial or lateral) and can offer immediate pain relief and improve their function, this supports their exercise plan and helps patients carry out their exercises and their day to day activities.

There is patient criteria set out by Sussex MSK and others in the UK for the Unloader to be prescribed and fitted which includes pain scores, function etc, which does include exercise, this has been an audited service since 2017. The cost can be neutral, as if the Unloader doesn’t work for a particular patient, there is a money back guarantee should it not be suitable. If the patient does find benefit, then it can have long term and positive outcomes i.e. reduction of pain killers, delay or avoid surgery.

Yes I totally agree that some braces can be cumbersome and certainly the older styles, heavier double upright versions that can limit function and as you say even migrate. Also for some of the patient population, hand dexterity can make it difficult for some braces to be put on and taken off, and therefore for a certain group of patients braces may not be suitable. However for a larger proportion of patients who can’t have surgery or want to avoid surgery, it can be a very good biomechanical solution for a biomechanical problem, by off-loading the affected compartment resulting in pain relief. Pain relief is often immediate with ongoing pain reduction and the stability the brace can offer, allowing the patient to carry out their exercise and activities of daily living

Regarding muscle weakness there has been growing evidence, showing that certain braces that are worn have the opposite effect. because the Unloader offers pain relief and stability by restoring the alignment of the limb without restricting muscle activation around the joint, with many patients describing that their knee felt ‘more secure’ and ‘more stable’, this in turn has given patients the confidence to carry out their daily exercises. Prof. Michael Callaghan, Manchester University has done some research around this topic, and along with Prof George Peat are coordinating a large trial looking into the provision of knee bracing in knee osteoarthritis. The study is funded at £1.6million by NIHR because of the preliminary findings. Also a study by Prof Paul YF Lee et al published in the BMJ in 2017 In an 8 year follow up study stated The Unloader delayed surgery for 39% patients and 25% did not require any form of surgical intervention by the end of the 8 year period. Patients in this study had end stage OA and were listed for surgery. This study had similar findings to Mike Callaghan’s in that, it showed that the longer patients wear the brace the better the PROMS.

“Will keep you posted. Happy to discuss further if you are interested in joint working?”