OA is a disease of articular cartilage, the gristle that caps and cushions the ends of long bones and allows the joint to glide. With OA, the cartilage begins to wear away prematurely.



Weight-bearing areas such as the neck, low back, hips, and knees are the areas most often involved. The knee, since it is so important for normal ambulation, is the joint that appears to give most patients a problem.

The treatment of symptomatic OA of the knee revolves around patient education, maintenance of ideal weight, exercise (stretching, strengthening, non impact aerobic), assistive devices such as canes or walkers if necessary, topical rubs, non-steroidal anti-inflammatory drugs (NSAIDS), injections of glucocorticoid (cortisone) or viscosupplements (lubricants) into the joint, and sometimes surgery.

One frequently neglected mode of treatment is bracing. Braces come in all shapes, sizes, and configurations. Braces are divided into two different groups, soft braces and hard braces.

Soft braces or "sleeves" are made of stretchable material such as synthetic cloth material or neoprene. Soft braces are designed to be either pulled up to fit around the knee or strapped into place using velcro or another similar method.

Soft braces have the benefits of being easy to use and easy to care for. They function by giving the knee a small amount of support. This support may be more of a function of proprioceptors (nerves that provide feedback as to orientation in space) around the knee than it is of actual knee stabilization since cloth or neoprene are not stiff enough to restrict motion. Patients with arthritis in the hands may also have difficulty pulling a sleeve up.

The other type of knee brace is the hard brace. These rigid braces are made of durable molded plastic. They have foam rubber liners for comfort and are reinforced with steel hinges. Technological advances have made these hard braces relatively light-weight but still much heavier than sleeves.

These braces are designed to stabilize the joint and alter knee mechanics. They work by applying pressure to the outside thigh and outside lower leg (on the opposite side from the narrowed part of the knee joint). The result is a redistribution of weight away from the painful inside compartment of the knee.

A number of different companies manufacture these hard braces. The two best companies in the OA of the knee bracing arena (in my opinion) are Generation II and Donjoy.

The braces are custom-fit and therefore expensive, ranging in price from $400-750. Most insurance companies do pay for these braces.

Since bracing is non-invasive- not requiring surgery- and is non-pharmacologic- not requiring drugs- it is a safe and viable alternative for patients with symptomatic OA of the knee. It also can be used as a complementary treatment- ie., used in conjunction with other forms of treatment.

In our clinic, we have found that some patients may require arthroscopy if they have meniscus tears (damage to cartilage in the knee). After an arthroscopy they often undergo viscosupplementation treatment. A rigid brace, following either or both of these other procedures, is an excellent complementary treatment.

Some studies have suggested that bracing can postpone the need for knee replacement.