Knee braces for osteoarthritis

By Mayo Clinic staff

• Definition
• Why it's done
• Risks
• How you prepare
• What you can expect
• Results

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Definition

A knee brace is a device worn around your knee to help you stay on your feet in spite of knee osteoarthritis. Knee braces come in a variety of designs, but most are constructed with a combination of rigid and flexible materials — plastic or metal for basic structure and support, and synthetic rubber or moldable foam for padding and positioning.

The knee braces used in osteoarthritis are "unloading" braces. You wear an unloading knee brace to counter the faulty knee mechanics that lead to joint damage.

Ideally, your knee should be aligned, so that the force of your weight falls evenly on the inner (medial) and outer (lateral) joint compartments. In reality, though, most people's knees fall short of the ideal. Instead, one or both knees rotate slightly inward, placing extra stress on one side of the joint — usually the medial compartment. This is exacerbated in osteoarthritis, where the loss of the "spacer" effect provided by the cartilage causes narrowing of the joint space and further malalignment.

A knee brace reduces knee rotation by pushing the joint in the opposite direction. This takes pressure off the part of your joint most affected by osteoarthritis and helps relieve pain. If your knee feels like it might buckle when you put weight on it, a knee brace can also help you stand and move around with more confidence.

Why it's done

A knee brace isn't a treatment in itself, but an addition to other treatments, such as medication, physical therapy and surgery. Bracing may be an option if:

• Your osteoarthritis involves the medial compartment in your knee joint
• Your knee pain limits your activity, even when you take medication and use other treatments
• You don't want to undergo knee surgery
• You want to delay knee surgery
• You have medical problems that make surgery unsafe

Risks

Risks of knee braces may include:

• Discomfort wearing the brace. A knee brace may feel heavy, bulky and hot at first. You might need to wear it for up to a month before you get comfortable.
• Skin irritation. The skin under the brace may become red and irritated if your knee brace fits poorly.
• Knee swelling. This uncommon side effect has been reported among people in the first six months of wearing a knee brace.
• Lack of benefit. Studies of knee braces for people with osteoarthritis have been limited, and results have been mixed. Some people experience no benefit. Others report diminished pain and increased function.

How you prepare

Discuss your interest in knee braces with your doctor. Together you can weigh the benefits and risks of knee braces to decide whether they are right for you.

If you decide to try a knee brace, you'll need to:

• Get a prescription from your doctor. Most knee braces require a prescription.
• Consider the cost. Knee braces may range in cost from a few hundred dollars for a standard model to more than $1,000 for a custom-made knee brace. Health insurance and Medicare don't always cover this cost.
• Make an appointment for a brace fitting. Ask your doctor for a referral to an orthotist — a health professional who designs, builds and fits braces and other devices to improve function in people with orthopedic problems.

What you can expect

Few studies have compared the many styles of knee braces with each other. The best bet is to speak up about your preferences and let the orthotist's expertise guide you in making a choice. In general, all knee braces fall into one of these categories:

• Off-the-shelf knee braces. These knee braces are ready-made in several sizes. Some designs allow you to adjust the pressure they apply to your knee, depending on how much support you need for different activities and at different times of day. If you find an off-the-shelf brace that fits you well, you may be able to take it home immediately.
• Custom knee braces. Custom knee braces are designed and built to fit your exact measurements. It takes time to build a custom knee brace, though, so be prepared to wait a few weeks to receive it. When your custom brace is ready, the orthotist will check the fit before you take it home.

During your knee brace fitting
You may adjust to wearing a knee brace more quickly if you start with a good fit, which is the goal of working with an orthotist. During the fitting, the orthotist may:

• Examine your knee
• Ask about your history of knee arthritis and the symptoms that trouble you most
• Ask what activities you hope to increase by wearing a knee brace
• Ask you to walk a few paces to show how your knee functions
• Take several measurements of your leg to determine what size you need in an off-the-shelf brace or to achieve a near-perfect fit in a custom brace
• Discuss the pros and cons of off-the-shelf and custom braces
• Explain how knee brace designs differ from each other
• Have you try various knee braces to determine what style feels best and is easiest for you to use

After your knee brace fitting
With help from the orthotist, you'll learn how to put on and take off the knee brace and how to tell whether it needs adjustment. You may walk around to try out your brace.

Follow the orthotist's or your doctor's instructions about when to wear your knee brace. You may wear it only during continuous activity, such as walking, or you may find it beneficial to wear the brace most of the day.

The muscles around your knee may become weakened if you rely only on the knee brace, so take occasional breaks from wearing it. Also continue the exercises or therapy program recommended by your doctor or your physical therapist.

Results

Knee braces may help reduce osteoarthritis symptoms. Some evidence suggests knee braces can:

• Improve knee function. A knee brace may reduce pain you feel when going up stairs, when walking or during other routine activities. A knee brace may make it possible to walk longer distances.
• Increase your confidence in your knee. Osteoarthritis can make you feel as if your knee is about to give out. As a result, you might automatically guard your knee and avoid putting weight on it. A knee brace may offer some stability and increase your confidence in your knee.

Some people experience less osteoarthritis pain when wearing a knee brace, while others do not. Studies haven't clearly shown that knee braces offer significant pain relief for everyone.

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