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Brace before you replace? Our clinical experience of 540 consecutive knees.

2021 Congress Paper Abstracts

Brace before you replace? Our clinical experience of 540 consecutive knees.

Lucy Oliver- Welsh, MBBS, MRCS, UNITED KINGDOM Paul Trikha, MBBS, MRCS, FRCS(Tr&Orth), UNITED KINGDOM Nimesh Patel, MBBS, MRCS, FRCS ( Tr & Orth), UNITED KINGDOM David Elliott, MBBS, FRCS, UNITED KINGDOM

Ashford & St Peters NHS Foundation Trust, Surrey, UNITED KINGDOM


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Summary: This paper set out to answer the question whether unloader bracing in knee osteoarthritis could really avoid or delay the need for surgery in over 500 patients, and whether this would be cost effective when used in the NHS in the UK.


Objectives:

To investigate the clinical efficiency and cost effectiveness of an unloader brace for managing unicompartmental knee osteoarthritis.

Design:

A retrospective cohort study of 540 consecutive patients managed with an unloader brace over 5 years at our unit.

Participants:

Out of the 540 patients, we have excluded 31 patients, as they did not fit our eligibility criteria.
We have included 509 consecutive participants (212 females and 297 males), aged 32 to 91 (mean of 59) years old, who were managed with an unloader brace for unicompartmental arthritis.

Intervention:

Each patient was prescribed an unloader brace, and followed up for a minimum of one year.
Main outcome measures
Failure of the brace was the end point of failure; this was defined by listing those patients for surgery for their knee OA.

Results

447 (87.82%) participants had medial compartment knee OA, and 62 (12.18%) had lateral compartment OA. 409 (80.4%) patients managed with an unloader brace did not require surgery for their knee OA; the mean follow-up was 3 years with a minimum follow-up of 1 year. 100 participants went on to have knee surgery; 96 had a total knee replacement (TKR), and 4 underwent a high tibial osteotomy. Those with lateral OA wore their brace for a mean of 8.3 months prior to surgery, whilst those with medial OA wore the brace for 7.1 months prior to surgery.
In this cohort, in our unit, we performed 141 fewer TKR’s at the trust than expected, in 2019, with an annual saving of £864,820.

Conclusions

As yet, to the best of our knowledge, this is the largest study supporting the use of an unloader brace for UKOA as both efficacious and cost effective; bracing has either delayed or negated the need for surgery for up to 5 years. As the global consensus deviates towards the non-operative treatment of orthopaedic problems, in the light of the emergence of the COVID19 pandemic, bracing could be a safe alternative for patients presenting with knee arthritis; Its use contributed to a reduction in the patients undergoing TKR surgery, thus resulting in significant cost saving.


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