What is the best type of knee brace for an adult patient with arthritis?

Best Knee Brace for Arthritis

For patients with unicompartmental knee osteoarthritis (typically medial compartment), a realignment knee brace (valgus brace for medial OA) is superior to simple knee sleeves or medical treatment alone, providing significant pain reduction and functional improvement. 1

Evidence-Based Brace Selection Algorithm

Step 1: Identify the Affected Compartment and Patient Characteristics

• Unicompartmental tibiofemoral OA (most common: medial compartment with varus alignment): Proceed to realignment brace 1
• Patellofemoral OA: Consider patellofemoral brace with lateral hinge and adjustable patellar buttress 2
• Unclear compartment involvement or mild generalized pain: Start with simple knee sleeve 1
• Age under 60 years with medial OA: Particularly strong therapeutic response to valgus bracing 1, 2

Step 2: Choose the Appropriate Brace Type

Realignment Braces (First-Line for Unicompartmental OA)

Realignment braces demonstrate superior outcomes compared to knee sleeves or medical treatment alone, with significantly better WOMAC scores, pain subscores, and pain during walking at 6-month follow-up. 1

Biomechanical benefits include:

• Reduce medial compartment loading by 11-17% 2
• Decrease external knee adduction moment by up to 20% 1
• Increase medial joint space width by 1.2mm during gait 1
• Improve proprioception and quadriceps strength 1

Design selection:

• Double-upright hinged braces: Maximum stability for patients with ligamentous laxity or instability 1, 3
• Single-upright hinged braces: Adequate benefit with better cosmesis and compliance; lower profile allows wearing under clothing 1, 3
• Low-profile braces: Better tolerated by patients concerned about appearance 1

Knee Sleeves (Alternative for Mild OA or Poor Brace Candidates)

• Simple, inexpensive intervention that reduces knee pain through improved proprioception and warmth 1
• Critical limitation: Do not enhance joint stability or provide mechanical unloading 1
• Inferior to realignment braces for pain and function in randomized trials 1
• Reasonable starting point when patient compliance with bulkier brace is uncertain 2

Step 3: Address Obesity and Fitting Concerns

Obesity is a critical barrier to brace effectiveness - patients who failed to achieve joint-space widening or pain relief were specifically those for whom obesity interfered with appropriate brace fitting. 2

Fitting requirements:

• Sufficient calf bulk needed to suspend the brace properly 1, 2
• Superior calf strap is most important to tighten for maintaining brace position 1, 2
• Measure thigh circumference 6 inches above patella and calf circumference at widest point for sizing 3
• Obese patients with difficult-to-fit legs may require custom-fit braces 1

If obesity prevents proper fitting:

• Consider cane use as alternative (also strongly recommended for significant ambulation impact) 2
• Prioritize weight loss before bracing 2
• Focus on progressive quadriceps and hip girdle strengthening 2

Step 4: Proper Fitting and Patient Education

Critical fitting pearls:

• Don brace slightly superior to desired position (settles with use) 1
• For diagonal strap braces: tighten strap while seated with knee flexed to 90° for greater correction after standing 1
• Have sample braces in clinic - if patient uncomfortable with idea of wearing brace, unlikely to comply 1
• Educate on proper donning and adjustment 1

Step 5: Set Realistic Expectations and Follow-Up

Expected outcomes at 12 months:

• Pain reduction in compliant patients 1
• Improved WOMAC scores and physical function 3
• Benefits maintained even in moderate-to-severe OA 1, 3

No evidence for disease modification - realignment braces reduce symptoms but do not slow anatomical progression of OA. 1

Critical Pitfalls to Avoid

• Do NOT prescribe wedged insoles - conditionally recommended against for knee OA 2
• Do NOT use realignment braces for tri-compartmental OA - only effective for unicompartmental disease 3
• Do NOT rely on brace alone - must combine with weight loss and progressive strengthening exercises, which are more important than bracing alone for long-term outcomes 2
• Do NOT ignore poor compliance due to obesity - consider alternative strategies like cane use first 2
• Do NOT over-tighten straps - hinge angle adjustment has greater effect on load reduction than excessive strap tension 3
• Avoid prescribing without ensuring patient tolerance - hinged braces are bulkier and require commitment to wear 3

Adjunctive Management Requirements

Bracing must be combined with:

• Weight loss efforts 2
• Progressive quadriceps and hip girdle strengthening 2
• Lower extremity muscle strengthening and flexibility exercises 2

These interventions are more important than bracing alone for long-term outcomes. 2