How long should a patient with severe arthritis in the knee wear a knee brace?

Duration of Knee Brace Wear for Severe Knee Arthritis

Patients with severe knee osteoarthritis should wear their knee brace during all weight-bearing activities on a daily basis, removing it only at night, as continuous use during activity provides sustained pain relief and functional improvement. 1

Duration Based on Disease Severity

• Patients with mild OA may only require a brace during high-impact activities, whereas those with more severe knee OA need to wear a brace during all weight-bearing activities 1
• For severe arthritis specifically, the evidence supports daily wear during all ambulatory activities for at least 12 months to achieve meaningful clinical benefits 2
• The brace should be removed at night when non-weight-bearing 2

Evidence for Long-Term Continuous Use

• A high-quality study of patients with severe medial compartment OA demonstrated that daily brace wear for 12 months (removing only at night) resulted in significant pain relief in 19 of 20 patients, improved knee pain scores from 18.0 to 21.5 during walking, and increased quadriceps strength from 36.8 Nm to 42.8 Nm 2
• The American College of Rheumatology guidelines support that bracing should be considered during all weight-bearing activities for patients with severe disease affecting ambulation, joint stability, or pain 3, 4

Critical Compliance Considerations

The major pitfall is that only 25-28% of patients continue regular brace use beyond 1 year, making patient selection and education crucial 5

• Patients who are not comfortable with the idea of wearing a brace during initial clinic trials are unlikely to wear one long-term 1
• Have sample braces available in clinic for patients to try before prescribing, as this significantly impacts compliance 1, 4
• The appearance of the brace (bulkiness, style), ease of donning, proper education in adjustment, and comfort all influence compliance 1

Practical Wearing Instructions

• The brace should be donned slightly superior to the desired position because of settling with use 1
• Sufficient calf bulk is needed to suspend the brace, and the superior calf strap is the most important one to tighten to maintain brace position 1
• For braces with diagonal straps for frontal plane correction, tighten this strap while seated with the knee flexed to approximately 90° for greater correction after standing 1

When to Discontinue or Modify

• If patients report lack of symptomatic relief, brace discomfort, poor fit, or skin irritation after proper fitting and education, consider alternative interventions such as canes, less restrictive brace designs, or kinesiotaping 5, 4
• Low-profile braces may be better tolerated by patients concerned about appearance, whereas double-upright designs may be more appropriate for patients with incompetent ligaments 1
• Patients who are obese or whose legs are difficult to fit with off-the-shelf braces may require custom-fit braces for sustained use 1

Mandatory Concurrent Treatments

Bracing alone is insufficient—quadriceps strengthening with concurrent hamstring stretching is the primary non-operative treatment and more important than any passive modality alone 4, 6

• Weight management is strongly recommended if the patient is overweight, as this directly impacts pain and disability 1, 4
• The brace should be part of a comprehensive treatment plan including exercise therapy and education programs 6