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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I'm not one to leap without looking first. So, I'm looking into what other people have to say about braces that older adults can wear who have unicompartmental arthritis (that's what I have). I understand these come in a standard off-the-shelf variety or for more money, I can have one custom made. What do you recommend?

Unicompartmental knee osteoarthritis is a common problem associated with alignment problems, obesity, and aging. It means that degenerative changes have affected one side of the joint -- either the medial side (closest to the other knee) or the lateral side (outside half of the joint). Misalignment problems appear to be the root cause of unicompartmental osteoarthritis. Uneven wear on the joint leads to cartilage degeneration and ligament laxity, bringing the joint surfaces closer together. The result is an increased load on one side of the joint. The unloader or off-loader brace uses adjustable straps and pads to apply an external force to distract the involved compartment. It's a mechanical intervention meant to reduce pain, which in turn, increases function. The long-term goal is to keep the arthritis from getting worse. By improving the alignment of the knee, compressive force and load are shifted off the already damaged area of the joint. What are patients saying who are using this brace about their results? Questionnaires evaluating knee pain and function show that the majority of carefully selected patients who use the off-loader report significant improvement in pain and function. They can walk longer and climb stairs with greater ease. Many patients were able to double their pain free walking time from an average of 51 minutes before bracing to 138 minutes with bracing. Improvements in daily function continue throughout the first year of wear. Patients were also able to reduce the amount of pain medication taken each day when using the brace. There were some studies that did not show an overall benefit from bracing. Patients were able to get some pain relief but their function and quality of life did not improve over time. Others found that the benefits only lasted as long as they wore the brace. Patient compliance dropped over time, possibly contributing to a decline in perceived benefit. Current evidence supports the use of an off-loader brace as a cost-effective way to treat unicompartmental knee osteoarthritis and delay surgery. Patients report decreased pain, better stability, and fewer falls. The overall level of evidence from analysis of all the updated data puts the strength of this recommendation at 76 per cent for the success of off-loader braces treating unicompartmental knee osteoarthritis. The higher the percentage, the higher the strength of the recommendation based on scientific evidence. Whether to use a one-size-fits-all (off-the-shelf) variety or get a custom-made brace is an individual decision. Not enough studies have not been done to present a definite answer on this one. Some research has shown that custom braces help reduce stiffness and thus increase function more than off-the-shelf bracing. But other studies didn't show any difference in function or quality of life in patients using one type over the other. The only significant finding was that wearing either brace helped reduce the amount of pain medications patients were using. Your orthopedic surgeon will be able to help you decide which one might be best for you based on your individual factors such as age, body mass index, signs and symptoms, posture, and alignment. Some patients find it is worth it to try the off-the-shelf brace and wear it for a year or two and then have a custom brace made if the results are good. Again, this is an individual decision made in conjunction with your physician. Consulting an orthotist (brace maker) may also provide you with further insights that can sway you one way or the other.


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