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Insoles or Braces Show Best Pain Relief for Knee Osteoarthritis
The use of braces or insoles in combination with nonbiomechanical treatments appear to deliver the greatest pain relief for patients with medial tibiofemoral osteoarthritis, although the evidence supporting these interventions has a high degree of uncertainty, according findings from a large meta-analysis of randomized, controlled trials presented at the OARSI 2021 World Congress.
“It’s been highlighted for several years now that due to the high rate of joint replacement, we need to promote more effective nonsurgical treatments,” Ans van Ginckel, PhD, of Ghent (Belgium) University, told the conference.
However, guidelines on the use of biomechanical treatments for knee OA pain vary widely, and there are few studies that compare the effectiveness of different interventions.
To address this, van Ginckel and colleagues conducted a network meta-analysis of 27 randomized, controlled trials – involving a total of 2,413 participants – of biomechanical treatments for knee OA pain. The treatments included were valgus braces, combined brace treatment (with added nonbiomechanical treatment), lateral or medial wedged insoles, combined insole treatment (with added nonbiomechanical treatment), contralateral cane use, gait retraining, and modified shoes.
“These treatments are mainly based on the premise that people with knee osteoarthritis likely experience a higher external knee adduction moment during walking, compared to healthy people,” van Ginckel told the conference, which is sponsored by the Osteoarthritis Research Society International. “This has been associated to some extent with disease onset, severity, and progression.”
When compared to nonbiomechanical controls, walking sticks and canes were the only intervention that showed a benefit in reducing pain, although the authors described the data supporting this as “high risk.”
When all the treatments were ranked according to the degree of pain relief seen in studies, combined insole and/or combined brace treatments showed the greatest degree of benefit.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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