Some low quality evidence that valgus unloader braces may be helpful for people with unicompartmental OA (small to moderate improvements in pain) -Moyer, R.F., Birmingham, T.B., Bryant, D.M., Giffin, J.R., Marriott, K.A. and Leitch, K.M. (2015), Valgus Bracing for Knee Osteoarthritis: A Meta-Analysis of Randomized Trials. Arthritis Care & Research, 67: 493-501. https://doi.org/10.1002/acr.22472.
Recommendations in guidelines vary, with RACGP OA natural for varus unloading braces for lateral compartment OA (insufficent evidence) and conditional against for valgus unloading brace for medial compartment OA. 2021 AAOS knee OA guidelines was moderate (conditional) for valgus and PF OA braces
Unloader braces may be less effective if deformity greater than 15 degrees or wide spread pain. Compliance with wearing can be an issue; and can have minor complications e.g. slipping, blisters, skin irritation. Effect may be due to other factors apart from shift in load-e.g. improved joint stability and proprioception, and expectation bias.
Unloader braces are also expensive (price from $800-$1200).
A recent systematic review and meta-analysis found no significant difference in pain for a PF brace (Callaghan, M.J., Palmer, E. & O’Neill, T. Management of patellofemoral joint osteoarthritis using biomechanical device therapy: a systematic review with meta-analysis. Syst Rev 10, 173 (2021). https://doi.org/10.1186/s13643-021-01708-3)
RACGP recommendation: NEUTRAL for Varus unloader braces (lateral tibiofemoral compartment OA)
CONDITIONAL AGAINST Valgus unloader braces (medial tibiofemoral compartment OA)
CONDITIONAL AGAINST Patellofemoral braces for patellofemoral OA
Medial wedge insoles are higher on the medial side, with the theory they would shift weight medially and thus help with lateral compartment OA. Limited evidence supports this, however due to the lack of larger RCTs, the RACGP guideline recommendation is NEUTRAL
Lateral wedge insoles are higher on the lateral side, with the theory they would shift weight latearlly and thus help with meidal compartment OA. RCTs have found no difference in outcomes for pain, function and quality of life, hence the RACGP guideline recommendation is CONDITIONAL AGAINST
RACGP guideline is NEUTRAL for shock absorbing insoles due to a lack of evidence (no RCTs)
Walking aids such as walking sticks may be helpful for people with antalgic gait, muscle weakness, or balance issues. One RCT found improvemned use of a walking aid was effective in improving pain and function, with RACGP guidelines giving a CONDITIONAL FOR recommendation.
A more recent RCT (A. Van Ginckel, R.S. Hinman, T.V. Wrigley, D.J. Hunter, C.J. Marshall, J. Duryea, L. Melo, M. Simic, J. Kasza, S.R. Robbins, J.A. Wallis, K.L. Bennell, Effect of cane use on bone marrow lesion volume in people with medial tibiofemoral knee osteoarthritis: randomized clinical trial, Osteoarthritis and Cartilage, Volume 27, Issue 9, 2019,
Pages 1324-1338) ,published after the RACGP guidelines found no difference in bone marrow lesions, pain, and quality of life between using a walking stick or no aid.
Various types of footwear have been suggested for knee OA, including minimalist and rocker footwear. RACGP guidelines gives a CONDITIONAL AGAINST recommendation for these types of footwear.
Wearing shoes which are shock absorbing and avoiding high heels is suggested, however limited evidence regarding this