Research Summary

OARSI recommendations for the management of hip and knee osteoarthritis, part II

Zhang, W., Moskowitz, R.W., Nuki, G., Abramson, S., Altman, R.D., Arden, N., Bierma-Zeinstra, S. Brandt, K.D., Crost, P., Doherty, M., Dougados, M., Hochberg, M., Hunter, D.J., Kwoh, K. Lohmander, L.S., and Tugwell, P. (2008) Osteo. Cart. 16: 137-62. doi:10.1016/j.joca.2007.12.013.

Key Findings


exercise recommended treatment for knee oa

Aerobic, muscle strengthening, and range of motion exercises were highly recommended with a 96% SOR score.


weight loss for some knee oa patients

For overweight patients, weight loss is considered an effective treatment with a 96% SOR score.


knee braces recommended in some cases

For patients with mild to moderate knee instability, knee braces are recommended with a 76% SOR score.

Sixteen medically-qualified experts evaluated existing evidence for the management of hip and knee osteoarthritis (OA) and developed 25 treatment recommendations. Literature of interest was systematically reviewed using the appraisal of guidelines research and evaluation instrument. To reach consensus, experts underwent six Delphi rounds and received feedback from Osteoarthritis Research International members. Strength of recommendation (SOR) scores for treatments were produced using a visual analogue scale.

Recommendations include 12 non-pharmacological treatments, including education and self-management, exercise, weight loss, and knee braces. The guidelines also include eight pharmacological treatments and five surgical treatments.

Non-pharmacologic treatments with the highest SOR scores included aerobic, muscle strengthening, and range of motion exercises (96%) and weight loss if the patient is overweight (96%). Knee braces (76% SOR) were recommended for patients with knee OA and mild to moderate varus or valgus instability. The recommendation is primarily based on evidence for valgus bracing and was reached with a 92% consensus.

Relevance to Spring Loaded Braces

Unlike the majority of OA knee braces on the market, the Spring Loaded knee brace offloads all three compartments of the knee and provides a powerful knee extension assist 1– Budarick, A.R. et al. (2020). J. Biomech. Eng. 142(1). As a result of its unique capabilities, a Spring Loaded brace has strong therapeutic value, particularly for individuals with multicompartmental or patellofemoral knee OA 2– Bishop, E.L. et al. (2020) Osteo. Cart. Under Peer Review. 28: S243-S244
– Budarick, A.R. et al. (2020) J. Prosthet. Orthot. Under Peer Review.

Of further therapeutic relevance, the Spring Loaded brace has been shown to reduce joint loads by an amount equivalent to losing 45 lb bodyweight 3– Budarick, A.R. et al. (2020). J. Biomech. Eng. 142(1). For many OA patients, a loss of 45 lb is considered a clinically relevant decrease that results in noticeable pain relief and multiple functional improvements4– Messier, S.P. et al. (2018) Arthritis Care Res. (Hobokin) 70(11): 1569–1575. As a result, the Spring Loaded brace can provide patients with outcomes similar to weight loss, which has been consistently recommended as a first line of treatment in the management of knee OA 5– Messier, S.P. et al. (2018) Arthritis Care Res. (Hobokin) 70(11): 1569–1575
– Jevsevar, D.S. (2013) J. Am. Acad. Orthop. Surg. 21(9): 571-6. doi: 10.5435/JAAOS-21-09-571
– McAlindon, T.E. et al. (2014) Osteo. Cart. 22(3): 363-88. doi: 10.1016/j.joca.2014.01.003.
. Spring Loaded bracing can also support adherence to exercise and weight loss regimens by reducing pain, improving function, and supporting increased physical activity levels 6– Budarick, A.R. et al. (2020) J. Prosthet. Orthot. Under Peer Review..

Multiple Forces Reduced

Each TCO brace model significantly reduced PF, TF, PC ligament, PT and QT forces during a deep knee bend test.

Reduced Joint Load

Each TCO brace model significantly reduced knee joint loads by at least 32% when compared to the non-braced condition.

Replicates & Extends Previous Research

Results corroborate the knee joint offloading capabilities of a TCO, as demonstrated in a previous study (Budarick et al. 2020).

more on this topic...