Unloader Knee Brace For Osteoarthritis | Pros, Cons, Tips, And More!

Written By on May 11, 2022 — Medically Reviewed By Kris Ceniza (PT)

Wearing an unloader knee brace for osteoarthritis can be a game-changer. But only if the cartilage damage is on one side of the knee joint.

See, an unloader is one of many types of knee brace. It reduces the pressure on the damaged side of the joint to provide pain relief.

And even though it can’t heal knee wear and tear – to date, nothing can -, it will definitely make your life easier if you have unicompartmental knee osteoarthritis.

So, here’s what we’ll cover below – click on any of these bullets to navigate through the article:

How does an unloader knee brace work?

This brace works by decompressing -or unloading- the inner or outer side of the knee joint. It does this through a 3-point pressure system with straps that removes the load from the affected compartment. (1)

As such, they’re recommended for patients with unicompartmental knee osteoarthritis.

Wait – what is unicompartmental knee osteoarthritis?

This is a type of knee osteoarthritis where cartilage damage is present on only one side – or one compartment – of the joint.

See, the knee joint has 3 compartments:

  • Medial, corresponding to the inner side of the joint.
  • Lateral, or the outer side of the joint.
  • Patellofemoral, at the front – it’s the space between the kneecap and the femur.

So, if someone has medial compartment knee osteoarthritis, their unloader brace would remove pressure from the inner side of the joint. This in turn can provide pain relief and improve function. (1, 2)

Pros of wearing an unloader knee brace

This type of knee brace can be especially effective at treating osteoarthritis in one compartment of the joint because it can (3, 4):



  • Reduce the pressure on the affected compartment, preventing further degeneration.
  • Significantly reduce pain thanks to its biomechanical effect.
  • Delay the need for knee surgery.
  • Provide benefits with little to no side effects – unlike NSAIDs, injections, and narcotics.
  • Increase the confidence in your knee by providing a sense of security.

For the right person, wearing an unloader can be a life-changer. It will help manage symptoms and delay the need for surgery with practically no risks.

Cons of unloader braces

One of the biggest cons is that you must have an ongoing brace use to see (and keep) your results. (2)

Some osteoarthritis clinical trials recommend wearing it 6 hours every day for at least 6-12 weeks to start to feel symptom relief. After that, some people keep feeling improvement even at the 52-week mark. (1, 2)

It’s true that once your symptoms improve you can wear it fewer times/hours per week. But still, the ongoing use can be very challenging to maintain in the long term.

Other cons of unloader braces include (2, 4):

  • Skin irritation.
  • Allergic reaction to the materials.
  • Brace discomfort due to its heaviness and/or bulkiness.
  • Lack of relief due to poor fit.
  • It can slide off/move out of place.
  • It takes time to put it on properly.
  • It may not fit under clothing.

Also, these assistive devices should be custom-made, meaning they’re on the expensive side. Over-the-counter options may be (much) cheaper but they may not fit properly.

Checklist to determine if you need an unloader knee brace

This type of brace is an investment of your money and time. So, I recommend making sure you actually need it first before going in.

Use the following checklist to help you make the best decision!

You’ll likely benefit from an unloader knee brace if:

  • You have symptomatic unicompartmental osteoarthritis, confirmed by imaging tests.
  • Your cartilage degeneration is mild to moderate.
  • You’re willing to put in the time and effort needed to see benefits.
  • Your skin is not sensitive or prone to irritation.

You should consider another type of knee brace if:

  • Your symptomatic knee OA affects more than one compartment.
  • Your osteoarthritis is not confirmed by imaging tests yet.
  • Your cartilage degeneration is severe, regardless of the type of OA.
  • You can’t or don’t want to commit the time and energy needed to reap the benefits.

Where to get an unloader brace?

First of all, this type of knee brace is usually prescribed by a physical therapist or a doctor. This is to make sure you actually need it.

If your healthcare provider recommends an off-the-shelf brace, he/she will give you specific instructions on how to choose it.

Several brands offer suitable unloading knee braces for osteoarthritis, in a wide variety of sizes, models, and for the right or left knee.

This will help: Here are the best unloader knee braces out there.

Now, here’s what happens if the prescription is for a custom-made unloader brace.

Your healthcare provider will likely refer you to an orthotist. This professional will then perform an initial fitting, measuring your leg and knee to design the brace itself.

It’s best to wear shorts for the fitting appointment. This will make it easier for the professional to do the fitting protocols so the end product fits right.

Afterward, she/he may need a few weeks to create the unloader knee brace. You’ll have another appointment to try the brace and make sure it fits properly once it’s ready.


Knee Force Knee Sleeve

The orthotist will then give you recommendations on how to wear and take care of it before you take it home.

What about the cost?

The average cost of an unloader knee brace is between $400 to $850. Some brands offer cheaper options, while some custom-made designs can exceed the $1500 mark.

Ready-made knee braces are cheaper because, well, they’re not tailored. Yet, they’re a great place to start and test this type of knee brace before committing to more expensive options.

Pro tip: Request the orthotist fees before committing and check if your health insurance covers the cost, at least partially.

Other knee braces available for knee osteoarthritis

There are several brace models available for managing osteoarthritis, not only unloader bracing. The other two designs that can help with this condition are:

Knee sleeves

These are minimalistic garments made of a compressive material, usually neoprene or a fabric blend.

They work by compressing the joint, which promotes blood flow to the area. This in turn can reduce pain, swelling, and improve knee function. (5)

In fact, some studies show that sleeves provide several benefits, similar to those of unloading braces. (4) Also, they are considerably cheaper – most are between $10 to $30.

So, you may want to try wearing a sleeve first before investing in an unloader.

Hinged knee braces

These have side hinges on both sides of the knee. Some are flexible, others are rigid – this will provide different levels of extra stability, depending on your needs.

The more rigid the hinge, the more stability it provides. So, this brace is best for patients with unstable knees from ligament or meniscus injuries associated with osteoarthritis.

Hinged braces are a little more expensive than sleeves, but nowhere near unloaders. There are thousands of options available, with a wide variety of features like:

  • Open kneecaps.
  • Removable hinges.
  • Adjustable straps.

5 Tips for wearing your unloader knee brace like a pro

Once the unloader knee brace is in your hands, your healthcare provider will give you instructions on when to wear it, when not to, and for how long.

With that said, here are a few pointers I give my patients to help them rip as many benefits as possible. They apply to both lateral and medial compartment osteoarthritis:

1) Start little by little

It’s not good to go from zero to wearing the brace several hours per day. Your knee joint and its skin are not used to that. Doing it can increase your risk of skin irritation and may even flare up your symptoms – we don’t want that.



Avoid this by starting with baby steps. The first week, wear the unloader a total of 1 or 2 hours per day, depending on your tolerance. You can do it in bouts of 30-45 minutes.

The following week, add 1-2 hours. Listen to your body – if it feels way too uncomfortable or painful, remove it and wait for a while before putting it on again.

Do this until you get to the hours recommended by your healthcare team.

2) Wear comfortable clothes

Unloader knee braces tend to be bulky. This makes them uncomfortable to wear under clothing, at least for some people.

So, prioritize wearing shorts, loose-fitting pants, skirts, etc. That way you’ll be able to wear the brace for longer and actually rip the benefits.

3) Be patient and consistent

If you see results after the first time, that’s great! But this doesn’t happen to everyone. For most people, the benefits happen after a few weeks – they’re accumulative.

Be patient and commit to wearing the brace for a few hours each day. Give yourself up to 12 weeks to really know if it’s actually working or not.

4) Try this if it keeps slipping down

The brace will likely slip down or move a little out of place the more consecutive hours you wear it. This is due to your sweat and the weight of the garment itself.

To avoid this from happening, make sure to clean the area thoroughly before putting the brace on. Take a shower or rub some alcohol on the skin to remove creams or rests of sweat. This will help the knee brace stay in place for longer.

Or try this: 9 ways to keep a knee brace from rolling down.

5) Remember – it’s not the only treatment for knee osteoarthritis

The unloader has a biomechanical effect that can definitely delay your need for surgery. (6) But in order to be effective for the long term, you have to combine it with other treatment strategies.

This garment won’t replace the benefits of medications, exercising, losing weight, or going to physical therapy. In reality, the unloader works in tandem with these treatments to give you as much relief as possible.

Other treatments for osteoarthritis knee pain

Once your diagnosis of knee OA is made, your healthcare team will design a treatment plan to control symptoms, prevent further degeneration, and help you get back to your usual activities.

This plan will likely include:

Physical therapy

This is a staple in any knee osteoarthritis treatment, regardless of its cause, severity, or type.



In the clinic, your physio will use a series of treatment strategies to reduce your symptoms of knee OA, like:

  • Thermotherapy.
  • Electrotherapy.
  • Therapeutic exercise.
  • Manual techniques.

Apart from that, your therapist will also be there to educate you on how to live with your osteoarthritis. This is a crucial part of your rehab – cartilage loss is irreversible, so the more you know how to manage it, the more in control you’ll be.

Some type of exercise

Doing physical activity it’s one of the best ways to manage the knee pain from this condition. It keeps your knee muscles strong, which in turn prevents further cartilage loss. (3)

In fact, it’s one of the most effective treatments for knee osteoarthritis. And the best part? Practically any exercise will do. (3)

The most important factor is that you enjoy doing it, as this will increase your likelihood of exercising in the long term.

Yet, if you have other medical conditions or you have severe pain, consult with your therapist about safe exercise options for you.

Home treatments

Knee osteoarthritis is irreversible by nature, but there are several home remedies available for you to manage symptoms on your own. These include, but are not limited to:

Now, the thing with home treatments is that there’s some trial and error involved too. This is completely normal, as every person is different. Be patient and try a few combinations of remedies to check which ones bring you the most relief.

This will help: 11 home treatments for knee osteoarthritis that work.

Pharmacological treatments

These treatments are ideal for managing knee pain flare-ups because they help reduce symptoms quickly.

Common medications include NSAIDs, acetaminophen, prescription drugs, and steroid injections. Yet, they are not recommended as a long-term strategy, as they come with a fair share of side effects. (7)

Check this out: 11 Medications for knee OA.

Surgery

This is the last resort. It becomes an option when the nonsurgical approach fails to provide relief after trying it for a considerable amount of time.

Now, for lateral or medial compartment knee osteoarthritis, there are two main surgical options available:

Tibial osteotomy

Here, the orthopedic surgeon cuts a wedge on the shin bone to reduce the pressure on the affected compartment. Then, uses hardware like screws or plates to keep everything in place. (8)

It’s usually recommended for younger patients or people under 60 years old with knock knees or bow legs due to osteoarthritis.

Some people may need additional surgery to remove the hardware. But overall, it can delay the need for a total replacement for up to 10 years. (3, 8)

Partial knee replacement

In this procedure, the surgeon replaces the affected compartment with an artificial one.

The outcomes tend to be very positive for people with OA in one knee compartment and without deformities. (8) But to be successful, the meniscus and ligaments on the other compartment must be healthy. (9)

For 80-90% of people undergoing this surgery, the artificial joint usually lasts up to 10 years. It should be replaced after that period. (9)

Learn more: When is surgery needed for knee osteoarthritis?

FAQs

Do knee unloader braces work?

Yes, but in unicompartmental osteoarthritis of the knee. If the degeneration affects other compartments, it’s best to consider a different brace.

How long do you wear an unloader knee brace for arthritis?

To rip the benefits, you should wear it daily for a few hours, for at least 3-6 months. (1, 2)

What kind of knee brace is good for osteoarthritis?

This depends on the type of osteoarthritis.

Unloaders are ideal for unicompartmental osteoarthritis, while sleeves are great for reducing pain and swelling in any type of knee OA.

Hinged designs are best for OA with instability and open kneecap designs can reduce symptoms in patellar OA (chondromalacia).

How does a medial unloader knee brace work?

It works by shifting the pressure from the medial to the lateral compartment of the knee. This can provide relief and may delay the degeneration of the affected side.

Conclusion: Using an unloader knee brace for osteoarthritis

Inner or medial knee osteoarthritis treated with unloader knee braces can definitely relieve symptoms and prevent degeneration.

Yet, it’s not the only treatment you should be doing. Physical therapy, exercise, and home treatments will bring much more relief in the long term than any knee brace.

Finally, remember that the unloader can be a huge help in specific cases, so make sure that you qualify first. If not, discuss other knee brace options with your healthcare team as well. Take the time to find the right design for you.

Resources

  1. Thoumie, Philippe et al. “Effect of unloading brace treatment on pain and function in patients with symptomatic knee osteoarthritis: the ROTOR randomized clinical trial.” Scientific reports vol. 8,1 10519. 12 Jul. 2018, DOI: 10.1038/s41598-018-28782-3
  2. Hjartarson, Hjörtur F, and Sören Toksvig-Larsen. “The clinical effect of an unloader brace on patients with osteoarthritis of the knee, a randomized placebo-controlled trial with one year follow up.” BMC musculoskeletal disorders vol. 19,1 341. 22 Sep. 2018, DOI: 10.1186/s12891-018-2256-7
  3. “The American Academy of Orthopaedic Surgeons Appropriate Use Criteria on the Non-Arthroplasty Treatment of Osteoarthritis of the Knee.” The Journal of bone joint surg. vol. 96,14 (2014): 1220-1221. DOI: 10.2106/JBJS.N.00225
  4. Squyer, Emily et al. “Unloader knee braces for osteoarthritis: do patients actually wear them?.” Clinical orthopaedics and related research vol. 471,6 (2013): 1982-91. DOI: 10.1007/s11999-013-2814-0
  5. Paluska, S A, and D B McKeag. “Knee braces: current evidence and clinical recommendations for their use.” American family physician vol. 61,2 (2000): 411-8, 423-4
  6. Lee, Paul Yf et al. “Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis.” BMJ open sport & exercise medicine vol. 2,1 e000195. 21 Feb. 2017, DOI: 10.1136/bmjsem-2016-000195
  7. “Guideline for the management of hip and knee osteoarthritis.” The Royal Australian College of General Practitioners. Retrieved on April 2022 from: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf
  8. de l’Escalopier, Nicolas et al. “Surgical treatments for osteoarthritis.” Annals of physical and rehabilitation medicine vol. 59, 3 (2016): 227-233. DOI: 10.1016/j.rehab.2016.04.003
  9. Rönn, Karolin et al. “Current surgical treatment of knee osteoarthritis.” Arthritis vol. 2011 (2011): 454873. DOI: 10.1155/2011/454873
Author
Mich Torres (PT)
Mitch is a physical therapist, personal trainer, and nutrition coach. Fascinated with the knee joint, Mitch poured that passion into writing about knee pain and how to overcome it with movement. His goal is to teach you how to apply this knowledge into your daily life, so you can keep knee pain away for good.