Study Finds Knee Brace Improves Activity Levels for Osteoarthritis Patients

A horseback riding accident mangled Cole Porter’s legs in 1937,
forcing the famous composer and lyricist to endure more than 30 operations in
20 years.

Even so, he kept writing hit songs until his right leg had to be removed
more than 20 years later in1958.


The amputation did Porter in, plunging him into deep depression.

“Cole’s creative productivity, his social power, and his
happiness plummeted,” according to the Cole Wide Web website,

Porter received an artificial leg. Nonetheless, “for the rest of
his life, Mr. Porter lived under the constant pressure of pain and, reversing
his previously gay social life, became a virtual recluse,” his New
York Times
obituary stated.

Porter died in 1964 at a Santa Monica, Calif., hospital. He was 73 years

A legend

“Mr. Porter wrote the lyrics and music for his songs, and to both
he brought such an individuality of style that a genre known as ‘the Cole
Porter song’ became recognized,” according to his obituary.

  Porter underwent amputation surgery after enduring years of pain as a result of a riding acident.
  Porter underwent amputation
surgery after enduring years of pain as a result of a riding acident.t
  Image: Wikimedia Commons (Public

His best-known music included “What Is This Thing Called
Love,” “Night and Day,” “Love for Sale,” “Begin
the Beguine,” “Let’s Do It,” “You’re the
Top,” “Just One of Those Things,” “From This Moment
On,” “It’s All Right With Me,” “Anything Goes”
and “I Get a Kick Out of You,” the obituary stated.

He penned music mostly for Broadway shows and movies, but spent much of
his life abroad.

“Between World Wars he and his wife, the former Linda Lee
[Thompson] of Louisville, Ky., were active in a gay international set that
gathered at Paris, the Riviera and Venice,” the obituary also stated.
“Their home on the Left Bank in Paris had platinum wallpaper and chairs
upholstered in zebra skin. Mr. Porter once hired the entire Monte Carlo Ballet
to entertain his house guests. For a party in Venice, where he rented the
Palazzo Rezzonico for $4,000 a month, he hired 50 gondoliers to act as footmen
and had a troupe of high-rope walkers perform in a blaze of lights.”

Porter was born on a farm near Peru, Ind., in 1891. At age the age of 6
years old, he could play the violin. He was playing the piano at the age of 8
years and at 10 years old composed a song that his mother got published in
Chicago, according to his obituary.


Porter attended Worcester Academy in Massachusetts and went on to Yale
University, where he wrote two of the best-known college tunes, the beloved
“Bingo, That’s the Lingo” and “Yale Bulldog,” the
obituary stated.

Porter also attended Harvard Law School but switched to the School of
Music at the suggestion of the law school dean.

In 1916, after his first Broadway production flopped, he volunteered for
the French Foreign Legion. Cole Wide Web maintains that he was not in the
Foreign Legion, but most other sources, including the Legion, say he was.

“…He had a specially constructed portable piano made for him
so that he could carry it on his back and entertain the troops in their
bivouacs,” according to the obituary.

A mishap

Porter married in 1919. He and his spouse, a divorcee, according to Cole
Wide Web, settled in Paris, where his fame grew. But his crippling accident
happened at a riding club in New York.

“His horse slipped, threw him and fell on top of him, breaking both
his legs and damaging his nervous system,” the obituary stated. “One
result of Mr. Porter’s accident was chronic osteomyelitis, a bone

The mishap caused compound fractures to both thigh bones, allowing
osteomyelitis to set in, according to “The Painful Life of Cole
Porter,” an article by Howard Markel, MD, PhD. Published by WebMD/Medscape
Health Network, it is also on the National Center for Biotechnical Information

“Always an optimist with his chin pointing decidedly northward,
Porter told friends that in the hours immediately after his fateful accident,
as he waited for emergency medical help, he took out his notebook and composed
the lyrics for what became the hit song, ‘At Long Last Love,’”
Markel wrote.

The injury was also a personal tragedy for Porter, according to Cole
Wide Web. He was “a vain man who placed an enormous value on looks for
both social and sexual reasons. His vibrant energy and obsession to maintain
his looks through elaborate daily rituals could not (in his opinion) compensate
for such a debilitating blow at his health and his ego.”

An exception

At the time of the accident, doctors wanted to remove his right leg and
possibly his left one. He resisted amputation. Because his injuries were made
worse by the osteomyelitis, Porter “was subjected to more than 30
operations during the next 20 years,” the obituary stated.

Markel said the seemingly endless rounds of surgeries would have been
enough to stay most people from their work. Porter was an exception.

Markel added that in 1945, Porter wrote to the choreographer Nelson
Barclift, explaining “the details of his latest operation in which the
surgeon had to re-break the bones of his legs, remove the jagged ends, splice
the Achilles’ tendons, and remove eight inches of his tibia bones to
perform a bone graft over the fractured areas. Most vexing, however, was
continued evidence of staphylococcal infection in the poorly healing bones and
severe pain from scar tissue pressing on the nerves that made tortuous even
something as light as the touch of a sheet.”


Despite severe pain in his legs, he refused to abandon his songwriting
or his social life.

“Porter continued full throttle as evidenced by the scores of
photographs during this era depicting the formally attired composer being
literally carried by his valet to social events and Broadway openings, not to
mention producing a torrent of songs,” Markel wrote.

Porter’s grim determination increased in the days after the
accident. Almost completely bedridden, he wrote the score for “Leave It to
Me,” the obituary stated. “In order to continue his work, he had his
piano placed on blocks so that he could roll up to the keyboard in his wheel

Porter became so famous that the 1945 movie, Night and Day, was
based on his life.

“Although great for his ego and likely hysterically funny for his
friends, history suffers because this movie had little relationship to the
actual life of Cole Porter,” according to Cole Wide Web. “The movie
purposely left out important parts of life, like his overly pampered and
controlled youth, his gay life, his sexless marriage of convenience, his
‘business’ marriage, and furthered the fantastic tall tales that Cole
spread about himself.”

Half the man

But Porter’s sadness was genuine when his wife died in 1954.
Afterwards, he retreated to a nine-room apartment in the Waldorf Towers in New
York City.

“On weekends he was driven to a 350-acre estate in the Berkshires
and in the summers he lived in California,” otherwise he mainly stayed in
his apartment, his obituary said.

Four years after Linda lost her life, he lost his limb.

“The germs inhabiting his bone marrow won and Porter’s right
leg was amputated at mid-thigh,” Markel wrote.”

Although he was fitted for a prosthesis and underwent rigorous physical
therapy, the man whose witty lyrics and melodies epitomized hope and joy had
little to be hopeful about. Porter told many friends, after the amputation,
‘I am only half a man now.’”

Porter’s grave is in Peru, near his family’s farm.

For more information:

  • Cole Wide Web. Available at:www.coleporter.orgAccessed: April 1, 2010.
  • The National Center for Biotechnical Information. Available at: Accessed: April 1, 2010.
  • vity levels, a recent study concluded.

    J. Richard Steadman, MD, co-founder of the Steadman
    Philippon Research Institute (SPRI) and Karen Briggs, MPH, director of clinical
    research at SPRI, presented their findings at the research briefing,
    Embracing Life: New Frontiers in Osteoarthritis Research,
    Prevention and Treatment
    ,” at the New York Academy of Sciences.

      Karen Briggs
      Karen Briggs

    Forty-nine patients — 29 men and 20 women — with moderate to
    severe OA in at least one of their knees completed the study. Their average age
    was 62 years. Patients were given a questionnaire that included the WOMAC test,
    Tegner activity level and expectations.

    “The purpose of this study was to determine whether the Unloader
    One brace will decrease instability and help patients maintain their active
    lifestyle,” Steadman said during the briefing.

    The medial and lateral Ossur Unloader One knee braces provided
    improvement in disability for active OA patients during the 6-month test
    period, the study found.

    “We wanted to look at patient expectations,” Briggs said.
    “Do you want to be able to walk to your mailbox or do you want to be able
    to ride your bike up a hill? That was crucial in determining how to best treat
    the patients.”

    Patients expected the knee brace to improve their confidence in the
    diagnosed knee, avoid future degeneration of the knee and improve ability to
    maintain their general health, according to Briggs.

    “We wanted to address the patient’s perspective and sometimes
    the researchers address their own perspectives, but this was designed to be a
    patient-friendly study,” Steadman said. “If the expectations were
    addressed, the patient would be satisfied.”

    Patients using the medial Unloader One brace showed more improvement
    compared to the lateral group. The large majority of the patients were
    satisfied with the results — only five patients discontinued the use of
    their brace. The median patient satisfaction of outcome was an eight out of 10
    (10 = very satisfied).

    The results indicated that 27% of the patients reported a decrease in
    pain medication. Thirty-one percent reported a decrease in over-the-counter
    anti-inflammatory drugs and 35% reported a decrease in prescription
    anti-inflammatory drugs.

    In 2005, approximately nine million American adults were diagnosed with
    knee OA. Of those nine million Americans, approximately 55% were aged 65 years
    and older, according to the American Academy of Orthopaedic Surgeons. These
    numbers are expected to climb as more baby boomers remain active at older ages.

    “Baby boomers do not take no for an answer, as far as exercising is
    concerned,” Steadman said. “If we can use a brace that makes the
    patient better and improves their activity level, then that would be a better
    answer to their problem.” — by Anthony Calabro

    For more information:

    • American Academy of Orthopaedic Surgeons. Knee osteoarthritis
      statistics. Available at: . Accessed: April 15, 2010.


    The study by Briggs and her colleagues shows that patient education and
    compliance makes the use of an unloader brace successful for the treatment of
    medial and lateral knee osteoarthritis.

    In this study, the more the medial joint space narrows, the more the
    pre-brace disability. The results showed that the unloader brace had a 50%
    improvement in disability.

    There is no question that to make the use of an unloader brace
    successful, several criteria must be met. The patient must be motivated to use
    a brace and this may be improved by patient education. Not every patient is
    convinced that they want to wear a brace for all activities. Many patients
    would rather have an operation than use a brace. Therefore, there is probably
    some selection bias in any brace study.

    The other criteria that are important are the size of the thigh and
    medial pseudo-laxity. It is very difficult to fit a brace to a conical thigh.
    The lean active patient is much more likely to continue with brace use. I have
    found that the patient who has medial pseudo-laxity compared to a fixed varus
    knee will respond better to unloader bracing.

    Finally, the company that supplied the brace supported this study. Thus,
    there are several selection biases that are evident in this study by Briggs,
    which should be recognized, but do not reduce the significance of the findings.

    — Donald H. Johnson, MD
    Director, Sports
    Medicine Clinic, Carleton University

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