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Treat Knee, Back, and Hip Pain with Orthotic Device that Helps Avoid Invasive Procedures

Published Date: Aug 22, 2022

For patients seeking alternative knee pain, hip pain or back pain treatment without surgery, a program that uses an innovative foot-worn device called Apos®, developed by AposHealth®, can bring relief. Covered by Horizon, Apos is a foot-worn device that relieves pain and improves function by changing the wearer's gait to readjust the load on the legs, pelvis and spine.

“We believe that Apos is going to revolutionize the way musculoskeletal conditions are treated,” said Clifford Bleustein, M.D., M.B.A., President and CEO of AposHealth. “From a health economics perspective, our partner locations have peer-reviewed published data demonstrating payer cost reductions through decreased utilization of health care resources, even for the sickest patients.”

Horizon is looking at Apos as a non-invasive treatment that provides an alternative to surgery. If Apos is able to rehab someoneby altering their gait and building up specific areas, the Horizon member may not need the surgical intervention.

How Apos Brings Relief to Back Pain, Knee Pain and Hip Pain

The foot-worn device looks like a sneaker with two rubber, mini half-balls attached to the bottom. During a patient's initial assessment, several factors of their gait are measured, including speed, length of stride, velocity and weight force. A trained clinician then custom calibrates and optimizes the pods' placement according to the patient's body alignment, symptoms, movement patterns and medical history.

“Apos works in two ways,” explained AposHealth's Chief Scientific Officer, Ganit Segal. “Apos has significant research behind it showing that it works on both biomechanical and neuromuscular levels. The pods' personalized calibration redistributes the patient's weight force, and their curved shape provides micro-instability that has a neuromuscular effect so that patients can receive relief even when not wearing Apos.”

Patients can do this pain treatment at home at their convenience by wearing the device daily for up to one hour while doing normal activities, including sitting. They are monitored throughout the course of the program and, as their gait improves, the device is adjusted for continued improvement and pain relief.

Who Can Use Apos for Pain Treatment?

“Apos can work at any stage of the care pathway, but we have focused on helping patients with moderate and severe conditions live a better life,” said Dr. Bleustein.

Apos is appropriate and shown to be effective for patients with varying levels of pain and osteoarthritis in their knees, back or hip, including many who are suitable for total knee replacement. It's not a suitable solution for people who have fallen a few times within the year or have balance issues due to underlying disease.

Apos is covered for many Commercial and Medicare Advantage members.

Benefits and Results of Apos as an Alternative to Surgery

Apos has shown consistently positive clinical results in more than 60 peer-reviewed publications and real-world outcomes — including among Horizon patients who have shown significant improvements in pain and velocity scores (n=397), according to Segal.

In a recent review of AposHealth published in the Journal of Orthopaedic Experience and Innovations, authors concluded that the current scientific evidence suggests a significant improvement in symptoms and biomechanical indicators after using Apos. As part of a value-based payment program to improve efficiency and effectiveness in delivering medical care, Apos should be considered as a non-invasive intervention for the management of knee and back pain.

In a clinical study published by the Journal of the American Medical Association (JAMA), knee osteoarthritis patients treated with Apos reported 70 percent pain reduction after six months of treatment. Ninety two percent of the patients treated with Apos reported a more than 30 percent reduction in pain, well above the minimal clinical important difference, and 83 percent of them reported more than 50 percent reduction in pain. For people experiencing severe chronic pain and in need of total knee replacement, the Apos system is clinically proven to delay surgery after two years of treatment for 86 percent of patients.

“We're providing patients a whole new way to get back to doing the things that they want and love to do, in the comfort of their own homes, in a way that easily fits in with their lifestyles. This in and of itself helps encourage compliance and patient success,” said Cheri Lin, Senior Vice President of Marketing for AposHealth.

Horizon is committed to helping members achieve their best health by finding solutions that go beyond traditional care.

How to Prescribe Apos for Knee Pain, Hip Pain or Back Pain

To help patients get this treatment, write a script for Apos indicating the patient has a relevant condition to be treated with Apos, and the patient should visit Apos to get started.


Reichenbach, S., Felson, David T., & Hincapie, Desar A. Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis. JAMA. 2020 May; 020;323(18):1802-1812. doi:10.1001/jama.2020.3565

Solomonow-Avnon, D., Herman, A., Levin, D., Rozen, N., Peled, E., Wolf, A. Positive outcomes following gait therapy intervention for hip osteoarthritis: A longitudinal study. Journal of Orthopedic Research. 2017 Oct;35(10):2222-2232. doi: 10.1002/jor.23511. Epub 2017 Jan 18. PMID: 28052440.

Lee, S.W., Veeramachaneni, R., Saleh, I.A., Morice, K., Tiu, T., Lo, Y., Frison, K., Bartels, M.N. Footwear-Generated Dynamic Biomechanical Manipulation and Perturbation Training for Chronic Nonspecific Low Back Pain. PM R. 2018 Aug;10(8):836-842. doi: 10.1016/j.pmrj.2018.02.005. Epub 2018 Feb 21. PMID: 29474997.

Miles, C., Greene, A. (June 16, 2020). The effect of treatment with a non-invasive foot worn biomechanical device on subjective and objective measures in patients with knee osteoarthritis- a retrospective analysis on a UK population. BMC Musculoskelet Disord., 21, 386.

Drew, I.S., Hoffing, M., Lim, C., Leece, D., Suess, M., Merkin, R. (April 26, 2022). Avoidance of Total Knee Replacement in a Population Health Setting: Introducing a Noninvasive Biomechanical Intervention for Patients with Knee Osteoarthritis. Population Health Management.